Cancers of the bile duct,including gallbladder cancer,extrahepatic cholangiocarcinoma,hilar and intrahepatic cholangiocarcinoma,present a significant treatment challenge.Characterized by their notorious difficulty to ...Cancers of the bile duct,including gallbladder cancer,extrahepatic cholangiocarcinoma,hilar and intrahepatic cholangiocarcinoma,present a significant treatment challenge.Characterized by their notorious difficulty to diagnose or biopsy,intricate anatomical locations and diverse clinical presentations,these malignancies collectively contribute to a significant burden on global health.The epidemiology of bile duct cancers reveals worldwide variations in incidence,prevalence,and mortality rates,emphasizing the need for a nuanced understanding of each subtype and the local environmental etiologies.Challenges in early diagnosis further compound the complexity of managing these cancers,often leading to advanced stage at the time of detection and treatment delays.Surgery remains the cornerstone of curative-intent treatment of bile duct cancers,yet the rate of recurrence and metastases underscores the importance of comprehensive multidisciplinary therapeutic strategies.Pivotal randomized clinical trials have been performed;however,they have been challenged by the lack of active agents,a limited number of accrued patients,and a grouping of all patients together regardless of where in the biliary tract the tumor originates.This has resulted in variations in treatment strategies and multiple treatment options that range from immunotherapy to radiation to hepatic artery infusion therapy(more on this later).A greater understanding of the mutational landscape of biliary tract cancers has resulted in optimism around appropriately targeted agents and combination immunotherapies.Yet,many of these regimens await robust outcomes data,and it is questionable if they significantly move the needle forward to improve overall survival.Thus now,more than ever,there is a need for updated treatment guidelines.展开更多
基金A.V.M.is supported by National Institutes of Health,National Cancer Institute(No.R37CA238435).
文摘Cancers of the bile duct,including gallbladder cancer,extrahepatic cholangiocarcinoma,hilar and intrahepatic cholangiocarcinoma,present a significant treatment challenge.Characterized by their notorious difficulty to diagnose or biopsy,intricate anatomical locations and diverse clinical presentations,these malignancies collectively contribute to a significant burden on global health.The epidemiology of bile duct cancers reveals worldwide variations in incidence,prevalence,and mortality rates,emphasizing the need for a nuanced understanding of each subtype and the local environmental etiologies.Challenges in early diagnosis further compound the complexity of managing these cancers,often leading to advanced stage at the time of detection and treatment delays.Surgery remains the cornerstone of curative-intent treatment of bile duct cancers,yet the rate of recurrence and metastases underscores the importance of comprehensive multidisciplinary therapeutic strategies.Pivotal randomized clinical trials have been performed;however,they have been challenged by the lack of active agents,a limited number of accrued patients,and a grouping of all patients together regardless of where in the biliary tract the tumor originates.This has resulted in variations in treatment strategies and multiple treatment options that range from immunotherapy to radiation to hepatic artery infusion therapy(more on this later).A greater understanding of the mutational landscape of biliary tract cancers has resulted in optimism around appropriately targeted agents and combination immunotherapies.Yet,many of these regimens await robust outcomes data,and it is questionable if they significantly move the needle forward to improve overall survival.Thus now,more than ever,there is a need for updated treatment guidelines.
