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Chemotherapy (chemo) is treatment with cancer-killing drugs that are usually given into a vein (IV) or taken by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancers that have spread beyond where they started.

When is chemotherapy used for gallbladder cancer?

• After surgery: Chemo may be given after surgery (often along with radiation therapy) to try to lower the risk that the cancer will come back. This is called adjuvant treatment. Doctors aren’t yet sure how useful it is in treating gallbladder cancer.
• As part of the main treatment for some advanced cancers: Chemo might be used (with or without radiation therapy) for more advanced cancers that cannot be removed or have spread to other parts of the body. Chemo does not cure these cancers, but it might help people live longer.
• As palliative therapy: Chemo can help shrink tumors or slow their growth for a time. This can help relieve symptoms of gallbladder cancer. For instance, it can help by shrinking tumors that are pressing on nerves and causing pain.

Chemo is given in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemo cycles generally last about 3 to 4 weeks. Chemo usually isn't recommended for patients in poor health, but advanced age by itself isn't a barrier to getting chemotherapy.

Hepatic artery infusion (HAI)

Because giving chemo into a vein (IV) isn't always helpful for gallbladder cancer, doctors have studied a different way to put it right into the main artery going into the liver, called the hepatic artery. The hepatic artery also supplies most gallbladder tumors, so putting chemo into this artery means more chemo goes to the tumor. The healthy liver then removes most of the remaining drug before it can reach the rest of the body. This can lessen the chemo side effects. HAI may help some people whose cancer couldn’t be removed by surgery live longer, but more research is needed. This technique often requires surgery to put a catheter into the hepatic artery, and many people with gallbladder cancer are not well enough to have this surgery.

Drugs used to treat gallbladder cancer

The chemo drugs most often used for gallbladder cancer include:

• Gemcitabine (Gemzar^?)
• Cisplatin (Platinol^?)
• 5-fluorouracil (5-FU)
• Capecitabine (Xeloda^?)
• Oxaliplatin (Eloxatin^?)
• Nab-paclitaxel (Abraxane?)

Sometimes, 2 drugs are combined. For example, combining gemcitabine and cisplatin may help people live longer than getting just gemcitabine alone. When chemo is given with radiation, most often 5-FU or capecitabine is used.

Possible side effects of chemo treatment for gallbladder cancer

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. Chemo can affect these cells, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. Side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Increased chance of infections (from too few white blood cells)
• Easy bruising or bleeding (from too few blood platelets)
• Fatigue (from too few red blood cells)
• Neuropathy (tingling in the hands and feet)
• Swelling

These side effects are usually short-term and go away after treatment ends. There are often ways to lessen these side effects or even prevent them. For example, drugs can be given to help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about medicines to help reduce side effects.

Along with the possible side effects above, some drugs can have their own specific side effects. For example, cisplatin and oxaliplatin can damage nerves (called neuropathy). This can cause numbness, tingling, weakness, and sensitivity to cold or heat, especially in the hands and feet. This goes away in most patients after treatment stops, but in some patients side effects can last a long time.

Most side effects can be treated. So report any symptoms you notice to your medical team so that they can be treated right away. In some cases, the doses of the chemo drugs may need to be reduced or treatment might need to be delayed or stopped to keep the effects from getting worse.