Current progress in perioperative chemotherapy for biliary tract cancer

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Biliary tract cancers (BTCs) are heterogeneous and often diagnosed at advanced stages.
• Radical resection offers curative potential but recurrence rates are high, necessitating perioperative strategies.
• Limited randomized trials exist for perioperative chemotherapy in BTCs due to rarity.

Purpose of the Study:

• To review current and ongoing clinical trials on adjuvant and neoadjuvant chemotherapy for BTCs.
• To highlight the role of perioperative chemotherapy in improving survival outcomes for BTC patients.
• To discuss the efficacy of specific chemotherapy regimens like S-1 and GCS.

Main Methods:

• Review of recent phase III clinical trials, including ASCOT, KHBO1401, and JCOG1920.
• Analysis of adjuvant chemotherapy regimens (S-1) and combination therapies (gemcitabine, cisplatin, S-1).
• Investigation into neoadjuvant chemotherapy efficacy for resectable BTCs.

Main Results:

• Adjuvant chemotherapy with S-1 significantly improved overall survival in resected BTCs (ASCOT trial).
• Gemcitabine, cisplatin plus S-1 (GCS) is the standard for advanced BTCs, showing improved survival and response rates (KHBO1401 trial).
• Ongoing trials (JCOG1920) are evaluating GCS as neoadjuvant chemotherapy for resectable BTCs.

Conclusions:

• Perioperative chemotherapy is crucial for improving survival in biliary tract cancers.
• S-1 and GCS represent significant advancements in adjuvant and systemic chemotherapy for BTCs.
• Further research into neoadjuvant chemotherapy holds promise for enhancing curative-intent treatment of BTCs.