Pharmacy Unit, IRCCS San Raffaele Hospital, Milan, Italy.
Oncology Unit, IRCCS San Raffaele Hospital, Milan, Italy.
Med Oncol. 2021 Feb 4;38(2):19. doi: 10.1007/s12032-021-01463-4.
Biliary tract cancer is an uncommon cancer in developed countries. In localized stages, surgery is the cornerstone of treatment with curative purpose. Conversely in advanced stages, chemotherapy with platinum-gemcitabine combination is the standard of care. Biliary tract cancers are a biologically heterogeneous group of malignancies, which perhaps explains the failure of targeted therapies in unselected patient populations to demonstrate benefit in advanced disease, although there are promises in selected populations (e.g. PD1/PD-L1 positive, BRAF-mutated or IDH1-mutant). In view of the limited benefit of second line therapies in metastatic biliary tract cancer, various targeted agents have been tested in progressive disease. Furthermore, several ongoing trials are using next-generation sequencing of multiple genes to identify molecular abnormalities in the tumors of patients with refractory cancers that may potentially be used in pretreated disease (e.g. FGFR or IDH genes). Immunotherapy with immune checkpoint inhibitors may be interesting for patients whose tumors have programmed cell death 1 ligand 1 (PD-L1) overexpression. Ongoing and future trials will further advance our knowledge toward the optimal treatment strategy for the management of biliary tract cancer in its different stages, starting from metastatic and then reaching early stages of disease. We here provided an overview of these novel treatment strategies for advanced biliary tract cancers not amenable of curative treatment modalities.
胆道癌在发达国家是一种罕见的癌症。在局部阶段，手术是有治愈目的的治疗的基石。相反，在晚期，铂类联合吉西他滨的化疗是标准治疗。胆道癌是一组生物学异质性的恶性肿瘤，这也许可以解释为什么在未选择的患者人群中，靶向治疗未能在晚期疾病中显示出获益，尽管在某些特定人群中（例如 PD1/PD-L1 阳性、BRAF 突变或 IDH1 突变）有希望。鉴于二线治疗在转移性胆道癌中的获益有限，在进展性疾病中已经测试了各种靶向药物。此外，几项正在进行的试验正在使用多种基因的下一代测序来识别复发性癌症患者肿瘤中的分子异常，这些异常可能在预处理疾病中使用（例如 FGFR 或 IDH 基因）。对于肿瘤程序性死亡配体 1（PD-L1）过表达的患者，免疫检查点抑制剂免疫疗法可能很有趣。正在进行和未来的试验将进一步提高我们对不同阶段胆道癌管理的最佳治疗策略的认识，从转移性开始，然后达到疾病的早期阶段。我们在这里概述了这些不能用治愈性治疗方法治疗的晚期胆道癌的新治疗策略。
