Neoadjuvant and Adjuvant Chemotherapy

Abstract

Even though the cornerstone of treatment for gallbladder cancer is curative surgical resection, more than two-thirds of the patients are diagnosed with the metastatic condition. Furthermore, prognosis after curative surgery is still poor with a 5-year survival rate less than 5%. Chemotherapy is the main therapeutic option for these situations. After the report of the Advanced Biliary Cancer-02 trial (ABC-02), Gemcitabine plus cisplatin was positioned as the standard treatment for palliative chemotherapy of biliary tract cancer including gallbladder cancer. In adjuvant and/or neoadjuvant setting, the clinical benefit of chemotherapy has some debate. Most of the studies were performed with all heterogeneous malignancies arising from bile duct system. So, the clinical benefit of adjuvant and/or neoadjuvant chemotherapy for gallbladder cancer could be addressed by subgroup analysis. For the adjuvant chemotherapy, there are two studies supporting the theoretical advantages of adjuvant therapy. Oral capecitabine or 5-FU plus mitomycin showed clinical benefit in terms of overall survival and disease-free survival. In the neoadjuvant setting, there were only small-sized retrospective data. So, it is hard to address concrete evidence supporting the role of neoadjuvant chemotherapy for gallbladder cancer. But, most of the studies for neoadjuvant chemotherapy were performed for the patients of locoregionally advanced gallbladder cancer. We need to wait for more confirmative data with prospective studies.