Systemic treatment of advanced or recurrent biliary tract cancer

Zhang, Wei; Zhou, Hongyuan; Wang, Yingying; Zhang, Zewu; Cao, Guangtai; Song, Tianqiang; Zhang, Ti; Li, Qiang

doi:10.5582/bst.2020.03240

Cited by 35 publications

(33 citation statements)

References 94 publications

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“…For locally advanced or metastatic unresectable GBC, gemcitabine and cisplatin based chemotherapy is the recommended treatment option (3,14). Furthermore, chemotherapy in combination with bevacizumab has shown promising results in the treatment of BTCs (15). We report here a case of a 47-year-old woman with GBC metastasized to liver and peritoneum who was treated with a biosimilar bevacizumab based Gemox-B regimen.…”

Section: Discussionmentioning

confidence: 99%

Bevacizumab based chemotherapy is a promising option in metastatic gallbladder adenocarcinoma

et al. 2021

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Gallbladder cancer (GBC) is one of the most frequently observed cancers in India that is usually diagnosed at an advanced stage. Although surgery remains the only curative option, the majority of GBCs are unresectable. Palliative chemotherapy with gemcitabine and cisplatin is the recommended treatment in such cases. The current study reports a case of a 47-year-old female who exhibited GBC that had metastasized to the liver and peritoneum. She was administered palliative chemotherapy with gemcitabine and cisplatin, but due to disease progression the regimen was changed and an aggressive treatment initiated with gemcitabine and oxaliplatin with additional biosimilar bevacizumab (modified Gemox-B regimen). The patient completed six chemotherapy cycles with partial response and received bevacizumab (7.5 mg/kg 3-weekly) based maintenance treatment for an additional 6 cycles, after which she demonstrated disease progression, thus having a progression free survival of ~11 months. The patient is currently receiving palliative chemotherapy with capecitabine.

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Section: Discussionmentioning

confidence: 99%

Bevacizumab based chemotherapy is a promising option in metastatic gallbladder adenocarcinoma

et al. 2021

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“…In general, the prognosis of patients with recurrent iCCA is poor, and despite advances in almost all fields of cancer therapy the median survival is usually no longer than 12 months [8, 22, 27]. For many years, palliative chemotherapy or best supportive care has been the standard of care.…”

Section: Intrahepatic Cholangiocarcinomamentioning

confidence: 99%

“…In up to 15–25% of patients with recurrent iCCA a surgical approach is possible. With ongoing progress in chemotherapy and in targeted therapy, response rates as well as repeated resectability might increase [5, 8, 9, 36]. We have to await further data of neoadjuvant treatment to draw valid conclusions regarding resection rates in primary as well as recurrent cholangiocarcinoma.…”

Section: Intrahepatic Cholangiocarcinomamentioning

confidence: 99%

“…Traditionally, patients with recurrent cholangiocarcinoma have been treated with a palliative intention, most often with best supportive care only. Currently, chemotherapy, usually triple regimens based on gemcitabine/cisplatin/nab paclitaxel or fluorouracil, leucovorin, and irinotecan plus oxaliplatin, if possible in combination with the antiangiogenic inhibitor bevacizumab, is the mainstay of treatment in advanced and also recurrent cholangiocarcinoma [1, 2, 8]. With the development of next-generation sequencing (NGS), molecular targeted therapies have become increasingly available.…”

Section: Introductionmentioning

confidence: 99%

“…For iCCA, the first promising results have been reported after treatment with fibroblast growth factor receptor and isocitrate dehydrogenase inhibitors. Other targeted therapies such as anti-human epidermal growth factor receptor-2 inhibitors or polyadenosine diphosphate ribose polymerase inhibitors may play a role in the future [8]. Despite ongoing improvements and some remarkable advances – i.e., a median survival of up to 21 months in a subgroup of patients treated with a fibroblast growth factor receptor inhibitor – results are still poor and survival is hardly longer than 12 months [1, 2, 8, 9].…”

Section: Introductionmentioning

confidence: 99%

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Surgical Approach to Recurrent Cholangiocarcinoma

Lang

2020

Visc Med

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Background: For recurrent cholangiocarcinoma, systemic chemotherapy is the standard of care. Repeated resection is a potential curative treatment, but data are scarce and outcomes are not well defined so far. Summary: In the last decade there has been an increasing number of reports suggesting a survival benefit and even cure after repeated surgery. This is particularly true for intrahepatic cholangiocarcinoma, where repeated resections offer similar or even better results than the first resection. In selected cases even a third liver resection is possible. In contrast, in perihilar and distal cholangiocarcinoma, repeated resection is only rarely possible. Although the improved outcome might be attributed to a careful patient selection and a favorable tumor biology, repeated surgical treatment should be attempted whenever possible. This necessitates a structured follow-up after resection. Key Message: Surgical resection offers the chance for prolonged survival and even for cure in recurrent cholangiocarcinoma. Hence, it is of the utmost importance to better understand the routes of metastases and to define factors qualifying for resection. Whether different patterns of recurrence reflect biological heterogeneity requires further investigation.

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Effect of local treatment in patients with oligo‐recurrence after surgery of distal bile duct cancer: A bi‐institutional study

et al. 2023

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Background: Distal extrahepatic bile duct (EHBD) cancer is highly recurrent.More than 50% of patients suffer from disease relapse after curative resection. Some patients present with oligo-recurrence which could be a single loco-regional mass or lesions limited to a single solid organ. The aim of this study was to examine the effect of local control (surgical resection or radiofrequency ablation) on survival outcomes in patients with oligo-recurrent distal EHBD cancer. Methods: Data of 1219 patients who underwent surgery for distal EHBD cancer from 2000 to 2018 were retrospectively reviewed. Clinicopathological characteristics and survival outcomes of patients with recurrence were investigated. Postrecurrence survival (PRS) was analyzed according to modalities of re-treatment (local treatment or systemic therapy alone).Results: Among 654 patients with recurrence, 90 patients who had oligo-recurrence showed better recurrence-free and overall survival than patients with non-oligorecurrent disease. Lymph node ratio and perineural invasion at initial pathology, timing of recurrence, and platelet-to-lymphocyte ratio at recurrence were independent risk factors for PRS in the oligo-recurrent group. Patients with local treatment for oligorecurrence had better 3-and 5-year PRS than those with systemic treatment alone (38.3% vs. 14.1%, p = 0.04; 28.3% vs. 7.1%, p = 0.04, respectively). Recurrence within 24 months after initial surgery was the only significant factor for PRS in the local treatment group. Conclusion:In patients with oligo-recurrence after resection of distal EHBD cancer, post-recurrence local treatment could improve survival outcomes, particularly for those with recurrence more than 2 years after initial resection.

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Systemic treatment of advanced or recurrent biliary tract cancer

Cited by 35 publications

References 94 publications

Bevacizumab based chemotherapy is a promising option in metastatic gallbladder adenocarcinoma

Bevacizumab based chemotherapy is a promising option in metastatic gallbladder adenocarcinoma

Surgical Approach to Recurrent Cholangiocarcinoma

Effect of local treatment in patients with oligo‐recurrence after surgery of distal bile duct cancer: A bi‐institutional study

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