The biliary tract (or biliary tree) is the path by which bile secreted by the liver gets transported to the duodenum, or small intestine. This includes the gallbladder, bile ducts inside the liver, and those outside the liver. Biliary tract cancers are fairly rare in developed countries. The incidence is high in the developing ones though. India has one of the highest incidence of gallbladder cancer. Females are mostly affected. Surgery is the only accepted curative approach. Most patients are diagnosed with locally advanced or metastatic disease. There is no established standard chemotherapy for the condition since no single randomized study had succeeded so far, in dictating a definite schedule. However recently performed small, early-phase clinical trials have now given hope that chemotherapy may have some effect in patients with locally advanced or metastatic biliary tract cancer.
Gemcitabine and cisplatin are the two anti-cancer drugs that have been studied in recent trials. Gemcitabine belongs to a class of drugs called anti-metabolites while cisplatin is a platinum based compound. Drugs belonging to class fluoro pyrimidines have also shown activity. Gemcitabine treatment for biliary tract cancer has been increasingly prescribed by oncologists who specialize in hepatobiliary disease. A randomized, controlled, phase 3 trial was performed to know which strategy was better: Gemcitabine alone or cisplatin plus gemcitabine. 410 patients from 37 centres in the United Kingdom across the National Cancer Research Network between February 2002 and October 2008 were recruited for the study.
AdvertisementThe results are in favour of using a cisplatin plus gemcitabine regimen. Cisplatin plus gemcitabine is an effective treatment option for locally advanced or metastatic biliary tract cancer. 'Patients treated with cisplatin plus gemcitabine lived an average of 3.6 months longer than those treated with gemcitabine alone,' reports the New England Journal of Medicine.
The survival advantage offered by cisplatin plus gemcitabine comes with no addition of substantial toxicity. This is an encouraging result and reassures us that an effective standard chemotherapy for advanced cases of biliary cancer will soon be out. More detailed studies are hence solicited.
Reference: New England Journal of Medicine
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