Current Therapy and Future Directions in Biliary Tract Malignancies

Abstract

OPINION STATEMENT Cancers of the biliary tree represent a rare group of diseases with a devastating impact on patients. Gallbladder cancer is often associated with cholelithiasis. Cholangiocarcioma may arise in the setting of biliary inflammation such as primary sclerosing cholangitis but most commonly occurs in patients without a particular risk factor. Surgical removal of biliary cancer is essential for cure, but it is associated with a very high rate of recurrence and for many patients is not possible at the time of diagnosis. Although risk factors differ for each anatomic site, systemic treatment is generally similar. Various adjunctive therapies such as radiation and embolization have been investigated for biliary tract cancers with modest success and efforts are ongoing to understand how to optimize these tools. Retrospective series and pooled analysis suggest a benefit for adjuvant treatment following resection, but prospective data is limited. Ongoing and planned phase 3 trials should help clarify the role of adjuvant chemotherapy and radiation. For advanced disease, chemotherapy improves quality of life and survival, and gemcitabine with cisplatin represents the standard of care. However, all patients ultimately progress on this therapy, so clinical trials of new and better agents are essential to expand the existing treatment options for patients.

Advanced biliary tract cancer: clinical outcomes with ABC-02 regimen and analysis of prognostic factors in a tertiary care center in the United States

“…There are about 14,000 new cases per year in the United States (1,2). Most cases of BTC are lethal due to advanced disease at presentation or high relapse rate after local treatment (3)(4)(5).…”

Raf kinase inhibitor protein inhibits cholangiocarcinoma cell metastasis by downregulating matrix metalloproteinase 9 and upregulating tissue inhibitor of metalloproteinase 4 expression

“…As such, these symptoms are difficult to treat and exhibit a poor prognosis ( 1 – 4 ). A previous study has reported the overall five-year survival rate following radical resection to be 15–50%, as cholangiocarcinoma cells easily metastasize, resulting in relapse ( 5 ). The formation of cholangiocarcinoma often proceeds through several steps, including interaction among the cancer-promoting environmental factors, oncogene activation and tumor-suppressor gene inactivation.…”

Inter-Individual Variability in Acute Toxicity of R-Pulegone and R-Menthofuran in Human Liver Slices and Their Influence on miRNA Expression Changes in Comparison to Acetaminophen

“…The level of γ-glutamyltransferase (1.13–3.5 µkat/L) was the only elevated parameter in all five patients. Elevation in γ-glutamyltransferase levels is often seen in patients with colorectal carcinoma with liver metastasis [ 37 ] or in patients with biliary tract diseases including malignancies [ 38 ]. All liver samples were also scored by the pathologist for steatosis (score of 0–1) and fibrosis (score of zero), and the obtained scores indicate no or mild signs of liver disease in patients’ biopsies.…”