A review of systemic therapy in biliary tract carcinoma.
| Autor: | Jansen H; Campus Virchow & Mitte Charité, Institute f. Med. Immunologie, Berlin, Germany., Pape UF; Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Germany.; Internal Medicine and Gastroenterology, Asklepios Klinik St. Georg, Asklepios Tumor Zentrum Hamburg, Germany., Utku N; Campus Virchow & Mitte Charité, Institute f. Med. Immunologie, Berlin, Germany.; CellAct Pharma GmbH, Dortmund, Germany. |
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| Jazyk: | angličtina |
| Zdroj: | Journal of gastrointestinal oncology [J Gastrointest Oncol] 2020 Aug; Vol. 11 (4), pp. 770-789. |
| DOI: | 10.21037/jgo-20-203 |
| Abstrakt: | Biliary tract carcinoma (BTC) has a poor prognosis and is increasing in incidence. Although surgery, chemotherapy and other treatment modalities have improved, surgery remains the only potential curative treatment and is appropriate for only those few patients who present with localized, resectable disease. However, for the majority of patients, unresectable disease is evident at diagnosis and about 95% of patients die within 10 years, despite the majority receiving chemotherapy. Long-term survival is significantly greater for patients with resected BTC compared to those with unresectable disease. In unresected disease, life expectancy is limited, with first-line gemcitabine/cisplatin (GEM/CIS) accepted as standard of care. Currently no standard second-line regimen which provides significant improvement of clinical outcomes exists for those who present with refractory disease or who relapse after first-line treatment. Of particular importance is establishing the impact of best supportive care (BSC) as a benchmark for survival outcomes to which the impact of treatment modalities can be compared. Survival outcome often differs significantly for patients with different prognostic factor profiles even when receiving the same therapy so that it can be difficult to predict which patient subgroup might benefit most from which therapy. Therefore, the influence of prognostic factors on survival under different therapies as well as under BSC needs to be further assessed in order to arrive at truly evidence-based, best therapeutic decisions for individual patients. Encouraging new research into the genomic landscape of BTC may help to further subdivide the BTC population into molecular-genetic clusters likely to be sensitive to different targeted therapy approaches leading to further improvements in survival. Consequently, an unmet need exists not only to develop new and more effective therapies for this devastating disease, but also to integrate original research findings into a more complex, dynamic, individualized therapeutic decision model to aid clinicians in making evidence-based, best therapeutic decisions for individual patients. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form.(Available at http://dx.doi.org/10.21037/jgo-20-203). NU reports a leadership role, stock ownership, receipt of honoraria and research funding, and holding of patents at CellAct Pharma GmbH. The other authors have no conflicts of interest to declare. (2020 Journal of Gastrointestinal Oncology. All rights reserved.) |
| Databáze: | MEDLINE |
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