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Updated: May 22, 2025
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
New systemic treatment paradigms in advanced biliary tract cancer and variations in patient access across Europe
Lorenza Rimassa1,2, Angela Lamarca3, Grainne M O'Kane4,5
1Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20072, Italy.
Abstract:
In recent years, treatment options for patients with advanced biliary tract cancer (BTC) have increased significantly due to the positive results from phase 2/3 clinical trials of immune checkpoint inhibitors, combined with chemotherapy, and molecularly targeted agents. These advances have led to the need for molecular testing to identify actionable alterations and patients amenable to targeted therapies. However, these improvements have brought with them many questions and challenges, including the identification of resistance mechanisms and therapeutic sequences. In this Series paper we aim to provide an overview of the current systemic treatment options for patients with BTC, highlighting disparities in access to innovative treatments and molecular testing across European countries, which lead to inequalities in the possibilities of treating patients with advanced BTC. We also discuss how ongoing European collaborative projects, such as the COST Action Precision-BTC-Network CA22125, supported by COST (European Cooperation in Science and Technology), linked to the European Network for the Study of Cholangiocarcinoma (ENSCCA), can help overcome these disparities and improve the current scenario.
Insights
Advanced biliary tract cancer (BTC) treatments are improving with new therapies like immune checkpoint inhibitors. However, disparities in access to molecular testing and treatments across Europe create inequalities, necessitating collaborative solutions.
Area of Science:
- Oncology
- Translational Medicine
Background:
- Recent advancements in systemic therapies, including immune checkpoint inhibitors, chemotherapy combinations, and molecularly targeted agents, have expanded treatment options for advanced biliary tract cancer (BTC).
- The increasing complexity of treatment necessitates molecular testing to identify actionable alterations and guide targeted therapy selection.
- Significant challenges remain, including understanding resistance mechanisms and optimizing therapeutic sequencing.
Purpose of the Study:
- To provide a comprehensive overview of current systemic treatment strategies for advanced BTC.
- To highlight disparities in access to innovative treatments and molecular testing across European nations.
- To discuss the role of European collaborative projects in addressing these inequalities and improving patient care.
Main Methods:
- Review of phase 2/3 clinical trial data for advanced BTC treatments.
- Analysis of current treatment guidelines and molecular testing accessibility in European countries.
- Discussion of ongoing collaborative initiatives, such as the COST Action Precision-BTC-Network CA22125 and ENSCCA.
Main Results:
- Significant progress in systemic treatment options for advanced BTC.
- Identified disparities in access to novel therapies and molecular diagnostics across European healthcare systems.
- Variability in patient outcomes linked to geographical differences in treatment availability.
Conclusions:
- Addressing disparities in access to advanced diagnostics and treatments is crucial for equitable care in advanced BTC.
- European collaborative networks offer a promising framework to overcome these challenges and standardize care.
- Further research and collaboration are needed to optimize treatment sequencing and overcome resistance mechanisms in BTC.
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