Advances in the treatment of biliary tract cancers

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 significa...

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Bibliographic Details
Published in:	Current opinion in gastroenterology Vol. 36; no. 2; pp. 85 - 89
Main Authors:	Uson Junior, Pedro L.S., Bogenberger, James, Borad, Mitesh J.
Format:	Journal Article
Language:	English
Published:	United States Wolters Kluwer Health, Inc. All rights reserved 01-03-2020 Copyright Wolters Kluwer Health, Inc. All rights reserved
Subjects:	Biliary Tract Neoplasms - drug therapy Humans Randomized Controlled Trials as Topic
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Summary:	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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	0267-1379 1531-7056
DOI:	10.1097/MOG.0000000000000606