Cholangiocarcinoma medical therapy

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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

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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

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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

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* 1.Chemotherapy
* Preferred regimen (1): 5-fluorouracil 600 mg/m2 with leucovorin 400 mg/m2 over 2 hours once every 2 weeks [2]
* Alternative regimen (2): Gemcitabine 1,000 mg/m2 plus cisplatin [3]
* Alternative regimen (3): Irinotecan 125 mg/m2 q14 days
* Alternative regimen (4): Oxaliplatin 400 mg/m2 [4]
* Alternative regimen (5): Doxorubicin 60-75 mg/m2 q21 days [5]
* Alternative regimen (6): Capecitabine 650 mg/m2 q21 days for 2 weeks
* Alternative regimen (7): Erlotinib PO 100 mg/day

### Regional therapies

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* Regional therapies is recommended among patients with small cholangiocarcinomas, when the general health condition of the patient does not allow a more aggressive treatment:[6][7]
* Transarterial chemoembolization (TACE)
* Radioembolization

### Photodynamic Therapy

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* Photodynamic therapy
* Injected with a light-sensitizing agent and light is then applied endoscopically directly to the tumor [8][9]

## References

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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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)

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