Biliary tract tumours, including bile duct, gallbladder, and ampulla of Vater malignancies, pose a rare but formidable oncologic challenge. Typically diagnosed at advanced stages, these tumours offer limited treatment options and dismal prognoses, with a five-year survival rate below 20%. First-line chemotherapy with gemcitabine-cisplatin has demonstrated only modest efficacy, leaving a pressing need for improved therapeutic strategies. This comprehensive review provides a detailed examination of the current landscape of second-line chemotherapy for biliary tract tumours. The pivotal ABC-06 trial established FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) as the standard second-line therapy, demonstrating improved overall survival compared to active symptom control alone. Conversely, the NIFTY trial introduced nal-IRI (nanoliposomal irinotecan) plus 5-FU/LV (5-fluorouracil and leucovorin) as an alternative option, demonstrating substantial gains in progression-free and overall survival. However, the posterior NALIRICC trial presented conflicting results, raising questions about the added benefit of nal-IRI. Challenges in delivering second-line chemotherapy include rapid patient performance deterioration post-first-line treatment and limited access to second-line therapy. Only a fraction of eligible patients receive second-line therapy, emphasising the need for more effective first-line therapies to maintain patient fitness. The role of monotherapy in the second-line setting remains uncertain, particularly in unfit patients, and the absence of biomarkers for tailored treatment underscores the need for ongoing research. While challenges persist, ongoing investigations offer hope for optimising second-line therapy for biliary tract tumours, promising improved outcomes for patients facing this disease. This review provides an overview of current facts and challenges when delivering second-line chemotherapy for advanced biliary tract tumours.
胆道肿瘤，包括胆管癌、胆囊癌和壶腹癌，虽属罕见但构成严峻的肿瘤学挑战。这类肿瘤通常在晚期确诊，治疗选择有限且预后不良，五年生存率低于20%。吉西他滨-顺铂一线化疗方案仅显示出有限疗效，因此亟需改进治疗策略。本综述系统梳理了当前胆道肿瘤二线化疗的研究现状。关键性ABC-06试验确立了FOLFOX方案（5-氟尿嘧啶、亚叶酸和奥沙利铂）作为标准二线疗法，证明其较单纯积极症状控制能改善总生存期。而NIFTY试验则提出纳米脂质体伊立替康联合5-氟尿嘧啶/亚叶酸作为替代方案，在无进展生存期和总生存期方面均显示出显著获益。然而后续的NALIRICC试验得出矛盾结果，使纳米脂质体伊立替康的附加获益受到质疑。实施二线化疗面临的主要挑战包括：患者在一线治疗后体能状态迅速恶化，以及二线治疗可及性有限。仅少数符合条件的患者能接受二线治疗，这凸显了开发更有效一线疗法以维持患者体能状态的必要性。单药治疗在二线治疗中的作用尚不明确，尤其对于体能状态不佳的患者，且缺乏指导个体化治疗的生物标志物，这些都需要持续研究。尽管挑战依然存在，但正在进行的临床研究为优化胆道肿瘤二线治疗带来希望，有望改善这类疾病患者的临床结局。本综述概述了晚期胆道肿瘤二线化疗的现状与挑战。
肿瘤(癌症)患者之家