The Implications of Treatment Delays in Adjuvant Therapy for Resected Cholangioc

Hi Gavin,

This is a really interesting research study.  How fast adjuvant treatment can start after surgery often reflects how quickly the patient recovers from surgery.  We have heard from several patients posting here over the years about delays due to their own hesitancies about chemotherapy.  Now that many patients are offered adjuvant capecitabine in pill form which is easier than coming in for chemo infusions, options for adjuvant chemo are easier.

The reasons given in the literature for not delaying adjuvant treatment mainly relate to a need to quickly “mop up” any stray cancer cells that were not removed by surgery.  Resection or Whipple surgeries are big ones, and your immune system may not be fully up to speed in the weeks after surgery to battle these stray cells.  The trauma to your body involved in having surgery (this is GOOD trauma, it is getting the tumor out) could also serve to activate any remaining cancer cells.  Hence surgery followed by adjuvant treatment, if recommended by your doctor, is viewed as a “one-two punch” in treating cholangiocarcinoma.

Since I mentioned capecitabine, a reminder about the rare enzyme deficiency called DPD deficiency is important.  DPD deficiency, if you have it, means that capecitabine may be more toxic for you and less safely tolerated.  If your oncologist is offering capecitabine (xeloda), please tell him or her if you know you have a DPD deficiency.  You may want to ask whether you are a candidate for DPD deficiency testing well before starting adjuvant treatment because the test results may take a week or more.  If you start taking capecitabine and experience side effects that are more severe than what your oncologist said to expect, this must be immediately reported to your medical team.

Take care, regards, Mary