Advances in the treatment of biliary tract cancers

Pedro L.S. Uson, James Bogenberger, Mitesh J. Borad

Research output: Contribution to journalReview article

Abstract

Purpose of reviewTo review new treatment and advances in biliary tract cancer (BTC).Recent findingsIn the prespecified per-protocol analysis of the randomized phase III trial BILCAP, adjuvant capecitabine offers overall survival (OS) benefit when compared with observation with statistical significance. In the first-line setting in metastatic BTC, gemcitabine and S-1 had noninferior OS compared with gemcitabine and cisplatin. In a separate phase III study, the triplet of gemcitabine, cisplatin and S-1 (GCS) had superior OS compared with standard gemcitabine and cisplatin. The regimen of modified FOLFOX (fluorouracil, leucovorin and oxaliplatin) regimen can be considered a potential standard option in the second-line setting for patients who failed first-line therapy with gemcitabine-based regimens. Trials in genomically selected patients indicate activity of fibroblast growth factor receptor inhibitors, mutant isocitrate dehydrogenase inhibitors and immune checkpoint inhibitors.SummaryCapecitabine is a new option for adjuvant treatment in resected BTC. In the metastatic setting, gemcitabine and S-1 or GCS are new options for first-line therapy and modified FOLFOX regimen should be considered as a potential new empirical standard of care in genomically agnostic patients requiring second-line therapy. Future randomized trials will evaluate the role of targeted agents and immunotherapy in advanced BTC, both in monotherapy and in combination.

Original languageEnglish (US)
Pages (from-to)85-89
Number of pages5
JournalCurrent Opinion in Gastroenterology
Volume36
Issue number2
DOIs
StatePublished - Mar 1 2020

Keywords

  • biliary cancer
  • cholangiocarcinoma
  • gallbladder carcinoma

ASJC Scopus subject areas

  • Gastroenterology

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