Protective Chemotherapy – Capecitabine Increased Survival in Bile Duct Cancers

Presented at the 2017 ASCO Cancer Congress in America, the chemotherapy capecitabine given after surgery for bile duct cancers significantly increased patients’ survival.

Also called cholangiocarcinoma or cholangiocancer, bile duct cancer occurs broadly in three areas: the bile ducts inside the liver (intrahepatic), the gallbladder and the bile ducts outside the liver (extrahepatic). Surgery is the primary treatment for early-stage bile duct cancers arising in these areas. Within 5 years after surgery, depending on tumor stage and location, recurrence occurs in %70-90 of patients. We oncologists give protective - adjuvant chemotherapy to prevent bile duct cancer recurrence after surgery. However, although well-designed comprehensive clinical trials have established which postoperative chemotherapy to use and for how long in many cancers, information in this area is insufficient for bile duct cancer.

ASCO 2017 reported a study dividing 447 operated bile duct cancer patients into two groups. One received the oral chemotherapy capecitabine for protection, while the other was observed without chemotherapy. Tumor locations were %47 intrahepatic or hilar, %18 gallbladder and %35 extrahepatic. After surgery, capecitabine was given according to body surface area at 1250 mg/m2 on days 1-14, followed by 7 days of rest, for 8 cycles. Postoperatively, %62 had no tumor, even microscopically, remaining at the surgical margin; %38 had positive margins, and %46 had lymph node involvement - metastasis .

Capecitabine chemotherapy given for approximately 6 months after bile duct cancer surgery reduced the risk of death by %25. Given protectively, it increased average survival from 36 to 53 months, and the findings were statistically significant.

For the first time in many years, a coherent, well-designed study provided guidance for protective treatment in bile duct cancer. These results offered milestone information for these patients. Based on these data, we believe 6 months of protective capecitabine after bile duct cancer surgery will quickly enter our everyday practice.