Chemotherapy in patients with hepatobiliary cancers and abnormal hepatic function

Hepatocellular carcinoma (HCC) and biliary tract cancer are among the leading causes of cancer death in the United States with an estimated 39,230 new cases and 27,170 deaths in both men and women in 2016 (1). The combination of cisplatin + gemcitabine represents the standard first-line therapy in advanced biliary cancer (ABC) based on survival advantages conferred over gemcitabine alone in the phase III ABC-02 trial (2). In the event cisplatin is contraindicated, i.e., renal dysfunction, alternative first-line regimens exist. Gemcitabine + capecitabine has demonstrated activity in phase II trials in ABC (3,4). Several phase II trials have similarly shown responses to gemcitabine + 5-fluorouracil (5-FU) + leucovorin (LV)] in unresectable or metastatic biliary cancer (5-7). Another option includes gemcitabine + oxaliplatin, which has been investigated in phase II trials, though this combination is often associated with increased myelosuppression and neurotoxicity compared to cisplatin + gemcitabine (8-10). For those who have progressed through first-line chemotherapy, best supportive care (BSC) remains an acceptable standard in ABC though second-line chemotherapy may offer some benefits (11). Capecitabine monotherapy, 5-FU/LV + oxaliplatin (FOLFOX), 5-FU/LV + irinotecan (FOLFIRI) represent options with activity in the second-line treatment of ABC (12-15)