New and emerging treatment options for biliary tract cancer

Abstract

Biliary tract cancer (BTC) is a group of relatively rare tumors with a poor prognosis. The current standard of care consists of doublet chemotherapy (platinum plus gemcitabine); however, even with cytotoxic therapy, the median overall survival is less than 1 year. The genetic basis of BTC is now more clearly understood, allowing for the investigation of targeted therapy. Combinations of doublet chemotherapy with antiepidermal growth factor receptor agents have provided modest results in Phase II and Phase III setting, and responses with small molecule inhibitors are limited. Moving forward as we continue to characterize the genetic hallmarks of BTC, a stepwise, strategic, and cooperative approach will allow us to make progress when developing new treatments.

Keywords: biliary tract cancer; cholangiocarcinoma; genetics; targeted therapy.

Figure 1

Pathways and targeted therapy in BTC. Notes: Drugs in red lettering represent agents that have been evaluated in trials that are now complete. Drugs in blue lettering represent agents that are in trials that are currently enrolling. Abbreviations: BTC, biliary tract cancer; PDGFR, platelet-derived growth factor receptor; EGFR, epidermal growth factor receptor; HER-2, human epidermal growth factor receptor 2; VEGFR, vascular endothelial growth factor receptor; AKT, protein kinase; mTOR, mammalian target of rapamycin; MEK, mitogen-activated protein kinase.