A review of current adjuvant and neoadjuvant systemic treatments for cholangiocarcinoma and gallbladder carcinoma

Abstract

Biliary tract cancers are a relatively rare heterogenous group of malignancies, including gallbladder cancer, intrahepatic, perihilar, and distal cholangiocarcinoma. Most patients are diagnosed with locally advanced or metastatic disease, and survival outcomes remain poor. This is also the case in the relatively few who undergo curative surgery. Efforts to improve patient survival outcomes have focussed on adjuvant and neoadjuvant chemotherapy and chemoradiotherapy. Adjuvant trials investigating the efficacy of systemic chemotherapy have primarily been negative to date, with challenges including compliance, recruitment rate, percentage of node-positive and R1 resections, and tumor heterogenicity observed. As reported in BILCAP, adjuvant capecitabine is currently considered the standard of care in many countries and guidelines, while chemoradiotherapy improves R1 outcomes as observed in the phase II trial SWOG S0809. Trials are ongoing to elicit the ideal combination of adjuvant treatment. Evidence for neoadjuvant chemotherapy continues to be based on retrospective analysis and a few phase II trials, with observed downstaging to surgery and improved R1 resection rates documented. This review documents the current evidence for systemic chemotherapy in adjuvant and neoadjuvant treatment of biliary tract cancers and highlights the ongoing clinical trials.

Keywords

Cholangiocarcinoma / gallbladder carcinoma / neoadjuvant chemotherapy / adjuvant chemotherapy

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