Adjuvant Therapy for Resected Biliary Tract Cancer: ASCO Clinical Practice Guideline

J Clin Oncol. 2019 Apr 20;37(12):1015-1027. doi: 10.1200/JCO.18.02178. Epub 2019 Mar 11.


Purpose: To develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with resected biliary tract cancer.

Methods: ASCO convened an Expert Panel to conduct a systematic review of the literature on adjuvant therapy for resected biliary tract cancer and provide recommended care options for this patient population.

Results: Three phase III randomized controlled trials, one phase II trial, and 16 retrospective studies met the inclusion criteria.

Recommendations: Based on evidence from a phase III randomized controlled trial, patients with resected biliary tract cancer should be offered adjuvant capecitabine chemotherapy for a duration of 6 months. The dosing used in this trial is described in the qualifying statements, while it should be noted that the dose of capecitabine may also be determined by institutional and regional practices. Patients with extrahepatic cholangiocarcinoma or gallbladder cancer and a microscopically positive surgical resection margin (R1 resection) may be offered chemoradiation therapy. A shared decision-making approach is recommended, considering the risk of harm and potential for benefit associated with radiation therapy for patients with extrahepatic cholangiocarcinoma or gallbladder cancer. Additional information is available at .

Publication types

  • Practice Guideline
  • Systematic Review

MeSH terms

  • Antimetabolites, Antineoplastic / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Biliary Tract Neoplasms / therapy*
  • Capecitabine / therapeutic use
  • Chemoradiotherapy, Adjuvant / standards
  • Chemotherapy, Adjuvant / standards
  • Clinical Trials, Phase II as Topic
  • Clinical Trials, Phase III as Topic
  • Combined Modality Therapy / methods
  • Combined Modality Therapy / standards*
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives
  • Evidence-Based Medicine
  • Humans
  • Oxaliplatin / administration & dosage
  • Practice Guidelines as Topic
  • Radiotherapy, Adjuvant / standards
  • Randomized Controlled Trials as Topic
  • Retrospective Studies


  • Antimetabolites, Antineoplastic
  • Oxaliplatin
  • Deoxycytidine
  • Capecitabine
  • gemcitabine