Understanding Biliary Tract Cancer and The Current Standard of Care

An expert explains what biliary tract cancers are and the current landscape of treatment as well as future advancements.

In the treatment of newly diagnosed biliary tract cancer, the current standard of care involves chemotherapy in combination with immunotherapy, utilizing agents such as Imfinzi (durvalumab) or Keytruda (pembrolizumab), according to Dr. Rachna Schroff, Chief of the Division of Hematology Oncology and AGI medical oncologist at the University of Arizona Cancer Center, in an interview with CURE.

Recent research, by lead study author Shroff, indicates that the addition of nab-paclitaxel to the standard gemcitabine and cisplatin regimen (GAP) did not improve overall survival in patients with advanced biliary tract cancer compared to gemcitabine and cisplatin alone, according to study findings published in the Journal of Clinical Oncology.

She further states that ongoing research focuses on enhancing this frontline regimen by integrating additional immunotherapy agents or novel therapeutic approaches. Importantly, the addition of immunotherapy has demonstrated minimal additional toxicity, supporting the feasibility of further treatment intensification.

Glossary:

Overall survival: the length of time from diagnosis or treatment start that patients remain alive.

Genomic profiling: the analysis of a tumor’s genetic mutations to identify potential targets for treatment.

Given the availability of multiple Food and Drug Administration (FDA)-approved targeted therapies, comprehensive genomic profiling at diagnosis is crucial to identify actionable mutations and inform treatment decisions upon disease progression, according to Shroff. Emerging research continues to identify novel targets and therapeutic agents, expanding potential treatment options beyond currently approved therapies. Additionally, she states that studies are investigating mechanisms of resistance in patients receiving targeted treatments and exploring strategies to overcome or bypass resistance, highlighting a critical area for future therapeutic advancements.

Transcript:

Advanced biliary tract cancers basically comprise a heterogeneous group of cancers that includes intrahepatic cholangiocarcinoma, extra hepatic cholangiocarcinoma and gallbladder cancer. Cholangiocarcinoma is just a fancy name for bile duct cancers. These are cancers that start either inside the liver, intrahepatic, or in the larger bile ducts that sit right at the entrance of the liver or outside of the liver, and those are extrahepatic cholangiocarcinoma, and then gallbladder cancer as well. And advanced simply means that this is not something that is resectable, as we call it, or something that can have a surgery to remove the tumor. So, it can either be locally advanced or metastatic, meaning spread to multiple areas.

Transcript was edited for clarity and conciseness.

Reference:

“SWOG S1815: A Phase III Randomized Trial of Gemcitabine, Cisplatin, and Nab-Paclitaxel Versus Gemcitabine and Cisplatin in Newly Diagnosed, Advanced Biliary Tract Cancers,” By Dr. Rachna T. Shroff, et al. Journal of Clinical Oncology.

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