How I treat biliary tract cancer

Area of Science:

• Oncology
• Gastroenterology
• Cancer Research

Background:

• Biliary tract cancers (BTCs) management is rapidly evolving, with surgery and adjuvant capecitabine for early stages.
• High relapse rates necessitate improved adjuvant strategies for cholangiocarcinoma and gallbladder cancers.
• Advanced BTCs are often treated with cisplatin and gemcitabine chemotherapy, with limited second-line options.

Purpose of the Study:

• To review the current and emerging treatment landscape for biliary tract cancers.
• To highlight the importance of molecular profiling in guiding therapy for advanced BTCs.
• To discuss the potential role of novel targeted therapies and future treatment modalities.

Main Methods:

• Review of current clinical practice and emerging research in BTC management.
• Analysis of standard chemotherapy regimens and second-line treatment options.
• Examination of targeted therapies based on specific molecular alterations (FGFR-2, IDH-1, BRAF, NTRK, HER-2, MSI).

Main Results:

• Surgical resection followed by adjuvant capecitabine is standard for resectable cholangiocarcinoma and gallbladder cancer.
• Chemotherapy with cisplatin and gemcitabine is the primary treatment for advanced BTCs without targetable alterations.
• Targeted therapies are transforming treatment for advanced BTCs with specific mutations or fusions, particularly intrahepatic cholangiocarcinoma.

Conclusions:

• Molecular profiling should be considered early in BTC patient pathways to personalize therapy.
• Targeted therapies are increasingly important for advanced BTCs with actionable molecular alterations.
• Immunotherapy, liver-directed therapy, and liver transplant are areas of ongoing research for future BTC management.