Biliary tract cancer: current challenges and future prospects

Abstract

Michele Ghidini,1 Claudio Pizzo,1 Andrea Botticelli,2 Jens Claus Hahne,3 Rodolfo Passalacqua,1 Gianluca Tomasello,1 Fausto Petrelli4 1Department of Oncology, Azienda Socio Sanitaria Territoriale of Cremona, Cremona, Italy; 2Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Rome, Italy; 3Division of Molecular Pathology, The Institute of Cancer Research, Sutton, Surrey, UK; 4Department of Oncology, Operative Unit of Oncology, Azienda Socio Sanitaria Territoriale of Bergamo Ovest, Treviglio, Bergamo, Italy Purpose: Incidence and mortality of biliary tract carcinoma (BTC) are increasing, especially in South America and Asia. Such a disease often bears a dismal prognosis because of diagnosis occurring at late stages and for the frequent relapses after surgery. The aims of this review were to summarize the state of the art of the treatment of BTC and give a view at possible future prospects linked with molecular profiling, immunotherapy, and targeted therapies. Design: We conducted a systematic literature search using MEDLINE and the 2018 ASCO Meeting abstract databases to identify published clinical trials, translational series, and meeting abstracts. All significant papers and abstracts available to date were included. Results: For resected BTC, thanks to the BILCAP study, adjuvant chemotherapy (CT) with capecitabine should be regarded as the new standard of care. For locally advanced inoperable and metastatic diseases, the use of chemoradiotherapy and radioembolization has not been supported by any randomized Phase III study. The standard of care remains the combination of CT with gemcitabine and cisplatin, as reported by the ABC-02 trial. All targeted therapies have failed to improve the survival outcomes, either in combination with CT or as single agents and are not recommended in the treatment of BTC. Whole-exome sequencing and molecular profiling have helped in identifying genetic signatures typical of different BTC subtypes. With this support, new trials with targeted agents and immunotherapy have been designed, and results are awaited. Conclusion: BTC still remains a disease with very few treatment options. Different BTC subtypes own peculiar gene mutations and pathways alterations. Therefore, molecular profiling may be the only key to enable new tailored strategies with targeted agents and immunotherapy. Keywords: surgery, cholangiocarcinoma, adjuvant treatment, first-line treatment, targeted therapies, molecular profiling

Keywords

• biliary tract cancer
• cholangiocarcinoma
• adjuvant treatment
• first line treatment
• targeted therapies
• molecular profiling