Can combination metronomic therapy overcome chemoresistance in cholangiocarcinoma? A literature review

Abstract

Cholangiocarcinoma (CCa) is relatively resistant to chemotherapy as well as radiation therapy, and complete resection is the main curative therapy for these patients. The prognosis for patients with unresectable intrahepatic CCa (iCCa) is extremely poor. A 55-year-old woman presented at our hospital with abdominal pain. After evaluation, she was diagnosed to have multifocal iCCa. She did not opt for standard chemotherapy and therefore received oral metronomic therapy with a combination of celecoxib, etoposide, and cyclophosphamide for a total of 30 months. Presently, she is 57 months post diagnosis and 27 months post cessation of all treatment and continues to be in complete radiological remission. In the present report, we review the literature and discuss whether metronomic scheduling of biologic agents and anticancer drugs will be able to overcome chemoresistance and improve the outcome in cholangiocarcinoma. References for the review were identified through searches of Pubmed for the last 10 years as well as searches of the files of the authors themselves. The final list was generated on the basis of originality and relevance to this review.

Metronomics in low and middle income countries: India showing the way!

“…Banavali et al, [25] from the Tata Memorial Hospital outreach center reported an interesting case of cholangiocarcinoma who underwent first line palliative care with a metronomics combination of celecoxib, cyclophosphamide and etoposide. This treatment led to a progressive response and ultimately a complete remission after 1 year of treatment.…”