A Practical Guide for the Systemic Treatment of Biliary Tract Cancer in Canada
Biliary tract cancers (BTC) are rare and aggressive tumors with poor prognosis. Radical surgery offers the best chance for cure; however, most patients present with unresectable disease, and among those receiving curative-intent surgery, recurrence rates remain high. While other locoregional therapi...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-07-01
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| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/30/8/517 |
| _version_ | 1797585072180690944 |
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| author | Ravi Ramjeesingh Prosanto Chaudhury Vincent C. Tam David Roberge Howard J. Lim Jennifer J. Knox Jamil Asselah Sarah Doucette Nirlep Chhiber Rachel Goodwin |
| author_facet | Ravi Ramjeesingh Prosanto Chaudhury Vincent C. Tam David Roberge Howard J. Lim Jennifer J. Knox Jamil Asselah Sarah Doucette Nirlep Chhiber Rachel Goodwin |
| author_sort | Ravi Ramjeesingh |
| collection | DOAJ |
| description | Biliary tract cancers (BTC) are rare and aggressive tumors with poor prognosis. Radical surgery offers the best chance for cure; however, most patients present with unresectable disease, and among those receiving curative-intent surgery, recurrence rates remain high. While other locoregional therapies for unresectable disease may be considered, only select patients may be eligible. Consequently, systemic therapy plays a significant role in the treatment of BTC. In the adjuvant setting, capecitabine is recommended following curative-intent resection. In the neoadjuvant setting, systemic therapy has mostly been explored for downstaging in borderline resectable tumours, although evidence for its routine use is lacking. For advanced unresectable or metastatic disease, gemcitabine-cisplatin plus durvalumab has become the standard of care, while the addition of pembrolizumab to gemcitabine-cisplatin has also recently demonstrated improved survival compared to chemotherapy alone. Following progression on gemcitabine-cisplatin, several chemotherapy combinations and biomarker-driven targeted agents have been explored. However, the optimum regimen remains unclear, and access to targeted agents remains challenging in Canada. Overall, this article serves as a practical guide for the systemic treatment of BTC in Canada, providing valuable insights into the current and future treatment landscape for this challenging disease. |
| first_indexed | 2024-03-11T00:01:41Z |
| format | Article |
| id | doaj.art-d675e5bc97264225a33cf325df2fb002 |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-11T00:01:41Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-d675e5bc97264225a33cf325df2fb0022023-11-19T00:46:11ZengMDPI AGCurrent Oncology1198-00521718-77292023-07-013087132715010.3390/curroncol30080517A Practical Guide for the Systemic Treatment of Biliary Tract Cancer in CanadaRavi Ramjeesingh0Prosanto Chaudhury1Vincent C. Tam2David Roberge3Howard J. Lim4Jennifer J. Knox5Jamil Asselah6Sarah Doucette7Nirlep Chhiber8Rachel Goodwin9Division of Medical Oncology, Department of Medicine, Nova Scotia Health, Dalhousie University, Halifax, NS B3H 2Y9, CanadaDepartment of Surgery and Oncology, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC H4A 3J1, CanadaDivision of Medical Oncology, Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, CanadaDepartment of Radiology, Radiation Oncology and Nuclear Medicine, University of Montreal, Montreal, QC H3T 1A4, CanadaDivision of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, CanadaDivision of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2M9, CanadaDepartment of Medicine, Division of Medical Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, CanadaIMPACT Medicom Inc., Toronto, ON M6S 3K2, CanadaIMPACT Medicom Inc., Toronto, ON M6S 3K2, CanadaDivision of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H 8L6, CanadaBiliary tract cancers (BTC) are rare and aggressive tumors with poor prognosis. Radical surgery offers the best chance for cure; however, most patients present with unresectable disease, and among those receiving curative-intent surgery, recurrence rates remain high. While other locoregional therapies for unresectable disease may be considered, only select patients may be eligible. Consequently, systemic therapy plays a significant role in the treatment of BTC. In the adjuvant setting, capecitabine is recommended following curative-intent resection. In the neoadjuvant setting, systemic therapy has mostly been explored for downstaging in borderline resectable tumours, although evidence for its routine use is lacking. For advanced unresectable or metastatic disease, gemcitabine-cisplatin plus durvalumab has become the standard of care, while the addition of pembrolizumab to gemcitabine-cisplatin has also recently demonstrated improved survival compared to chemotherapy alone. Following progression on gemcitabine-cisplatin, several chemotherapy combinations and biomarker-driven targeted agents have been explored. However, the optimum regimen remains unclear, and access to targeted agents remains challenging in Canada. Overall, this article serves as a practical guide for the systemic treatment of BTC in Canada, providing valuable insights into the current and future treatment landscape for this challenging disease.https://www.mdpi.com/1718-7729/30/8/517biliary tract cancercholangiocarcinomagallbladder carcinomasystemic therapyadjuvant therapyneoadjuvant therapy |
| spellingShingle | Ravi Ramjeesingh Prosanto Chaudhury Vincent C. Tam David Roberge Howard J. Lim Jennifer J. Knox Jamil Asselah Sarah Doucette Nirlep Chhiber Rachel Goodwin A Practical Guide for the Systemic Treatment of Biliary Tract Cancer in Canada Current Oncology biliary tract cancer cholangiocarcinoma gallbladder carcinoma systemic therapy adjuvant therapy neoadjuvant therapy |
| title | A Practical Guide for the Systemic Treatment of Biliary Tract Cancer in Canada |
| title_full | A Practical Guide for the Systemic Treatment of Biliary Tract Cancer in Canada |
| title_fullStr | A Practical Guide for the Systemic Treatment of Biliary Tract Cancer in Canada |
| title_full_unstemmed | A Practical Guide for the Systemic Treatment of Biliary Tract Cancer in Canada |
| title_short | A Practical Guide for the Systemic Treatment of Biliary Tract Cancer in Canada |
| title_sort | practical guide for the systemic treatment of biliary tract cancer in canada |
| topic | biliary tract cancer cholangiocarcinoma gallbladder carcinoma systemic therapy adjuvant therapy neoadjuvant therapy |
| url | https://www.mdpi.com/1718-7729/30/8/517 |
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