Gallbladder Cancer: Current Multimodality Treatment Concepts and Future Directions

Abstract

Gallbladder cancer (GBC) is the most common primary tumor site of biliary tract cancer (BTC), accounting for 0.6% of newly diagnosed cancers and 0.9% of cancer-related deaths. Risk factors, including female sex, age, ethnic background, and chronic inflammation of the gallbladder, have been identified. Surgery is the only curative option for early-stage GBC, but only 10% of patients are primary eligible for curative treatment. After neoadjuvant treatment, up to one-third of locally advanced GBC patients could benefit from secondary surgical treatment. After surgery, only a high-risk subset of patients benefits from adjuvant treatment. For advanced-stage GBC, palliative chemotherapy with gemcitabine and cisplatin is the current standard of care in line with other BTCs. After the failure of gemcitabine and cisplatin, data for second-line treatment in non-resectable GBC is poor, and the only recommended chemotherapy regimen is FOLFOX (5-FU/folinic acid and oxaliplatin). Recent advances with the PD-L1 inhibitor durvalumab open the therapy landscape for immune checkpoint inhibition in GBC. Meanwhile, targeted therapy approaches are a cornerstone of GBC therapy based on molecular profiling and new evidence of molecular differences between different BTC forms and might further improve the prognosis of GBC patients.

Successful Surgical Management of an Invasive Adenocarcinoma Within a Duplicated Gallbladder by an Extensive Hepatic Resection: A Case Report

“…For locally advanced gallbladder cancer, neoadjuvant chemotherapy could transform primary non-resectable patients into eligible patients for resection. However, the current evidence does not cover cases of gallbladder cancer within a duplicated gallbladder [ 17 ]. More future studies and data collection would be useful to determine the most appropriate management of this rare presentation.…”

Impact of Medicaid expansion on the multimodal treatment of biliary tract cancer

“…25 Multimodal treatment has been increasingly considered as an important treatment strategy for patients diagnosed with BTC. 26,27 Despite this benefit, adjuvant treatment for BTC is known to be underutilized. 28,29 For example, Kemp Bohan et al revealed that among patients with resected pathologic stage I-III GBC, only 17.5% of individuals received adjuvant chemotherapy.…”

“…Multimodal treatment has been increasingly considered as an important treatment strategy for patients diagnosed with BTC 26,27 . Despite this benefit, adjuvant treatment for BTC is known to be underutilized 28,29 .…”

FOXA2 suppresses gallbladder carcinoma cell migration, invasion, and epithelial‐mesenchymal transition by targeting SERPINB5

“…GBC is early‐stage asymptomatic and lacks early effective screening methods. The vast majority of patients have already developed local invasion and distant metastasis at the time of diagnosis, thus missing the chance of radical resection, and even patients who undergo radical resection often relapse within 1 year 4 . Given the highly aggressive biological behavior and poor prognosis of GBC, it is critical to investigate the mechanisms underlying its progression and metastasis and identify potential therapeutic targets to improve patient outcomes.…”