Biliary tract cancer accounts for <1% of all cancers and affects chiefly an elderly population, with predominance in men. We distinguish cholangiocarcinoma (intrahepatic, hilar and distal) and gallbladder cancer, with different pathogenesis and prognosis. The treatment is based on surgery (whenever possible), radiotherapy in selected cases, and chemotherapy. The standard cytotoxic treatment for advanced/metastatic disease is represented by the combination of gemcitabine and cisplatin, whereas fluoropyrimidines are generally administered in second line setting. At the present time, no biologic drug demonstrated a clear efficacy in this cancer, although the molecular characterisation could provide a promising basis for experimental treatments. A good supportive care and an early palliative care are warranted in most patients and should be delivered as a part of a global approach.

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Irinotecan and infusional 5-fluorouracil-based chemotherapy (FOLFIRI) plus bevacizumab (FOLFIRI-B) is one of the most effective treatments of advanced colorectal cancer (CRC). However, this schedule is regarded more extensively as first-line therapy and its efficacy has not been proven in phase III randomised trials in oxaliplatin-pretreated patients. We have performed a systematic review through PubMed and EMBASE, including all prospective and retrospective publications exploring the efficacy of FOLFIRI-B as second-line chemotherapy in advanced CRC patients pretreated with oxaliplatin and not with B. Pooled estimates of the response rates (RR), weighted medians of progression-free survival (PFS), and overall survival (OS) from all FOLFIRI-B-containing arms were calculated. A total of 11 studies (one randomised phase II trial, two phase II trials, two observational studies, two prospective non-randomised collections, and four retrospective case series) were retrieved giving a total of 435 patients. Overall, the pooled RR (n = 11 publications) was 26 %. Median PFS and OS (n = 11 and 10 publications, respectively) were 8.3 and 17.2 months. FOLFIRI-B is a reasonable and effective option for stage IV CRC pretreated with oxaliplatin and not exposed to B during first-line treatment. Its activity seems better than historical FOLFIRI-based second-line trials.

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