Oncologie

, Volume 12, Issue 10, pp 623–628 | Cite as

Chimiothérapie systémique des cancers avancés des voies biliaires: actualités et perspectives

Synthèse / Review Article
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Résumé

Les cancers biliaires, avec moins de 2 000 nouveaux cas par an en France, doivent être considérés comme des tumeurs orphelines. Il n’existe actuellement aucune preuve de l’intérêt d’une chimiothérapie et/ou d’une radiothérapie néoadjuvante ou adjuvante en cas de cancer biliaire résécable. Dans les formes non résécables, le traitement symptomatique est essentiel, notamment un drainage biliaire efficace. La combinaison gemcitabine-cisplatine (GEMCIS) constitue le premier standard de chimiothérapie palliative de première ligne chez les patients avec cancer biliaire avancé à l’état général encore conservé. Malgré l’absence d’essai contrôlé randomisé comparant les schémas GEMCIS et gemcitabine-oxaliplatine (GEMOX), ce dernier représente une option thérapeutique intéressante. Aucune donnée ne permet de définir actuellement de standard au-delà de la première ligne. Les prochaines avancées thérapeutiques viendront vraisemblablement des associations d’agents ciblés à la chimiothérapie cytotoxique, en sélectionnant des patients sur les altérations oncogéniques tumorales d’intérêt.

Mots clés

Cancers biliaires Chimiothérapie Agents ciblés 

Systemic chemotherapy for advanced biliary tract cancers: present and future

Abstract

Biliary tract cancers, with fewer than 2,000 new cases per year in France, must be regarded as orphan tumors. There is currently no evidence of the benefit of neoadjuvant or adjuvant chemotherapy and/or radiotherapy in resectable biliary tract cancers. In unresectable disease, best supportive care is the mainstay of treatment, especially effective biliary drainage. Gemcitabinecisplatin combination (GEMCIS regimen) is the first standard for first-line palliative chemotherapy in patients with advanced biliary tract cancer and correct performance status. Despite the absence of randomized controlled trials comparing GEMCIS and gemcitabine-oxaliplatin (GEMOX) regimens, the latter represents an interesting option. Currently, no data allow to define a standard for second-line and further therapies. Future therapeutic advances will likely come from the combination of targeted agents with chemotherapy, with selection of patients on tumor oncogenic alterations of interest.

Keywords

Biliary tract cancer Chemotherapy Targeted therapy 

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Copyright information

© Springer Verlag France 2010

Authors and Affiliations

  1. 1.Unité de gastroentérologie, département de médecine oncologique, institut Gustave-Roussyuniversité Paris-XIVillejuif cedexVillejuif, France

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