The role of chemotherapy in the treatment of bile duct cancer

Abstract Cancer of the bile ducts continues to account for about 4,000 deaths yearly in the United States. Resection is often not possible, and overall survival is poor. In view of this, chemotherapy has been employed over the years in the hope of achieving enhanced response rates with increased survival. Despite the limitation of the approach, it does have a role as is indicated by a review of the literature. Systemic chemotherapy, employing such drugs as 5‐fluorouracil (5‐FU) and mitomycin C as single agents and the combination of 5‐FU with adriamycin and mitomycin C (FAM), resulted in a collective response rate of 29% (28 of 97 patients) . Regional infusion chemotherapy may have a special role as a more effective treatment for this disease, which is locally confined for long periods with dissemination only in the later stages. The blood supply to the bile ducts allows a high concentration of such drugs as 5‐FU, floxuridine (FUDR), and mitomycin C to be given over prolonged periods with enhanced response rates. A recent report of biliary sclerosis as a toxic effect from regional infusion by implantable pumps further corroborates the selective action of this treatment. The series from the literature show a collective response rate of 39% (15 of 38 patients) for regional infusion chemotherapy. This article should provide stimulation for further investigation of this method of treatment for bile duct cancer .