Chemotherapy: Knowing When to Start, Evaluate for Response, and Stop

Abstract

Chemotherapy is essential treatment in pancreatobiliary cancer patients. Knowing optimal time of chemotherapy initiation is important. Usually good performance status and general condition without jaundice is first recommendation for initiating chemotherapy. Good performance status is defined as Eastern Cooperative Oncology Group 0-1, with good biliary drainage and adequate nutritional intake. Percutaneous or endoscopic biliary drainage is recommended before chemotherapy in patient who shows high bilirubin level. The optimal timing of chemotherapy after diagnosis is not standardized but guideline recommends chemotherapy less 2 months after initial cancer diagnosis. Regard to chemotherapy response evaluation, Response Evaluation Criteria in Solid Tumors criteria is used per 2-3 months. Response Evaluation Criteria in Solid Tumors criteria evaluate the chemotherapy responsiveness. With regular tumor response, clinicians must determine whether patient can undergo chemotherapy continuously without complication. For example, Eastern Cooperative Oncology Group 3 or poor general condition make patient not to undergo chemotherapy and focus on end-of-life care. As a result, knowing about the start and stop of chemotherapy can help relieve the patient's symptoms, prolong survival and improve the quality of life.