- To provide an update on the role of adjuvant chemotherapy in the management of early stage biliary tract cancer
- To summarise clinical investigation advances in terms of chemotherapy, radiotherapy and targeted therapy in patients with advanced biliary cancer
- To elaborate the emerging role of immunotherapy in advanced hepatocellular carcinoma
In this E-Learning module, the author summarises the evidence of benefit from adjuvant chemotherapy for early stage biliary tract cancer, he reflects on new horizons from therapeutic investigations in advanced biliary tract cancer and provides emphasis on the emerging role of immunotherapy in patients with advanced hepatocellular carcinoma.
Overall, prognosis in patients with biliary tract cancer is poor. A minority of patients present with resectable disease. Gallbladder cancer is mostly curable if found incidentally. Relapse rates are high and the aims of adjuvant therapy are to provide loco-regional control, prevent systemic relapse and improve survival. In this E-Learning module the author underlines that before 2017 there was no conclusive evidence of benefit from adjuvant chemotherapy and puts into context data from prospective randomised control trials with adjuvant chemotherapy in the modern era.
In terms of chemotherapy for advanced biliary cancer, there have been no practice-changing studies since 2010. The author reviews the outcomes from new agents under evaluation for biliary tract cancer, triple combinations, new delivery mechanism and questions a role for second-line chemotherapy. In terms of radiotherapy, the author elaborates the results of studies with stereotactic body radiotherapy and proton beam therapy. In terms of targeted therapies for advanced biliary tract cancer, upon reviewing results from randomised studies with EGFR and VEGF inhibitors, the author puts emphasis on the importance of improved understanding of the genetic environment of biliary tract cancer and subsequently reviews actionable targets and the results from studies with targeted therapies.
In the last part of the module, the author says that preclinical evidence suggests that hepatocellular carcinoma may be responsive to immune modulation. Approaches include targeting CTLA-4 and/or PD-1/PD-L1 or both. In that regard the author reviews the evolving immunotherapy landscape in patients with advanced hepatocellular carcinoma and concludes that the results of pivotal studies in first- and second-line are awaited.
This E-Learning module was published in 2018 and expired in 2020.
The author has reported consulting or advisory role for Agios, Astra-Zeneca, Baxalta, Celgene, Delcath, Ipsen, Lilly, Merck, Midatech, Novartis, Pfizer. Speakers’ Bureau for Celgene, Ipsen, Novartis, Pfizer. Travel grant from Celgene, Lilly and Novartis. Institutional grant from Novartis.