Here is the list of chemo agents that mostly used for CCA that I can find at this point. most of them are used in combination to get the best results (synergy) out of the combo that used in the regimen.
Taken by Mouth:(not necessary FDA approval indications for CCA but doctors can use them out of protocol)
1.Xeloda(oral form of 5FU)-see 5Fu below;diarrhea and hand and foot symptoms are the side effects.
2.erlotinib(Tarceva)---EGFR cell pathway inhibitor(tyrosine kinase inhibitor);
inhibit angiogensis (cut off blood supply to cancer cells and cause them to die);cause cell death by interrupting the reproduction of cancer cells;smoking will decrease the drug effects by 24% which may result in treatment failure.
3.sorafenib.(Nexavar)---Multiple cancer cell pathways inhibitor; inhibit cell proliferation and angiogenesis(cut of blood supply to cancer)
4. Celecoxib-an antiflammatory agent belongs to the COX2-an enzyme family.but use much less recently.
Taking as Infusion:
1. 5FU.---a chemo agent belongs to the Antimetabolite family that inhibits RNA synthesis and function ; may also on DNA synthesis but to the less degree. in doing so,cause cancer cell to die.
2.Gemzar---a chemo agent belongs to the Antimetabolite family that inhibits the DNA synthesis in the cancer cells;induce tumor cell death (apoptosis);
some study indicated Gemzar is more effective in treating CCA than 5FU,but both 5FU and Gemzar are FIRST LINE chemotherapy agents of choice to combine with other chemo agents in CCA regimens;other study indicated effectiveness of both agents are more or less the same.
3.Cisplatin---1st generation of the platinum family, an alkylating agent affects cell DNA replications thus causes cancer cell death(apoptosis);may cause kidney impairment and impairs hearing (ototoxicity);usually use in combination with Gemzar or 5FU to provide the synergic effect of the regimen of GEM/CIS or FOLFOX.
4.Oxaliplatin--- the 3rd. generation of the platinum family;less kidney impairment than cisplatin but more patients experienced peripheral neuropathy
5.Carboplatin--- the 2nd generation for the platinum family;decrease platelet production;much less toxicity on the kidney compare to others in the platinum family; cause less peripheral neuropathy than oxaliplatin.
6.Avastin(bevacizumab)-a VEGF cell pathway inhibitor--- an angiogensis inhibitor to cut of blood supply to tumor cells.and cause cancer to die.
7.Erbitux(cetuximab)-an EGFR cell pathway inhibitor;blinds to the cancer cells surface receptor of EGFR and block their stimulation;therefore renders the cell pathway useless.
8.Leucovorin(it is not a chemo drug but used to enhance 5 FU effect)
9.FUDR(Floxurdine)-it is an analog of 5FU,belongs to the Antimetabolite family. Administered via the hepatic artery(pump);hepatic toxicity is high.
10.Epirubicin--- a chemo agent belongs to the Anthracyclines family which is less used nowadays.
11.Adriamycin---a chemo agent belongs to the Anthracycline family;interrupt the DNA and RNA synthesis in cancer cells and cause cell death;used in chemoembo in CCA;major BOX warning by FDA is myocardial toxicity ;also neutropenia and leukopenia(75%)
12.Irinotecan(Camptosar)-inhibits DNA synthesis in tumor cells by inhibiting an enzyme called topoisomerase1 ; useful but tough to take.
13.Docetaxel-chemo agent belongs to the Taxane family,interrupt the mitosis of the cancers cells cycle to reproduce and cause tumor death.
14.Mitomycin- a chemo agent belongs to the Alkylating family; inhibit DNA and RNA synthesis and thus cause cancer cell death ;use in chemoembo for CCA and can be combined with 5FU for treating CCA too.
15.Panitumumab(similar to cetuximab ;but difference from them is that this is the first 100% HUMAN monoclonal antibody direct against EGFR cell pathway; therefore you may expect less allergic reaction from Panitumumab.
16.paclitaxel-(Taxol) a chemo agent in the Taxane family that primary inhibits the cell cycle during mitosis;thus the tumor cell cannot duplicated and die;Taxol should be given before cisplatin if both drugs are used at the same time for maximum benefit of the combo.;also inhibits angiogenesis but is very tough to take.
Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.