Cholangiocarcinoma medical therapy: Difference between revisions

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__NOTOC__
{{Cholangiocarcinoma}}
{{Cholangiocarcinoma}}
{{CMG}}
{{CMG}};{{AE}} {{F.K}}, {{PSK}}
 
==Overview==
==Overview==
Chemotherapy is indicated for unresectable cholangiocarcinoma as [[palliation|palliative chemotherapy]]. Chemotherapy agents used to treat cholangiocarcinoma include [[5-fluorouracil]], [[gemcitabine]], [[irinotecan]], [[cisplatin]], or [[doxorubicin]].
==Medical Therapy==
The majority of cases of cholangiocarcinoma present as unresectable disease.<ref>{{cite journal |author=Vauthey J, Blumgart L |title=Recent advances in the management of cholangiocarcinomas |journal=Semin. Liver Dis. |volume=14 |issue=2 |pages=109-14 |year=1994 |pmid=8047893}}</ref> If the tumor cannot be surgically removed, patients are often treated with [[palliation|palliative]] [[chemotherapy]] with or without [[radiotherapy]].
===Chemotherapy===
* 1.'''Chemotherapy'''
** Preferred regimen (1): [[5-fluorouracil]] 600 mg/m2 with [[leucovorin]] 400 mg/m2 over 2 hours once every 2 weeks <ref name="pmid23919111">{{cite journal |vauthors=Ramírez-Merino N, Aix SP, Cortés-Funes H |title=Chemotherapy for cholangiocarcinoma: An update |journal=World J Gastrointest Oncol |volume=5 |issue=7 |pages=171–6 |year=2013 |pmid=23919111 |pmc=3731530 |doi=10.4251/wjgo.v5.i7.171 |url=}}</ref>
** Alternative regimen (2): [[Gemcitabine]] 1,000 mg/m2 plus cisplatin <ref name="pmid15800324">{{cite journal |vauthors=Knox JJ, Hedley D, Oza A, Feld R, Siu LL, Chen E, Nematollahi M, Pond GR, Zhang J, Moore MJ |title=Combining gemcitabine and capecitabine in patients with advanced biliary cancer: a phase II trial |journal=J. Clin. Oncol. |volume=23 |issue=10 |pages=2332–8 |year=2005 |pmid=15800324 |doi=10.1200/JCO.2005.51.008 |url=}}</ref>
** Alternative regimen (3): [[Irinotecan]] 125 mg/m2 q14 days
** Alternative regimen (4): [[Oxaliplatin]] 400 mg/m2 <ref name="pmid15319238">{{cite journal |vauthors=André T, Tournigand C, Rosmorduc O, Provent S, Maindrault-Goebel F, Avenin D, Selle F, Paye F, Hannoun L, Houry S, Gayet B, Lotz JP, de Gramont A, Louvet C |title=Gemcitabine combined with oxaliplatin (GEMOX) in advanced biliary tract adenocarcinoma: a GERCOR study |journal=Ann. Oncol. |volume=15 |issue=9 |pages=1339–43 |year=2004 |pmid=15319238 |doi=10.1093/annonc/mdh351 |url=}}</ref>
** Alternative regimen (5): [[Doxorubicin]] 60-75 mg/m2 q21 days <ref name="pmid11705850">{{cite journal |vauthors=Patt YZ, Hassan MM, Lozano RD, Waugh KA, Hoque AM, Frome AI, Lahoti S, Ellis L, Vauthey JN, Curley SA, Schnirer II, Raijman I |title=Phase II trial of cisplatin, interferon alpha-2b, doxorubicin, and 5-fluorouracil for biliary tract cancer |journal=Clin. Cancer Res. |volume=7 |issue=11 |pages=3375–80 |year=2001 |pmid=11705850 |doi= |url=}}</ref>
** Alternative regimen (6): [[Capecitabine]] 650 mg/m2 q21 days for 2 weeks
** Alternative regimen (7): [[Erlotinib]] PO 100 mg/day


==Adjuvant chemotherapy and radiation therapy==
===Regional therapies===
*Regional therapies is recommended among patients with small cholangiocarcinomas, when the general health condition of the patient does not allow a more aggressive treatment:<ref name="pmid22627601">{{cite journal |vauthors=Halappa VG, Bonekamp S, Corona-Villalobos CP, Li Z, Mensa M, Reyes D, Eng J, Bhagat N, Pawlik TM, Geschwind JF, Kamel IR |title=Intrahepatic cholangiocarcinoma treated with local-regional therapy: quantitative volumetric apparent diffusion coefficient maps for assessment of tumor response |journal=Radiology |volume=264 |issue=1 |pages=285–94 |year=2012 |pmid=22627601 |doi=10.1148/radiol.12112142 |url=}}</ref><ref name="pmid21460876">{{cite journal |vauthors=Patel T |title=Cholangiocarcinoma--controversies and challenges |journal=Nat Rev Gastroenterol Hepatol |volume=8 |issue=4 |pages=189–200 |year=2011 |pmid=21460876 |pmc=3888819 |doi=10.1038/nrgastro.2011.20 |url=}}</ref>
**[[Transcatheter arterial chemoembolization|Transarterial chemoembolization]] ([[Transcatheter arterial chemoembolization|TACE]])
**[[Therapeutic embolization|Radioembolization]]


If the tumor can be removed surgically, patients may receive [[adjuvant#oncology|adjuvant]] [[chemotherapy]] or [[radiation therapy]] after the operation to improve the chances of cure. If the tissue margins are negative (i.e. the tumor has been totally [[excision|excised]]), adjuvant therapy is of uncertain benefit. Both positive<ref>{{cite journal |author=Todoroki T, Ohara K, Kawamoto T, Koike N, Yoshida S, Kashiwagi H, Otsuka M, Fukao K |title=Benefits of adjuvant radiotherapy after radical resection of locally advanced main hepatic duct carcinoma |journal=Int J Radiat Oncol Biol Phys |volume=46 |issue=3 |pages=581-7 |year=2000 |pmid=10701737}}</ref><ref>{{cite journal |author=Alden M, Mohiuddin M |title=The impact of radiation dose in combined external beam and intraluminal Ir-192 brachytherapy for bile duct cancer |journal=Int J Radiat Oncol Biol Phys |volume=28 |issue=4 |pages=945-51 |year=1994 |pmid=8138448}}</ref> and negative<ref name="nakeeb"/><ref>{{cite journal |author=González González D, Gouma D, Rauws E, van Gulik T, Bosma A, Koedooder C |title=Role of radiotherapy, in particular intraluminal brachytherapy, in the treatment of proximal bile duct carcinoma |journal=Ann Oncol |volume=10 Suppl 4 |issue= |pages=215-20 |year= |pmid=10436826}}</ref><ref>{{cite journal |author=Pitt H, Nakeeb A, Abrams R, Coleman J, Piantadosi S, Yeo C, Lillemore K, Cameron J |title=Perihilar cholangiocarcinoma. Postoperative radiotherapy does not improve survival |journal=Ann Surg |volume=221 |issue=6 |pages=788–97; discussion 797-8 |year=1995 |pmid=7794082}}</ref> results have been reported with adjuvant radiation therapy in this setting, and no prospective [[randomized controlled trial]]s have been conducted as of March 2007. Adjuvant chemotherapy appears to be ineffective in patients with completely resected tumors.<ref>{{cite journal |author=Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, Nagakawa T, Nakayama T |title=Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma |journal=Cancer |volume=95 |issue=8 |pages=1685–95 |year=2002 |pmid=12365016}}</ref> The role of combined chemoradiotherapy in this setting is unclear. However, if the tumor tissue margins are positive, indicating that the tumor was not completely removed via surgery, then adjuvant therapy with radiation and possibly chemotherapy is generally recommended based on the available data.<ref name="nccn">{{PDFlink|[http://www.nccn.org/professionals/physician_gls/PDF/hepatobiliary.pdf National Comprehensive Cancer Network (NCCN) guidelines on evaluation and treatment of hepatobiliary malignancies]|216&nbsp;[[Kibibyte|KiB]]<!-- application/pdf, 221777 bytes -->}}. Accessed [[March 13]] [[2007]].</ref>
===Photodynamic Therapy===
 
*[[Photodynamic therapy]]
==Treatment of advanced disease==
**Injected with a light-sensitizing agent and light is then applied [[endoscopy|endoscopically]] directly to the tumor <ref>{{cite journal |author=Ortner M, Caca K, Berr F, Liebetruth J, Mansmann U, Huster D, Voderholzer W, Schachschal G, Mössner J, Lochs H |title=Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study |journal=Gastroenterology |volume=125 |issue=5 |pages=1355–63 |year=2003 |pmid=14598251}}</ref><ref>{{cite journal |author=Zoepf T, Jakobs R, Arnold J, Apel D, Riemann J |title=Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy |journal=Am J Gastroenterol |volume=100 |issue=11 |pages=2426–30 |year=2005 |pmid=16279895}}</ref>
====Chemotherapy====
The majority of cases of cholangiocarcinoma present as unresectable disease.<ref>{{cite journal |author=Vauthey J, Blumgart L |title=Recent advances in the management of cholangiocarcinomas |journal=Semin. Liver Dis. |volume=14 |issue=2 |pages=109-14 |year=1994 |pmid=8047893}}</ref> If the tumor cannot be surgically removed, patients are often treated with [[palliation|palliative]] [[chemotherapy]] with or without [[radiotherapy]].  Chemotherapy has been shown in a [[randomized controlled trial]] to improve [[quality of life]] and extend survival in patients with inoperable cholangiocarcinoma.<ref>{{cite journal |author=Glimelius B, Hoffman K, Sjödén P, Jacobsson G, Sellström H, Enander L, Linné T, Svensson C |title=Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer |journal=Ann Oncol |volume=7 |issue=6 |pages=593–600 |year=1996 |id=PMID 8879373}}</ref> There is no single chemotherapy regimen which is universally used, and enrollment in [[clinical trial]]s is often recommended when possible.<ref name="nccn"/> Chemotherapy agents used to treat cholangiocarcinoma include [[5-fluorouracil]] with [[leucovorin]],<ref>{{cite journal |author=Choi C, Choi I, Seo J, Kim B, Kim J, Kim C, Um S, Kim J, Kim Y |title=Effects of 5-fluorouracil and leucovorin in the treatment of pancreatic-biliary tract adenocarcinomas |journal=Am J Clin Oncol |volume=23 |issue=4 |pages=425-8 |year=2000 |pmid=10955877}}</ref> [[gemcitabine]] as a single agent,<ref>{{cite journal |author=Park J, Oh S, Kim S, Kwon H, Kim J, Jin-Kim H, Kim Y |title=Single-agent gemcitabine in the treatment of advanced biliary tract cancers: a phase II study |journal=Jpn J Clin Oncol |volume=35 |issue=2 |pages=68–73 |year=2005 |pmid=15709089}}</ref> or gemcitabine plus [[cisplatin]],<ref>{{cite journal |author=Giuliani F, Gebbia V, Maiello E, Borsellino N, Bajardi E, Colucci G |title=Gemcitabine and cisplatin for inoperable and/or metastatic biliary tree carcinomas: a multicenter phase II study of the Gruppo Oncologico dell'Italia Meridionale (GOIM) |journal=Ann Oncol |volume=17 Suppl 7 |issue= |pages=vii73-vii77 |year= |pmid=16760299}}</ref> [[irinotecan]],<ref>{{cite journal |author=Bhargava P, Jani C, Savarese D, O'Donnell J, Stuart K, Rocha Lima C |title=Gemcitabine and irinotecan in locally advanced or metastatic biliary cancer: preliminary report |journal=Oncology (Williston Park) |volume=17 |issue=9 Suppl 8 |pages=23-6 |year=2003 |pmid=14569844}}</ref> or [[capecitabine]].<ref>{{cite journal |author=Knox J, Hedley D, Oza A, Feld R, Siu L, Chen E, Nematollahi M, Pond G, Zhang J, Moore M |title=Combining gemcitabine and capecitabine in patients with advanced biliary cancer: a phase II trial |journal=J Clin Oncol |volume=23 |issue=10 |pages=2332–8 |year=2005 |pmid=15800324}}</ref> A small pilot study suggested possible benefit from the [[tyrosine kinase]] inhibitor [[erlotinib]] in patients with advanced cholangiocarcinoma.<ref>{{cite journal |author=Philip P, Mahoney M, Allmer C, Thomas J, Pitot H, Kim G, Donehower R, Fitch T, Picus J, Erlichman C |title=Phase II study of erlotinib in patients with advanced biliary cancer |journal=J Clin Oncol |volume=24 |issue=19 |pages=3069–74 |year=2006 |pmid=16809731}}</ref>
 
====Photodynamic Therapy====
[[Photodynamic therapy]], an experimental approach in which patients are injected with a light-sensitizing agent and light is then applied [[endoscopy|endoscopically]] directly to the tumor, has shown promising results compared to supportive care in two small [[randomized controlled trial]]s. However, its ultimate role in the management of cholangiocarcinoma is unclear at present.<ref>{{cite journal |author=Ortner M, Caca K, Berr F, Liebetruth J, Mansmann U, Huster D, Voderholzer W, Schachschal G, Mössner J, Lochs H |title=Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study |journal=Gastroenterology |volume=125 |issue=5 |pages=1355–63 |year=2003 |pmid=14598251}}</ref><ref>{{cite journal |author=Zoepf T, Jakobs R, Arnold J, Apel D, Riemann J |title=Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy |journal=Am J Gastroenterol |volume=100 |issue=11 |pages=2426–30 |year=2005 |pmid=16279895}}</ref>


==References==
==References==
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Latest revision as of 15:43, 7 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Farima Kahe M.D. [2], Suveenkrishna Pothuru, M.B,B.S. [3]

Overview

Chemotherapy is indicated for unresectable cholangiocarcinoma as palliative chemotherapy. Chemotherapy agents used to treat cholangiocarcinoma include 5-fluorouracil, gemcitabine, irinotecan, cisplatin, or doxorubicin.

Medical Therapy

The majority of cases of cholangiocarcinoma present as unresectable disease.[1] If the tumor cannot be surgically removed, patients are often treated with palliative chemotherapy with or without radiotherapy.

Chemotherapy

Regional therapies

Photodynamic Therapy

References

  1. ↑ Vauthey J, Blumgart L (1994). "Recent advances in the management of cholangiocarcinomas". Semin. Liver Dis. 14 (2): 109–14. PMID 8047893.
  2. ↑ Ramírez-Merino N, Aix SP, Cortés-Funes H (2013). "Chemotherapy for cholangiocarcinoma: An update". World J Gastrointest Oncol. 5 (7): 171–6. doi:10.4251/wjgo.v5.i7.171. PMC 3731530. PMID 23919111.
  3. ↑ Knox JJ, Hedley D, Oza A, Feld R, Siu LL, Chen E, Nematollahi M, Pond GR, Zhang J, Moore MJ (2005). "Combining gemcitabine and capecitabine in patients with advanced biliary cancer: a phase II trial". J. Clin. Oncol. 23 (10): 2332–8. doi:10.1200/JCO.2005.51.008. PMID 15800324.
  4. ↑ André T, Tournigand C, Rosmorduc O, Provent S, Maindrault-Goebel F, Avenin D, Selle F, Paye F, Hannoun L, Houry S, Gayet B, Lotz JP, de Gramont A, Louvet C (2004). "Gemcitabine combined with oxaliplatin (GEMOX) in advanced biliary tract adenocarcinoma: a GERCOR study". Ann. Oncol. 15 (9): 1339–43. doi:10.1093/annonc/mdh351. PMID 15319238.
  5. ↑ Patt YZ, Hassan MM, Lozano RD, Waugh KA, Hoque AM, Frome AI, Lahoti S, Ellis L, Vauthey JN, Curley SA, Schnirer II, Raijman I (2001). "Phase II trial of cisplatin, interferon alpha-2b, doxorubicin, and 5-fluorouracil for biliary tract cancer". Clin. Cancer Res. 7 (11): 3375–80. PMID 11705850.
  6. ↑ Halappa VG, Bonekamp S, Corona-Villalobos CP, Li Z, Mensa M, Reyes D, Eng J, Bhagat N, Pawlik TM, Geschwind JF, Kamel IR (2012). "Intrahepatic cholangiocarcinoma treated with local-regional therapy: quantitative volumetric apparent diffusion coefficient maps for assessment of tumor response". Radiology. 264 (1): 285–94. doi:10.1148/radiol.12112142. PMID 22627601.
  7. ↑ Patel T (2011). "Cholangiocarcinoma--controversies and challenges". Nat Rev Gastroenterol Hepatol. 8 (4): 189–200. doi:10.1038/nrgastro.2011.20. PMC 3888819. PMID 21460876.
  8. ↑ Ortner M, Caca K, Berr F, Liebetruth J, Mansmann U, Huster D, Voderholzer W, Schachschal G, Mössner J, Lochs H (2003). "Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study". Gastroenterology. 125 (5): 1355–63. PMID 14598251.
  9. ↑ Zoepf T, Jakobs R, Arnold J, Apel D, Riemann J (2005). "Palliation of nonresectable bile duct cancer: improved survival after photodynamic therapy". Am J Gastroenterol. 100 (11): 2426–30. PMID 16279895.

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