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Published on: September 30, 2021
Systemic approaches in biliary tract cancers: a review in the era of multidirectional precision medicine
Cha Len Lee1, Anna Saborowski2, Arndt Vogel1,2,3
1Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Ontario, Canada.
Introduction:
Despite a rising incidence, biliary tract cancers (BTCs) are still considered a rare tumor entity. The disease's subtle clinical presentation and lack of effective early detection strategies often lead to a diagnosis at an advanced or unresectable stage, where curative options are limited.
Areas Covered:
This review provides an overview of current systemic therapies and emerging novel approaches for BTC. For decades, the combination of gemcitabine with cisplatin (GemCis) has been the standard of care for palliative treatment. However, since 2020, the diagnostic and therapeutic landscape for BTC has evolved considerably, not only in the first-line setting but also beyond, driven by the development of clinical trials exploring immunotherapy and molecularly targeted agents. Due to the high frequency of targetable genetic alterations in BTC patients, there is a growing emphasis on obtaining tissue or liquid biopsy samples to identify markers like microsatellite instability and other actionable oncogenic driver genes.
Expert Opinion:
Early initiation of systemic therapies in combination with multimodal approaches is essential for maximizing survival outcomes in patients with BTC.
Insights
Biliary tract cancers (BTCs) are rare but increasing. Advances in systemic therapies, including immunotherapy and targeted agents, offer new hope for patients, especially when initiated early with multimodal approaches.
Area of Science:
- Oncology
- Gastroenterology
- Cancer Research
Background:
- Biliary tract cancers (BTCs) present subtly, often diagnosed at advanced stages.
- Limited curative options exist for unresectable BTC.
- Rising incidence of BTC necessitates improved treatment strategies.
Purpose of the Study:
- To review current systemic therapies for BTC.
- To explore emerging novel treatment approaches for BTC.
- To highlight the importance of early diagnosis and treatment initiation.
Main Methods:
- Review of current systemic therapies for BTC.
- Exploration of novel therapeutic strategies including immunotherapy and molecularly targeted agents.
- Emphasis on diagnostic and therapeutic landscape evolution since 2020.
Main Results:
- Gemcitabine with cisplatin (GemCis) was the long-standing standard palliative care.
- Recent advancements include immunotherapy and molecularly targeted agents.
- Identification of targetable genetic alterations via tissue or liquid biopsies is crucial.
Conclusions:
- Early systemic therapy initiation is vital for maximizing survival in BTC patients.
- Multimodal approaches combined with early therapy improve outcomes.
- The evolving landscape of BTC treatment emphasizes personalized medicine.
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