Abraxane for cholangiocarcinoma – pro
Chemotherapy has a role in metastatic disease in biliary cancers. In advanced disease, one randomised study of combination chemotherapy versus best supportive care reported a significantly improved survival (four months of benefit) and quality of life to the chemotherapy arm. (The study also included pancreatic cancers with a positive result although the analysis was separate.) Conclusions from predominately phase II studies suggest that cholangiocarcinomas are relatively chemosensitive, with most studies being 5-fluorouracil (5-FU) based, and 1020% partial response rates to (older) single agents, partial response rates to newer single agents, such as gemcitabine, vary from 20% to 30% and partial response rates to recent phase II combinations vary from 20 to 40%.
Abraxane appears to have some activity in combination with gemcitabine and there is some evidence to support its use in the earlier line, but only a retrospctive study to support its sue as a single agent (Unseld et al).
Unseld M, Scheithauer W, Weigl R, et al. Nab-paclitaxel as alternative treatment regimen in advanced cholangiocellular carcinoma. J Gastrointest Oncol. 2016;7(4):588-94.
Sahai V, Catalano PJ, Zalupski MM, et al. Nab-Paclitaxel and Gemcitabine as First-line Treatment of Advanced or Metastatic Cholangiocarcinoma: A Phase 2 Clinical Trial. JAMA Oncol 2018.
NCCN, Cholangiocarcinoma 2018