Department of Internal Medicine, Medical Oncology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan.
J Hepatobiliary Pancreat Sci. 2012 Jul;19(4):337-41. doi: 10.1007/s00534-011-0494-2.
The purpose of chemotherapy in patients with advanced solid cancers, including biliary tract cancer, is generally to improve the survival and quality of life of the patients. Also, adjuvant chemotherapy is expected to increase the curability of surgery in patients scheduled to undergo surgery. Most patients with unresectable biliary tract cancer develop obstructive jaundice, and biliary drainage is needed before any of the aforementioned treatments. Once jaundice is resolved by stenting of the bile duct or bilio-intestinal bypass, cholangitis often develops, leading to rapid deterioration of the patient's general condition. Therefore, the beneficial effect of chemotherapy in such patients remains controversial. A few randomized controlled trials have demonstrated the survival benefit of chemotherapy as compared with supportive care. In one of these trials, improvement of the quality of life was also confirmed. Recently, since the survival benefit of combined gemcitabine plus cisplatin therapy over gemcitabine alone has been demonstrated in randomized controlled clinical trials, this combined regimen has been recognized as a standard therapy for unresectable biliary tract cancer. A second-line regimen is now expected to be established for patients with gemcitabine-refractory biliary tract cancer, although the significance of second-line therapy remains unclear. One of the next issues in relation to chemotherapy for biliary tract cancer is the development of molecular-targeted agents; however, few large clinical trials of such agents have been conducted for biliary tract cancer. Various issues in chemotherapy for biliary tract cancer remain to be investigated, and global cooperation is necessary to conduct large clinical trials.
化学疗法在包括胆管癌在内的晚期实体瘤患者中的目的通常是改善患者的生存和生活质量。此外，辅助化疗有望增加计划接受手术的患者的手术治愈率。大多数不可切除的胆管癌患者会出现梗阻性黄疸，在进行上述任何治疗之前都需要进行胆道引流。一旦胆管支架置入或胆肠旁路术缓解了黄疸，往往会发生胆管炎，导致患者一般状况迅速恶化。因此，此类患者的化疗的有益效果仍存在争议。少数随机对照试验表明，与支持性护理相比，化疗具有生存获益。其中一项试验还证实了生活质量的改善。最近，由于随机对照临床试验证实了吉西他滨联合顺铂治疗比吉西他滨单药治疗更具生存获益，因此该联合方案已被认为是不可切除胆管癌的标准治疗方案。现在有望为吉西他滨耐药的胆管癌患者建立二线治疗方案，尽管二线治疗的意义仍不清楚。胆管癌化疗的下一个问题之一是开发分子靶向药物；然而，针对胆管癌的此类药物的大型临床试验很少。胆管癌化疗中仍有许多问题有待研究，需要全球合作开展大型临床试验。
