Chemotherapy for Biliary Tract Cancer in 2021

Abstract

Biliary tract cancer refers to a group of malignancies including cholangiocarcinoma, gallbladder cancer, and ampullary cancer. While surgical resection is considered the only curative treatment, postoperative recurrence can sometimes occur. Adjuvant chemotherapy is used to prolong prognosis in some cases. Many unresectable cases are also treated with chemotherapy. Therefore, systemic chemotherapy is widely introduced for the treatment of biliary tract cancer. Evidence on chemotherapy for biliary tract cancer is recently on the increase. Combination chemotherapy with gemcitabine and cisplatin is currently the standard of care for first-line chemotherapy in advanced cases. Recently, FOLFOX also demonstrated efficacy as a second-line treatment. In addition, efficacies of isocitrate dehydrogenase inhibitors and fibroblast growth factor receptor inhibitors have been shown. In the adjuvant setting, capecitabine monotherapy has become the standard of care in Western countries. In addition to conventional cytotoxic agents, molecular-targeted agents and immunotherapy have been evaluated in multiple clinical trials. Genetic testing is used to check for genetic alterations and molecular-targeted agents and immunotherapy are introduced based on tumor characteristics. In this article, we review the latest evidence of chemotherapy for biliary tract cancer.

Keywords: biliary tract cancer; chemotherapy; cholangiocarcinoma; cytotoxic agents; genetic testing; immunotherapy; molecular targeted agents; precision medicine.

Figure 1

Proposed treatment algorithm of chemotherapy for advanced biliary tract cancer. GEM; gemcitabine, CDDP; cisplatin, FOLFOX; 5-fluorouracil + leucovorin + oxaliplatin, IDH; isocitrate dehydrogenase, FGFR; fibroblast growth factor receptor, MSI; microsatellite instability, NTRK; neurotrophic tyrosine receptor kinase.