Chemotherapy for Bile Duct Cancer (Cholangiocarcinoma)

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Memorial Sloan Kettering medical oncologist Ghassan Abou-Alfa.

Medical oncologist Ghassan Abou-Alfa and his clinical team work closely to ensure that chemotherapy and other treatments are well-coordinated. This provides patients with the highest level of care.

Chemotherapy is a drug or a combination of drugs that kills cancer cells wherever they are in the body. You may receive chemotherapy before surgery to shrink a bile duct tumor. This is called neoadjuvant therapy. If you receive chemotherapy after surgery to destroy and cancer cells that may remain, it is called adjuvant therapy.

The standard chemotherapy drugs for bile duct cancer are gemcitabine (Gemzar®) and cisplatin. Other drugs sometimes used include fluorouracil (also called 5-FU), oxaliplatin (Eloxatin®), and capecitabine (Xeloda®). We will carefully tailor your treatment to make sure that it’s as effective as possible while helping maintain your quality of life.

If you have bile duct cancer that has spread, you may receive chemotherapy as the main treatment if surgery is not an option. Research has suggested that the combination of gemcitabine and cisplatin can lengthen the lives of people with bile duct cancer that cannot be removed by surgery.

Chemotherapy is also occasionally given to relieve symptoms due to bile duct cancer, such as a tumor that is pressing on a nerve and causing pain.

Chemotherapy with Hepatic Arterial Infusion

MSK researchers are evaluating the potential of a new chemotherapy technique called hepatic arterial infusion (HAI) in the treatment of bile duct cancer. HAI involves delivering a high dose of chemotherapy drugs directly to the liver through a tiny pump implanted under the skin in the lower belly. The chemotherapy passes from the liver into the bile ducts. HAI therapy may be used to shrink tumors before surgery.

Targeted Therapies for Bile Duct Cancer

Targeted therapies block specific changes in cancer cells that help them grow and survive or disrupt their blood supply. MSK is currently investigating several targeted therapies for bile duct cancer.

Ivosidenib blocks an abnormal form of a protein called IDH1. Abnormal IDH1 causes too much of a substance called 2-HG to be produced. Scientists believe that too much 2-HG can fuel the growth of bile duct cancer.

Two other targeted therapies, pemigatinib (INCB054828) and infigratinib (BGJ398) help reduce the production of the abnormal form of a protein called FGFR2 in cancer cells. MSK is testing these targeted therapies in certain people with bile duct cancer whose tumors carry mutations in FGFR2 and several other specific genes.