Topic: Compare 5FU-Based and Gemcitabine-based Chemo w/wo Cisplatin
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Current available literature from uptodate.com indicated:
1. 5FU alone and older 5FU- based combination therapies- the objective response rates(OR ) is between 0-34%. Higher responses rate(OR=32%) are reported when using either infusional 5FU or 5FU with leucovorin(ie:using continuous infusion pump for 48 hrs);For unclear reasons,capecitabine as a single agent is LESS effective against CCA than for gallbladder(GB) cancer;(thus ,in my opinion and not from any other sources, Xeloda is more effective in extrahepatic CCA than intrahepatic CCA due to the physiological location of the extrahepatic bile ducts are closer to the GB than the intrahepatic bile ducts that originated from the inside of the liver for the intrahepatic CCA..
2.Gemcitabine ALONE-The Objective responses rate is around 7-27%; for Gemzar+cisplatin combination ,a pooled analysis of 104 trails of a variety of chemotherapy regimens in advanced biliary cancer (dose not included the famous ABC trial which total pt. pop=410,CCA pt=242;gallbladder=148;ampullary=20 that means this famous ABC02 trials is not exclusively for CCA either) concluded that the GEM/CIS regimen offered the highest rates of objective response and tumor control compared to either gemcitabine-free or cisplatin-free regimens.,however,this did not translate into significant benefit in terms of either time to progression(ie:the time from the last scan that shows no tumor growth or stable to the time the new scan shows tumor is growing or new lesion is discovered) ; median overall survival (ie; is the middle number in months of all the patients who survived.eg. if have 100 patient in a study,and the MEDIAN overall survival is 20 months;that means 50 patients will survive less than 20 months and the other 50 patients will be live longer than 20 months); therefore the Gem/Cis regimen in their view(the uptodate literature review panel) should be considered a standard option,but NOT the definitive REFERENCE standard for treatment of advanced CCA.