Optimizing Patient Pathways in Advanced Biliary Tract Cancers: Recent Advances and a French Perspective.
Cindy NeuzilletPascal ArtruEric AssenatJulien EdelineXavier AdhouteJean-Christophe SabourinAnthony TurpinRomain CoriatDavid MalkaPublished in: Targeted oncology (2023)
Biliary tract cancers (BTCs) are a heterogeneous group of tumors that are rare in Western countries and have a poor prognosis. Three subgroups are defined by their anatomical location (intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma and gallbladder carcinoma) and exhibit distinct clinical, molecular, and epidemiologic characteristics. Most patients are diagnosed at an advanced disease stage and are not eligible for curative-intent resection. In addition to first- and second-line chemotherapies (CisGem and FOLFOX, respectively), biologic therapies are now available that target specific genomic alterations identified in BTC. To date, targets include alterations in the genes for isocitrate dehydrogenase (IDH) 1, fibroblast growth factor receptor (FGFR) 2, v-raf murine sarcoma viral oncogene homolog B1 (BRAF), human epidermal growth factor receptor 2 (HER2 or ERRB2), and neurotrophic tyrosine receptor kinase (NTRK), and for those leading to DNA mismatch repair deficiency. Therapies targeting these genomic alterations have demonstrated clinical benefit for patients with BTC. Despite these therapeutic advancements, genomic diagnostic modalities are not widely used in France, owing to a lack of clinician awareness, local availability of routine genomic testing, and difficulties in obtaining health insurance reimbursement. The addition of durvalumab, a monoclonal antibody targeting the immune checkpoint programmed cell death ligand-1, to CisGem in the first-line treatment of advanced BTC has shown an overall survival benefit in the TOPAZ-1 trial. Given the high mortality rates associated with BTC and the life-prolonging therapeutic options now available, it is hoped that the data presented here will support updates to the clinical management of BTC in France.
Keyphrases
- poor prognosis
- health insurance
- epidermal growth factor receptor
- copy number
- monoclonal antibody
- end stage renal disease
- tyrosine kinase
- long non coding rna
- prognostic factors
- chronic kidney disease
- endothelial cells
- newly diagnosed
- rheumatoid arthritis
- cancer therapy
- clinical trial
- sars cov
- single molecule
- peritoneal dialysis
- affordable care act
- metastatic colorectal cancer
- case report
- cardiovascular events
- healthcare
- rectal cancer
- type diabetes
- phase iii
- circulating tumor
- electronic health record
- machine learning
- dna methylation
- double blind
- protein kinase
- drug delivery
- bioinformatics analysis
- genome wide analysis