First-Line Treatment of Locally Advanced or Metastatic Ampullary Adenocarcinoma — pMMR, Intestinal Subtype
Ampullary adenocarcinoma presenting at a locally advanced or metastatic stage requires a systematic first-line approach. Tumour subtype and mismatch repair status directly influence regimen selection in this setting.
Clinical scenario
- Locally advanced or metastatic ampullary carcinoma
- Proficient mismatch repair (pMMR)
- Intestinal (INT) subtype
- ECOG performance status ≤ 2
Treatment approach
First-line treatment involves chemotherapy, with the specific regimen adapted to the patient's general condition and performance status. Several evidence-based options exist — the full structured regimen and selection criteria are in the protocol.
References
DOI: 10.1016/j.dld.2024.04.027
- For pMMR AC, first line chemotherapy may be adapted according to general condition, and INT / PB / MT subtype.
- CAPOX (grade C)
- The only available phase II trial studied first-line CAPOX regimen (capecitabine 750 mg/m²/12h D1-D14 and oxaliplatin 130 mg/m² on D1, D21=D1) in 25 metastatic patients (but only 12 were AC, the other patients being small intestine carcinoma).
- mFOLFOX6 (expert opinion)
- FOLFIRINOX without bolus (expert opinion)
- FOLFIRI (expert opinion) if contraindication for oxaliplatin
- 5FU (expert opinion) if contraindication for oxaliplatin
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