Postoperative adjuvant chemotherapy for resectable cholangiocarcinoma

Hi Snecl,

Gavin does a great job in keeping us up to date on published research.  I was curious about your reaction to this particular study.  There has been a lot of debate about the effectiveness of adjuvant treatment.  There have not been a lot of major studies so far, and results from smaller scale studies that look promising, may not have as much statistical strength.  The UK research mentioned in the abstract is for a study called BILCAP.  This study had positive results in terms of longer survival, and has influenced current day treatment decisions more so than the other studies.  I will post a citation below that discusses BILCAP and how it has become standard of care.

A decision on whether to pursue adjuvant treatment is one that patients discuss thoroughly with their doctors, as each patient’s situation is unique and patients have different views on treatment.  Because there remains some debate in the medical community about adjuvant treatment, our doctors sometimes leave it to patients to decide.  When you are recovering from surgery, it can be daunting to think about adjuvant treatment.  My observation from the many experiences we see on this board, however, is some patients come to regret not having the additional treatment.  In my own case, I wasn’t asked if I wanted adjuvant treatment.  Rather I was told I needed it because I had multiple high risk features.  I had both chemo and radiation, and thankfully am still NED (no evidence of disease) now six years after surgery.

To be effective, adjuvant treatment needs to start around the time the patient has recovered sufficiently from surgery.  The theory behind it is that some cancer cells may have been left behind and the adjuvant treatment mops them up.  Also, having surgery is a shock to your system which might activate any remaining cancer cells and/or reduce your body’s ability to fight against them in the months right after surgery.  If this is a decision you are considering, please check with your doctor what the optimal timing would be to start adjuvant treatment.

Here is some info regarding BILCAP (adjuvant capecitabine). https://dailynews.ascopubs.org/do/10.5555/ADN.19.190212/full/

Regards, Mary