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
- monoclonal antibody
- copy number
- tyrosine kinase
- end stage renal disease
- prognostic factors
- ejection fraction
- chronic kidney disease
- single molecule
- newly diagnosed
- genome wide
- clinical trial
- cancer therapy
- sars cov
- wild type
- south africa
- randomized controlled trial
- risk factors
- healthcare
- gene expression
- low grade
- metastatic colorectal cancer
- cell free
- young adults
- drug delivery
- electronic health record
- big data
- clinical practice
- cardiovascular events
- rectal cancer
- peritoneal dialysis
- phase iii
- dna methylation
- machine learning
- free survival
- induced pluripotent stem cells
- circulating tumor cells