All authors: Vanderbilt University, Nashville, TN.
J Clin Oncol. 2015 Jun 1;33(16):1845-8. doi: 10.1200/JCO.2014.59.7591. Epub 2015 Apr 27.
Biliary tract cancers are a heterogeneous group of cancers that arise in either the intra- or extrahepatic bile ducts or the gallbladder. Local therapy with surgical resection and perhaps radiation therapy is used for localized disease. There is no known effective adjuvant therapy, although various combinations have been used clinically without definitive data showing a benefit. The most standard chemotherapy for metastatic disease is gemcitabine plus cisplatin based on a single positive randomized trial. Genetic mutations that may lead to better, targeted therapy choices are being identified, albeit with variable frequency. Early studies of targeted agents have been negative, but these were in unselected patients where it was unknown whether the target was activated in any individual patient. Careful selection of patients enrolling onto trials of targeted agents will make the subsets of biliary tract cancers even smaller but is likely necessary to improve outcomes from these deadly diseases.
胆道癌是一组异质性癌症，可发生于肝内或肝外胆管或胆囊。对于局限性疾病，采用手术切除和可能的放射治疗进行局部治疗。目前尚无有效的辅助治疗方法，尽管临床上已经使用了各种联合治疗方法，但没有明确的数据显示其有益。转移性疾病的最标准化疗是基于一项阳性随机试验的吉西他滨联合顺铂。正在确定可能导致更好的靶向治疗选择的基因突变，尽管其频率不同。针对靶向药物的早期研究结果为阴性，但这些研究对象是未经选择的患者，因此无法确定每个患者的靶点是否被激活。仔细选择入组靶向药物试验的患者将使胆道癌亚组更小，但这可能是改善这些致命疾病预后的必要条件。
