title: Second-line therapy in advanced biliary tract cancer: what should be the standard?
abstract: Biliary tract cancer is a rare malignant tumor. Accordingly, to perform prospective and randomized trials is difficult and the knowledge of its natural history and optimal management remains limited. Chemotherapy is commonly used to improve the outcome and to delay tumor progression in advanced disease. Only recently, cisplatin-gemcitabine combination was identified as the new standard first-line therapy. Despite the outcome improvement, disease progression is a constant and approximately half of patients failing upfront treatment maintain a good performance status and are willing to undergo further treatment. No standard salvage chemotherapy regimen has been identified yet. Experiences of salvage therapy in advanced biliary tract cancer are sparse and yielded disappointing results. Well designed multi-institutional randomized trials are warranted to clarify the role and the activity of a second-line therapy.
authors.affiliation: Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy. Electronic address: cereda.stefano@hsr.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cereda
authors.forename: Carmen
authors.initials: C
authors.lastname: Belli
authors.forename: Alessia
authors.initials: A
authors.lastname: Rognone
authors.forename: Elena
authors.initials: E
authors.lastname: Mazza
authors.forename: Michele
authors.initials: M
authors.lastname: Reni
mesh_terms: D001661:Biliary Tract Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D009367:Neoplasm Staging; D011379:Prognosis; D016879:Salvage Therapy; D059039:Standard of Care
keywords: Biliary tract cancer; Chemotherapy; Progressive disease; Salvage therapy; Second-line therapy