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
- 1.Chemotherapy
- Preferred regimen (1): 5-fluorouracil with leucovorin 400 mg/m2 over 2 hours once every 2 weeks
- Alternative regimen (2): Gemcitabine 1,000 mg/m2 plus cisplatin
- Alternative regimen (3): Irinotecan 125 mg/m2 q14 days
- Alternative regimen (4): Oxaliplatin 400 mg/m2
- Alternative regimen (5): Doxorubicin 60-75 mg/m2 q21 days
- Alternative regimen (6): Capecitabine 650 mg/m2 q21 days for 2 weeks
- Alternative regimen (7): Erlotinib PO 100 mg/day
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:
- Transarterial chemoembolization (TACE)
- Radioembolization
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.[2][3]
References
- ↑ Vauthey J, Blumgart L (1994). "Recent advances in the management of cholangiocarcinomas". Semin. Liver Dis. 14 (2): 109–14. PMID 8047893.
- ↑ 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.