From the Guidelines
For gallbladder cancer that has spread beyond the serosa to the peritoneum, systemic chemotherapy is the most accepted treatment option, with the standard first-line regimen typically consisting of gemcitabine combined with cisplatin. This approach is based on the study by 1, which demonstrated a clear survival advantage for the combination of gemcitabine and cisplatin in patients with advanced or metastatic biliary tract cancer. The recommended dosing for gemcitabine is 1000-1250 mg/m² on days 1 and 8, while cisplatin is administered at 25-30 mg/m² on days 1 and 8 of a 21-day cycle.
Some key points to consider when treating gallbladder cancer with peritoneal spread include:
- The disease is considered metastatic and not amenable to curative surgical resection, making chemotherapy the primary treatment option.
- Alternative regimens may include gemcitabine with oxaliplatin, which has shown antitumor activity and good tolerability in phase II trials, as mentioned in the study by 1.
- Treatment typically continues for 4-6 months or until disease progression or intolerable toxicity occurs.
- Patients should also receive comprehensive supportive care, including pain management, nutritional support, and treatment of biliary obstruction if present.
It's worth noting that the study by 1 also mentions that liver transplantation may be an option under strict research protocols at selected centers, but this approach is experimental and should not be offered outside the scope of clinical trials. Additionally, photodynamic therapy may be considered in certain cases, but its effect may be limited in patients with a large visible mass on radiographic studies.
Overall, the goal of treatment for gallbladder cancer with peritoneal spread is to control disease progression, alleviate symptoms, and potentially extend survival, with a focus on improving quality of life for the patient.
From the Research
Treatment Options for Gallbladder Cancer
The most accepted treatment option for gallbladder cancer with spread beyond the serosa to the peritoneum is not limited to surgical interventions such as cholecystectomy or resection of segment 4 quadrant.
- For advanced stages, especially when the cancer has spread beyond the serosa to the peritoneum, chemotherapy regimens are considered a primary approach.
- Studies have shown that combination chemotherapy, particularly gemcitabine and cisplatin 2, 3, 4, 5, is effective in treating advanced gallbladder cancer.
- The addition of other drugs like durvalumab 2 or nab-paclitaxel 4 to gemcitabine and cisplatin has also shown promise in achieving favorable responses in patients with advanced gallbladder cancer.
- Maintenance therapy after first-line treatment has been explored as a means to improve disease control rate, with options including capecitabine or S-1 4.
- Prognostic factors such as metastasis to the liver, neutrophil-to-lymphocyte ratio, CEA, and CA19-9 levels have been identified as significant in determining overall survival in patients with unresectable gallbladder cancer treated with gemcitabine plus cisplatin 5.
- The role of radiotherapy in the treatment of gallbladder cancer, especially when combined with systemic therapies, is an area of ongoing research, with its effectiveness in adequately surgically treated patients still to be demonstrated 6.
Chemotherapy Regimens
Chemotherapy regimens, specifically gemcitabine and cisplatin, are considered the standard of care for advanced-stage gallbladder cancer 3, 5.
- These regimens have shown a high disease control rate in patients with unresectable gallbladder cancer 5.
- The efficacy of these treatments, along with the potential for targeted therapies and the role of maintenance therapy, underscores the complexity of managing gallbladder cancer that has spread beyond the serosa to the peritoneum.