Adjuvant Therapy for Resected Biliary Tract Cancer

Published online March 11, 2019, DOI:10.1200/JCO.18.02178

Rachna T. Shroff, Erin B. Kennedy, Melinda Bachini, Tanios Bekaii-Saab, Christopher Crane, Julien Edeline, Anthony El-Khoueiry, Mary Feng, Matthew H.G. Katz, John Primrose, Heloisa P. Soares, Juan Valle, and Shishir K. Maithel

Purpose

To develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with resected biliary tract cancer.

Methods

ASCO convened an Expert Panel to conduct a systematic review of the literature on adjuvant therapy for resected biliary tract cancer and provide recommended care options for this patient population.

Results

Three phase III randomized controlled trials, one phase II trial, and 16 retrospective studies met the inclusion criteria.

Recommendations

Based on evidence from a phase III randomized controlled trial, patients with resected biliary tract cancer should be offered adjuvant capecitabine chemotherapy for a duration of 6 months. The dosing used in this trial is described in the qualifying statements, while it should be noted that the dose of capecitabine may also be determined by institutional and regional practices. Patients with extrahepatic cholangiocarcinoma or gallbladder cancer and a microscopically positive surgical resection margin (R1 resection) may be offered chemoradiation therapy. A shared decision-making approach is recommended, considering the risk of harm and potential for benefit associated with radiation therapy for patients with extrahepatic cholangiocarcinoma or gallbladder cancer. 

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