Hepatobiliary

Chemoembolization – pro

Lay Summary: TACE is often used for hepatocellular carcinoma and neuroendocrine cancers of the liver.   This technique takes advantage of the fact that HCC is a very vascular (contains many blood vessels) tumor and gets its blood supply exclusively from the branches of the hepatic artery. This procedure is similar to intra-arterial infusion of chemotherapy. But in TACE, there is the additional step of blocking (embolizing) the small blood vessels

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Gemcitabine Taxotere and Xeloda (GTX) for pancreatic cancer – pro

GTX is a promising regimen for pancreatic cancer but still not adequately supported. Current treatment options for pancreatic cancer include surgery, radiation, and chemotherapy. Although single-agent chemotherapy with gemcitabine has been a standard treatment for pancreatic cancer, research has increasingly focused on the development of combination regimens. Recently, the U.S. Food and Drug Administration approved the combination of the targeted

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PTK787 for pancreat cancer – pro

PTK 787 is a selective inhibitor of all three types of the VEGF receptors. It has been shown to reduce the number of tumor microvessels with resultant dilation of the remaining vessels. It has also been shown to inhibit VEGF receptors and has been effective in animal tumor models. In addition, dynamic contrast-enhanced MRI (DCE-MRI) and PET imaging have shown a reduction in blood flow to tumors after the administration of PTK 787. A phase 1 study

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Radiofrequency ablation for the liver – pro

A R Gillams Liver ablation therapy Br. J. Radiol., September 1, 2004; 77(921): 713 - 723. P. Liang, B. Dong, X. Yu, Y. Yang, D. Yu, L. Su, Q. Xiao, and L. Sheng Prognostic Factors for Percutaneous Microwave Coagulation Therapy of Hepatic Metastases Am. J. Roentgenol., November 1, 2003; 181(5): 1319 - 1325. http://www.nice.org.uk/nicemedia/pdf/ip/IPG092guidance.pdf NCCN, 2013: Hepatocellular adn Neuroendocrine cancer

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Xeloda for hepatocellular cancer – pro

Metastatic hepatocellular carcinoma (HCC) is a difficult problem to treat. Nexavar has recently been FDA approved for HCC. Among other options are older drugs, such as capecitabine (Xeloda).  A pilot study showed that capecitabine (1000 mg/m2 twice daily for 14 days every 21 days) achieved a response rate of 19% in patients with advanced biliary cancer . A larger review showed that at 2,000 mg/m2/d, capecitabine produced a 50% response rate and

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Cryosurgical ablation of hepatocullular carcinoma – pro

Cryosurgical ablation, or cryosurgery, involves freezing of target tissues, usually by inserting a probe into the tumor through which coolant is circulated. Cryosurgery may be performed as an open surgical technique or as a closed procedure under laparoscopic or ultrasound guidance. National Comprehensive Cancer Network (NCCN, 2007) hepatocellular carcinoma guidelines state that microwave ablation, cryotherapy, radiofrequency ablation, and percutaneous

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Tarceva for biliary cancer – pro

Erlotinib has shown activity individually, as single drugs, or in combination with chemotherapy in upper gastro-intestinal cancers, including esophageal and gastro-esophageal adenocarcinomas, gastric cancer and pancreatic cancer. Overexpression of EGFR has been reported to be observed in 10.7%, 5.1%, 12.4% and 0% of cases of intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, gallbladder cancer and ampulla of Vater cancer, respectively

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Adjuvant chemotherapy after Whipple’s for cholangiocarcinoma – pro

The role of adjuvant chemothhapy after complete resection of cholangiocarcinoma is changing. The cancer have a high incidence of local failure after surgical resection reaching 52%, a locoregional adjuvant treatment may be considered. Several retrospective reports on adjuvant and recently also on neoadjuvant (chemo)radiotherapy suggest survival benefit in both gallbladder and biliary duct cancer and postoperative chemoirradiation may be considered

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Hepatoblastoma – pro

Hepatoblastoma is a rare pediatric cancer that can be cured by surgery. Preoperative chemotherapy followed by complete surgical excision according to International Society of Paediatric Oncology guidelines yields excellent results with a current survival rate of 80%.Liver transplantation is a curative option as well.Various chemotherapy regimens have been reported but there are no prospective studies and no studies of second line chemotherapy. Czauderna

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Intrahepatic therapies ablative therapies – pro

Percutaneous ablation is a commonly used modality of treatment when resection is not possible for HCC. Other local modalities are radiofrequency ablation or chemo embolization. When direst intratumor injection is used, alcohol is most commonly used and it is FDA approved for this purpose. However, acetic acid is more potent in animal models. Only a few studies tested the various modlaities against one another. A systematic review of RCTs published

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