Treatment protocols for hepatobiliary cancer

INTRODUCTION — The following material represents a subset of chemotherapy and immunotherapy regimens that are used for the treatment of patients with biliary cancer and hepatocellular cancer (HCC). This is not an exhaustive list; it includes regimens that are considered by the authors and editors to be commonly used and important for the care of patients with hepatobiliary cancer. Additional regimens may be added over time, particularly as treatment for hepatobiliary cancer evolves.

This topic review is intended to provide only a listing of chemotherapy and immunotherapy regimens. It does not address the appropriate context for use of these regimens in the care of patients with hepatobiliary cancer. Clinicians should refer to the individual disease-oriented topic reviews that discuss the use of these protocols in appropriate clinical situations:

●(See "Systemic therapy for advanced cholangiocarcinoma".)

●(See "Treatment of advanced, unresectable gallbladder cancer".)

●(See "Ampullary carcinoma: Treatment and prognosis".)

●(See "Systemic treatment for advanced hepatocellular carcinoma".)

●(See "Prognosis and adjuvant treatment for localized, resected gallbladder cancer".)

●(See "Adjuvant and neoadjuvant therapy for localized cholangiocarcinoma".)

These tables are provided as examples of how to administer these regimens; there may be other acceptable methods. All chemotherapy and immunotherapy regimens must be administered by clinicians who are trained in the use of chemotherapy and immunotherapy. The clinician is expected to use his or her independent medical judgment in the context of individual circumstances to make adjustments, as necessary.

REGIMENS

Biliary or hepatocellular cancer (HCC)

Short-term infusional fluorouracil plus leucovorin for advanced gastrointestinal cancer (modified de Gramont schedule) —  (table 1)

Modified FOLFOX6 (fluorouracil plus leucovorin and oxaliplatin) —  (table 2)

Capecitabine and oxaliplatin for locally advanced or metastatic HCC or biliary cancer —  (table 3)

Bilary tract cancer

Single agent gemcitabine for adjuvant treatment of biliary tract cancer —  (table 4)

Gemcitabine and capecitabine (GEMCAP) followed by concurrent capecitabine and radiotherapy for adjuvant therapy of biliary tract cancer —  (table 5)

Single agent gemcitabine for metastatic biliary tract cancer —  (table 6)

Gemcitabine and cisplatin for locally advanced or metastatic biliary tract cancer —  (table 7)

Gemcitabine and oxaliplatin (GEMOX) for locally advanced or metastatic biliary tract cancer —  (table 8)

Modified gemcitabine and oxaliplatin (GEMOX) for advanced gallbladder cancer —  (table 9)

Gemcitabine and capecitabine (GEMCAP) for advanced biliary tract cancer —  (table 10)

Gemcitabine plus nanoparticle albumin-bound paclitaxel (nabpaclitaxel) for advanced pancreatic and biliary cancer —  (table 11)

FOLFIRI (fluorouracil plus leucovorin and irinotecan) plus bevacizumab —  (table 12)

Hepatocellular cancer (HCC)

Gemcitabine and pegylated liposomal doxorubicin for advanced HCC —  (table 13)

Gemcitabine and oxaliplatin (GEMOX) for advanced HCC —  (table 14)

Pembrolizumab monotherapy —  (table 15)

Nivolumab monotherapy —  (table 16)

Nivolumab plus ipilimumab for advanced HCC —  (table 17)

ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Scott M Wirth, PharmD, BCOP, who contributed to an earlier version of this topic review.