According to a randomized phase III study from Japan, adjuvant chemotherapy has little effect and is usually not recommended, unless it is administered in connection with a study.
Cholangiocarcinoma is relatively sensitive to chemotherapy (2, 3). A Nordic study has shown an increase in survival with 5FU compared to BSC (6.5 months versus 2.5 months) (4).
There are a series of phase II studies using newer chemotherapy drugs and combination regimens that have given response rates of 20–40%, and prolonged survival for 5–15 months (2, 3). However, there is no established international standard treatment. Downstaging with conversion to secondary surgery and long-term survival has occurred.
Patients with metastasis and good general health status with acceptable bilirubin values should be assessed for palliative chemotherapy. Appropriate regimens are cisplatin or oxaliplatin-based chemotherapy, combined with capecitabine or gemcitabine.