Where does chemotherapy stands in the treatment of ampullary carcinoma? A review of literature

Abstract

Ampullary carcinoma (AC) is a rare gastrointestinal tumor without clear treatment recommendations. The management of this tumor is usually extrapolated from the treatment of pancreatic, biliary duct and intestinal cancers. Few papers have studied the AC as an independent entity and yet succombs to several limitations. These studies were retrospective single institutional experiences with limited sample sizes recruited over a long period of time. Unlike metastatic ACs where chemotherapy is the only recommended option, localized AC once excised may be approached by either chemotherapy alone or concomitant chemoradiation therapy. In this review, we report the overall survival and recurrence factors of more than 1000 patients from all the studies treating exclusively ACs. We also review the medical treatment of this tumor and conclude to the necessity of multi-institutional randomized controlled studies for AC exclusively.

Frequency and clinicopathologic associations of DNA mismatch repair protein deficiency in ampullary carcinoma: Routine testing is indicated

“…Currently, treatment guidelines for advanced disease in patients with ampullary cancer have not been fully defined, and most treatment protocols are extrapolated from those established for pancreatobiliary and intestinal cancers. 57 Recently, the introduction of checkpoint immunotherapies has revolutionized the oncologic targeted therapy paradigm in various organs. 58 There is robust literature regarding PD-L1 signaling as a major immune checkpoint target for immunotherapy in MMRdeficient colorectal cancer, 5,59 as deficiencies in MMR lead to hypermutated tumors/high tumor mutation burden, which is strongly correlated with clinical response to treatments with anti-PD-L1 therapies.…”

Ampullary cancer: Evaluation of somatic and germline genetic alterations and association with clinical outcomes

“…Compared with patients with pancreatic and biliary cancers, patients with AC generally have a higher surgical resectability rate and a more favorable prognosis. Current adjuvant therapy and the treatment of advanced disease for patients with AC have not been fully defined, and most treatment protocols are extrapolated from established treatment protocols for pancreatic, biliary, and intestinal cancers . These points underpin the need for better characterization of this disease through genomic evaluations to further explore therapeutic targets and facilitate improvements in outcomes.…”

Surgical Treatment of Ampullary Adenocarcinoma – Single Center Experience and a Review of Literature

“…This seems to be a significant prog nostic factor [31,32]. Chang et al [32] in his cohort showed prognostic di versity in these subtypes.…”

“…Due to the rarity of the dis ease, there are no estimated clear guidelines for adjuvant treatment of the adenocarcinoma of the ampulla of Vater by oncologic committees [31]. Moreover, approaches are different in the US and in Europe.…”

“…Adjuvant oncologic ther apy should be considered if risk factors occur (positive lymph nodes, positive resection margins, unfavorable grading, perineural, angio or lymphovascular invasion) [3,12]. With regard to TNM staging, tumor grade, angio or lymphagio invasion, resection margins, performance status and experiences of the oncologic center, adjuvant chemother apy or chemoradiother apy must be always considered [31]. Nevertheless, it is necessary to approach each patient individually, tak ing into account his over all health condition, polymorbidity and patient's choice.…”