Chemotherapy The role of chemotherapy (CT) in cholangiocarcinoma has not been established. Most chemotherapy trials have been small single institution phase II trials, and there have been no large prospective randomized trials. Additionally, most chemotherapy trials include patients with intrahepatic, extrahepatic and gallbladder carcinomas, as well as patients with locally advanced and metastatic disease. Response rates have ranged from 0-40% with no complete remissions. The most extensively investigated CT agent has been 5-fluorouracil (5-FU), which has disappointing response rates of 9% as a single agent. Response rates were not improved by the addition of streptozotocin or methyl-CCNU (Semustine) to 5-FU in a randomized trial performed by Eastern Cooperative Oncology Group (ECOG).6 Multiple combination CT regimens have been investigated in small clinical trials, and none have shown a survival benefit.