First-Line Treatment of Advanced or Metastatic Gallbladder Carcinoma in Patients with ECOG Performance Status 0–1
In patients with advanced or metastatic gallbladder carcinoma who have preserved functional status (ECOG 0–1), systemic combination therapy is the established standard of care. Combination chemotherapy is associated with improved overall survival compared with best supportive care alone.
Clinical Scenario
This protocol is indicated for patients with advanced or metastatic gallbladder carcinoma and an ECOG performance status of 0–1. Adequate functional reserve in this population supports eligibility for first-line combination systemic therapy.
Treatment Approach
First-line treatment is built around a platinum-based chemotherapy doublet; depending on individual patient factors, an immunotherapy component may also be incorporated into the regimen. The complete protocol — including all agents, selection criteria, and decision algorithm — is available in full below.
Monitoring Goals
Treatment efficacy is assessed every 8–12 weeks by CT or MRI. Where relevant tumour markers are secreted, CA 19-9 or CEA levels may supplement imaging to monitor disease course.
References
DOI: 10.1016/j.annonc.2022.10.506
- Cisplatin–gemcitabine is recommended as SoC in the first-line setting for patients with a PS of 0-1.
- ChT is the current SoC for first-line treatment of advanced BTC; OS is improved when compared with best supportive care alone and the cisplatin–gemcitabine doublet demonstrated an OS benefit over gemcitabine mono-therapy in the UK ABC-02 study and the Japanese BT22 study.
- The combination of cisplatin–gemcitabine with durvalumab should be considered in first-line BTC.
- Oxaliplatin may be substituted for cisplatin when renal function is of concern.
- During systemic and locoregional therapy for advanced disease, follow-up should be conducted at a frequency of 8-12 weeks to allow best assessment of treatment efficacy, or as required for disease-related complications.
- In addition to imaging by CT or MRI, CA 19-9 or carcinoembryonic antigen (CEA) levels may be used to monitor the course of the disease if one or both are known to be secreted.
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