Chemotherapy in Patients with Advanced Cholangiocarcinoma

This chapter analyses the role of chemotherapy in the palliative treatment of patients with locally advanced or metastatic cholangiocarcinoma.In the wake of evidence of the superiority of cheniotherapy over best supportive care, many studies have evalueted diffrent chemotherapeutic agents. Among them gemcitabine proved the most avtice against biliary tract cancer and its combination with platinum compounds like cisplatin (Gemcis) or oxaliplatin (Gemox) has proved the best systemic therapeutic strategy. Given the results of recent large phase III studies, gemcitabine in association with cisplatin should be considered the standard of care in the first-line setting of advanced cholangiocarcinoma even if no comparative study between Gemcis and Gemox has ever been conducted and a literature analysis of hte main published studies showed that the results obtained with Gemox are not very different from those obtained with Gemcis. Few studies on a salvage chemotherapy after failure of first-line treatment have been coducted due to the rarity of the disease and the frequent rapid decline of perfomance status of patients in this advanced setting.