Advances in the treatment of metastatic or unresectable biliary tract cancer
Open Access
- 1 October 2010
- journal article
- review article
- Published by Elsevier BV in Annals Of Oncology
- Vol. 21, vii345-vii348
- https://doi.org/10.1093/annonc/mdq420
Abstract
The prognosis for advanced/inoperable biliary tract cancer is poor and the management of biliary obstruction and sepsis remains the cornerstone of best supportive care (BSC). Many phase II studies have reported some activity of chemotherapy, usually involving one or more of a fluoropyrimidine, a platinum agent and gemcitabine. No adequately powered study has shown conclusively a benefit for chemotherapy compared with BSC alone although three small randomized studies have suggested an improved survival. Results from the randomized phase III ABC-02 study demonstrated a survival advantage of cisplatin and gemcitabine doublet-chemotherapy over gemcitabine monotherapy {median survival of 11.7 compared with 8.1 months, hazard ratio (HR), 0.64 [95% confidence interval (CI) 0.52 to 0.80]; log rank P < 0.001} as well as a significantly longer progression-free survival [median 8 compared with 5 months; HR 0.63 (95% CI 0.51 to 0.77); log rank P < 0.001]. A similar magnitude of benefit was seen in Japanese patients in a second study using the same treatment regimens (the BT-22 study). Ongoing studies are underway evaluating other chemotherapy regimens in first-line although attention is turning to the addition of targeted therapies; these will be reviewed. Pivotal to success in this process is both the identification of appropriate targets across this heterogeneous group of malignancies (e.g. EGFR, VEGF, MEK inhibition, amongst others) and collaboration between investigators to deliver relevant, timely and adequately powered studies.Keywords
This publication has 17 references indexed in Scilit:
- Cisplatin plus Gemcitabine versus Gemcitabine for Biliary Tract CancerNew England Journal of Medicine, 2010
- Gemcitabine alone or in combination with cisplatin in patients with advanced or metastatic cholangiocarcinomas or other biliary tract tumours: a multicentre randomised phase II study – The UK ABC-01 StudyBritish Journal of Cancer, 2009
- Capecitabine plus oxaliplatin as first-line treatment in patients with advanced biliary system adenocarcinoma: a prospective multicentre phase II trialBritish Journal of Cancer, 2008
- Clinicopathological and prognostic significance of EGFR, VEGF, and HER2 expression in cholangiocarcinomaBritish Journal of Cancer, 2007
- Molecular pathology of biliary tract cancersCancer Letters, 2007
- Chemotherapy in advanced biliary tract carcinoma: a pooled analysis of clinical trialsBritish Journal of Cancer, 2007
- CholangiocarcinomaGastroenterology, 2005
- Gemcitabine combined with oxaliplatin (GEMOX) in advanced biliary tract adenocarcinoma: a GERCOR studyAnnals of Oncology, 2004
- Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus documentGut, 2002
- Recent Advances in the Management of CholangiocarcinomasSeminars in Liver Disease, 1994