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Adjuvant therapy for resected biliary tract cancer

Published ahead of print, a study in the Alimentary Pharmacology & Therapeutics compares major adjuvant therapies for biliary tract cancer in terms of patient survival rates after resection and toxic effects.

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Major adjuvant therapies for biliary tract cancer include fluorouracil, gemcitabine and chemoradiation, but the optimum regimen remains inconclusive.

Dr Zheng and colleagues from China compared these therapies in terms of patient survival rates after resection and toxic effects.

The research team searched PubMed for controlled trials comparing the above three therapies with each other or observation alone until 2014.

The team estimated the hazard ratios for death and odds ratios for toxic effects among different therapies.

Subgroup analyses based on positive lymph node or resection margin were also performed.
Chemoradiation did not provide a significant improvement in survival vs gemcitabine
Alimentary Pharmacology & Therapeutics

The research team included 12 eligible articles.

Gemcitabine improved 5-year survival, whereas fluorouracil and chemoradiation provided a poorer survival outcome compared with gemcitabine after 1 year.

Similarly, for 5-year survival rates, although differing, chemoradiation did not provide a significant improvement in survival compared with gemcitabine.

The team found that fluorouracil did not appear to provide benefit over gemcitabine.

The research team noted that chemoradiation was ranked highest for toxic effects including hematological and nonhematological.

Dr Zheng's team concludes, "Chemotherapy with gemcitabine is the optimum adjuvant treatment with a balanced benefit-toxicity ratio for resected biliary tract cancer."

"Chemoradiation was more likely to cause toxic effects."

Aliment Pharmacol Ther 2014: DOI: 10.1111/apt.12900
08 August 2014

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