Treatment Options for Gallbladder Cancer: Essential Information
Gallbladder cancer, a rare form of cancer that affects the gallbladder and bile ducts, can be a challenging disease to treat, especially in its advanced stages.
Treatment Options
In the fight against advanced gallbladder cancer (GBC), surgery, chemotherapy, and radiation therapy are common treatment options. Gallbladder removal, or cholecystectomy, can be an option in early stage gallbladder cancer. Radiation therapy uses high energy radiation to shrink and destroy cancer cells, while chemotherapy is a treatment that uses cancer-killing drugs to prevent cancer cells from multiplying and spreading.
However, the survival rate for advanced GBC is generally poor, with a median overall survival (mOS) typically below 13-16 months, despite chemotherapy and emerging immunotherapy options.
Factors Affecting Treatment and Survival
Several key factors play a significant role in the treatment plan and survival outcomes for advanced GBC.
Cancer Stage at Diagnosis
Early detection is crucial in the fight against advanced GBC. Doctors usually diagnose gallbladder cancers in their early stages, and treatment at these stages can lead to excellent 5-year survival rates of 80-90%. Localized but resectable cancer has a 5-year survival of 30-60%. Unfortunately, advanced (stage IV) GBC with distant spread has a poor prognosis and is typically treated palliatively.
Surgical Resectability
Complete radical resection with negative margins (R0 resection) is associated with better long-term survival. However, advanced cases often are unresectable, limiting curative options.
Treatment Modality
Standard chemotherapy yields median survival under a year. However, regimens like gemcitabine-cisplatin may improve survival, with median OS up to 71.5 months in some biliary tract cancer cohorts including GBC, although these improvements are mostly seen in earlier stages. Immunotherapy, especially immune checkpoint inhibitors like pembrolizumab, durvalumab, or tislelizumab combined with chemotherapy, shows promise. Tislelizumab has demonstrated progression-free survival of 7 months and overall survival of 16 months in one case report of stage IVB GBC.
Performance Status and Patient Fitness
Advanced patients with poor functional status often are excluded from trials or aggressive therapies, affecting outcomes.
Molecular Profiling
Targeted therapies, such as for HER2-amplified tumors, are emerging but currently survival remains below 13 months in advanced stages despite these advances.
Conclusion
In summary, the median survival for advanced GBC is typically less than 1 to 1.5 years despite treatment. However, novel chemoimmunotherapy combinations may slightly improve outcomes. The main treatment goal in advanced unresectable cases is palliation. Survival improves with early detection, radical surgery with negative margins, appropriate chemotherapy (such as gemcitabine-cisplatin), and potentially immunotherapy tailored to patient and tumor characteristics.
Proton therapy, a form of radiation therapy could potentially be a promising treatment for advanced gallbladder cancer (GBC), given its ability to target cancer cells more precisely than traditional radiation therapy. Science continues to advance in the field of medical-conditions like gallbladder cancer, and cancer-killing drugs (chemotherapy) are being combined with immunotherapy options to improve treatment outcomes. In the realm of health-and-wellness, regular check-ups and awareness about cancer symptoms can aid early detection of gallbladder cancer, enhancing chances of successful treatment.
