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    Advances in the treatment of metastatic or unresectable biliary tract cancer.

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    Authors
    Valle, Juan W
    Affiliation
    Christie Hospital/The University of Manchester, Manchester, UK.
    Issue Date
    2010-10
    
    Metadata
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    Abstract
    The prognosis for advanced/inoperable biliary tract cancer is poor and the management of biliary obstruction and sepsis remains the cornerstone of best supportive care (BSC). Many phase II studies have reported some activity of chemotherapy, usually involving one or more of a fluoropyrimidine, a platinum agent and gemcitabine. No adequately powered study has shown conclusively a benefit for chemotherapy compared with BSC alone although three small randomized studies have suggested an improved survival. Results from the randomized phase III ABC-02 study demonstrated a survival advantage of cisplatin and gemcitabine doublet-chemotherapy over gemcitabine monotherapy {median survival of 11.7 compared with 8.1 months, hazard ratio (HR), 0.64 [95% confidence interval (CI) 0.52 to 0.80]; log rank P < 0.001} as well as a significantly longer progression-free survival [median 8 compared with 5 months; HR 0.63 (95% CI 0.51 to 0.77); log rank P < 0.001]. A similar magnitude of benefit was seen in Japanese patients in a second study using the same treatment regimens (the BT-22 study). Ongoing studies are underway evaluating other chemotherapy regimens in first-line although attention is turning to the addition of targeted therapies; these will be reviewed. Pivotal to success in this process is both the identification of appropriate targets across this heterogeneous group of malignancies (e.g. EGFR, VEGF, MEK inhibition, amongst others) and collaboration between investigators to deliver relevant, timely and adequately powered studies.
    Citation
    Advances in the treatment of metastatic or unresectable biliary tract cancer. 2010, 21 Suppl 7:vii345-vii348 Ann Oncol
    Journal
    Annals of Oncology
    URI
    http://hdl.handle.net/10541/115845
    DOI
    10.1093/annonc/mdq420
    PubMed ID
    20943640
    Type
    Article
    Language
    en
    ISSN
    1569-8041
    ae974a485f413a2113503eed53cd6c53
    10.1093/annonc/mdq420
    Scopus Count
    Collections
    All Christie Publications
    Medical Oncology

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