Cholangiocarcinoma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]
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
- Chemotherapy has been shown in a randomized controlled trial to improve quality of life and extend survival in patients with inoperable cholangiocarcinoma.[2]
- There is no single chemotherapy regimen which is universally used, and enrollment in clinical trials is often recommended when possible.
- Chemotherapy agents used to treat cholangiocarcinoma include 5-fluorouracil with leucovorin,[3] gemcitabine as a single agent,[4] or gemcitabine plus cisplatin,[5] irinotecan,[6]oxaliplatin, doxorubicin, or capecitabine.[7] A small pilot study suggested possible benefit from the tyrosine kinase inhibitor erlotinib in patients with advanced cholangiocarcinoma.[8]
Regional therapies
Regional therapies are considered as an option for treating small cholangiocarcinomas when the general health condition of the patient does not permit a more aggressive treatment:
- Transarterial chemoembolization (TACE), which increases the local concentration of chemotherapeutic agents and reduces systemic exposure, has shown promising results, increasing survival.
- Radioembolization also seems to increase survival.
Photodynamic Therapy
Photodynamic therapy, an experimental approach in which patients are injected with a light-sensitizing agent and light is then applied endoscopically directly to the tumor, has shown promising results compared to supportive care in two small randomized controlled trials. However, the ultimate role of photodynamic therapy in the management of cholangiocarcinoma is unclear at present.[9][10]
References
- ↑ Vauthey J, Blumgart L (1994). "Recent advances in the management of cholangiocarcinomas". Semin. Liver Dis. 14 (2): 109–14. PMID 8047893.
- ↑ Glimelius B, Hoffman K, Sjödén P, Jacobsson G, Sellström H, Enander L, Linné T, Svensson C (1996). "Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer". Ann Oncol. 7 (6): 593–600. PMID 8879373.
- ↑ Choi C, Choi I, Seo J, Kim B, Kim J, Kim C, Um S, Kim J, Kim Y (2000). "Effects of 5-fluorouracil and leucovorin in the treatment of pancreatic-biliary tract adenocarcinomas". Am J Clin Oncol. 23 (4): 425–8. PMID 10955877.
- ↑ Park J, Oh S, Kim S, Kwon H, Kim J, Jin-Kim H, Kim Y (2005). "Single-agent gemcitabine in the treatment of advanced biliary tract cancers: a phase II study". Jpn J Clin Oncol. 35 (2): 68–73. PMID 15709089.
- ↑ Giuliani F, Gebbia V, Maiello E, Borsellino N, Bajardi E, Colucci G. "Gemcitabine and cisplatin for inoperable and/or metastatic biliary tree carcinomas: a multicenter phase II study of the Gruppo Oncologico dell'Italia Meridionale (GOIM)". Ann Oncol. 17 Suppl 7: vii73–vii77. PMID 16760299.
- ↑ Bhargava P, Jani C, Savarese D, O'Donnell J, Stuart K, Rocha Lima C (2003). "Gemcitabine and irinotecan in locally advanced or metastatic biliary cancer: preliminary report". Oncology (Williston Park). 17 (9 Suppl 8): 23–6. PMID 14569844.
- ↑ Knox J, Hedley D, Oza A, Feld R, Siu L, Chen E, Nematollahi M, Pond G, Zhang J, Moore M (2005). "Combining gemcitabine and capecitabine in patients with advanced biliary cancer: a phase II trial". J Clin Oncol. 23 (10): 2332–8. PMID 15800324.
- ↑ Philip P, Mahoney M, Allmer C, Thomas J, Pitot H, Kim G, Donehower R, Fitch T, Picus J, Erlichman C (2006). "Phase II study of erlotinib in patients with advanced biliary cancer". J Clin Oncol. 24 (19): 3069–74. PMID 16809731.
- ↑ 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.
- ↑ 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.