Villalba Cuesta Paula, Avedillo Ruidiaz Mercedes, Ruiz Hispán Eva, Fuentes Mateos Raquel, Lamarca Angela
Department of Medical Oncology-OncoHealth Institute, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain.
Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK.
Cancers (Basel). 2023 Nov 23;15(23):5543. doi: 10.3390/cancers15235543.
Biliary tract tumours, including bile duct, gallbladder, and ampulla of Vater malignancies, pose a rare but formidable oncologic challenge. Typically diagnosed at advanced stages, these tumours offer limited treatment options and dismal prognoses, with a five-year survival rate below 20%. First-line chemotherapy with gemcitabine-cisplatin has demonstrated only modest efficacy, leaving a pressing need for improved therapeutic strategies. This comprehensive review provides a detailed examination of the current landscape of second-line chemotherapy for biliary tract tumours. The pivotal ABC-06 trial established FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) as the standard second-line therapy, demonstrating improved overall survival compared to active symptom control alone. Conversely, the NIFTY trial introduced nal-IRI (nanoliposomal irinotecan) plus 5-FU/LV (5-fluorouracil and leucovorin) as an alternative option, demonstrating substantial gains in progression-free and overall survival. However, the posterior NALIRICC trial presented conflicting results, raising questions about the added benefit of nal-IRI. Challenges in delivering second-line chemotherapy include rapid patient performance deterioration post-first-line treatment and limited access to second-line therapy. Only a fraction of eligible patients receive second-line therapy, emphasising the need for more effective first-line therapies to maintain patient fitness. The role of monotherapy in the second-line setting remains uncertain, particularly in unfit patients, and the absence of biomarkers for tailored treatment underscores the need for ongoing research. While challenges persist, ongoing investigations offer hope for optimising second-line therapy for biliary tract tumours, promising improved outcomes for patients facing this disease. This review provides an overview of current facts and challenges when delivering second-line chemotherapy for advanced biliary tract tumours.
胆道肿瘤，包括胆管癌、胆囊癌和壶腹恶性肿瘤，是一种罕见但严峻的肿瘤学挑战。这些肿瘤通常在晚期被诊断出来，治疗选择有限，预后不佳，五年生存率低于20%。吉西他滨-顺铂一线化疗仅显示出适度的疗效，因此迫切需要改进治疗策略。本综述详细探讨了胆道肿瘤二线化疗的现状。关键的ABC-06试验确立了FOLFOX（5-氟尿嘧啶、亚叶酸钙和奥沙利铂）作为标准二线治疗方案，与单纯积极的症状控制相比，总生存期有所改善。相反，NIFTY试验引入了纳米脂质体伊立替康（nal-IRI）加5-氟尿嘧啶/亚叶酸钙（5-FU/LV）作为替代方案，显示无进展生存期和总生存期有显著改善。然而，后续的NALIRICC试验结果相互矛盾，引发了对nal-IRI附加益处的质疑。二线化疗面临的挑战包括一线治疗后患者表现迅速恶化以及二线治疗可及性有限。只有一小部分符合条件的患者接受二线治疗，这凸显了需要更有效的一线治疗来维持患者身体状况良好。单药治疗在二线治疗中的作用仍不确定，尤其是在身体状况不佳的患者中；而且缺乏用于个性化治疗的生物标志物，这突出了持续研究的必要性。尽管挑战依然存在，但正在进行的研究为优化胆道肿瘤二线治疗带来了希望，并有望为面临这种疾病的患者带来更好的治疗结果。本综述概述了晚期胆道肿瘤二线化疗目前的实际情况和挑战。
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