Chemotherapy for bile duct cancer

Chemotherapy uses anti cancer drugs to destroy cancer cells. These drugs are also called cytotoxic drugs Open a glossary item. They circulate throughout the body in the bloodstream.

Chemotherapy is a common treatment for people with bile duct cancer. 

When you have chemotherapy

You might have chemotherapy:

  • after surgery to remove bile duct cancer
  • to control the cancer if it can't be removed, or if it has come back after surgery 

Chemotherapy after surgery

Your doctor might suggest you have chemotherapy after surgery to remove bile duct cancer. This is to lower the chance of it coming back.

Chemotherapy to shrink the cancer

Your doctor might recommend you have chemotherapy if you can’t have surgery to remove bile duct cancer. Or if the cancer comes back after having it removed.

Unfortunately, chemotherapy won’t cure bile duct cancer. You usually have it to control the cancer or slow down its growth. This can help to relieve pain and other symptoms. 

Your doctor will talk to you about the benefits of chemotherapy and the possible side effects. It is a good opportunity to ask them any questions you might have. 

Types of chemotherapy

You may have one chemotherapy drug or a combination of them. This depends on if you are having it after surgery or to control the cancer. The most common chemotherapy drugs for bile duct cancer are:

  • capecitabine
  • gemcitabine and cisplatin
  • a combination called FOLFOX

Capecitabine

Your doctor normally recommends you have capecitabine after surgery to remove bile duct cancer. You usually have it for 6 months.

Gemcitabine and cisplatin

This is a chemotherapy combination. You have if the cancer has spread to an area near the bile ducts (locally advanced bile duct cancer) or if the cancer has spread elsewhere in your body. This is called advanced bile duct cancer. You usually have gemcitabine and cisplatin with an immunotherapy drug called durvalumab.

Gemcitabine and cisplatin is a first line treatment for bile duct cancer. This means it is the first treatment you have after being diagnosed. Or the first treatment you have if the cancer comes back.

If your general health is poor you may have gemcitabine on its own. Or you may have the chemotherapy drug oxaliplatin instead of cisplatin if your kidneys don't work very well.

FOLFOX

This is a combination of the chemotherapy drugs:

  • folinic acid
  • fluorouracil (5FU)
  • oxaliplatin

FOLFOX is a second line treatment for bile duct cancer. This means it is a treatment you have if the first line treatment doesn’t work or the cancer stops responding to it. 

You usually have FOLFOX if the cancer doesn't have certain gene Open a glossary item changes (mutations). If it does, you might have an immunotherapy or targeted cancer drug as your second line treatment.

Research into chemotherapy for bile duct cancer

Your doctor may ask you to take part in a clinical trial looking at chemotherapy for bile duct cancer. Or looking at other treatments combined with chemotherapy. Trials are an important way to find out which treatments work best.

Before you start chemotherapy

Before your first chemotherapy, your doctor will explain what drugs you need, how you have them, and what the side effects are. You’ll sign a consent form. This is a good time to ask any questions you might have.

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. 

Your doctors and pharmacists work out your chemotherapy dose based on your:

  • blood cell levels
  • weight and height
  • general health

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called dihydropyrimidine dehydrogenase (DPD) in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Before starting treatment with capecitabine or fluorouracil you have a blood test to check levels of DPD. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor or nurse will talk to you about this.

Before each cycle of treatment

You usually have cancer drug treatment in cycles. A cycle means that you have a single cancer drug or a combination of drugs and then have a rest. This gives your body time to recover. 

You have blood tests before each cycle of treatment. This is to check your blood cells have recovered from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test. 

How you have chemotherapy

You have most chemotherapy drugs for bile duct cancer into your bloodstream (intravenously). Capecitabine is a tablet.

Into your bloodstream

You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment. This means your doctor or nurse won't have to put in a cannula every time you have treatment.

Taking tablets

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • increased risk of getting an infection
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

When you go home

Chemotherapy for bile duct cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

  • Biliary tract cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow up
    A Vogel and others
    Annals of Oncology, 2023. Volume 34, Issue 2, Pages 127–140

  • British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma
    SM Rushbrook and others
    Gut, 2024. Volume 73, Pages 16-46

  • National Institute for Health and Care Excellence (NICE)
    Various guidance
    Last accessed October 2024

  • Scottish Medicines Consortium
    Various guidance
    Last accessed October 2024

  • Electronic Medicines Compendium (eMC)
    Last accessed October 2024

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
09 Oct 2024
Next review due: 
09 Oct 2027

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