John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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New standards and personalised approaches in cholangiocarcinoma Volume 26, supplement 6, Décembre 2019

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Author
Institut Curie, Université Versailles Saint-Quentin, Département d’Oncologie Médicale, 35 rue Dailly, 92210 Saint Cloud
* Correspondance

Biliary tract carcinoma (BTC) is a group of tumors developed from biliary epithelium that displays anatomical, prognostic, molecular and therapeutic heterogeneity. The diagnosis of cholangiocarcinoma (CCA), especially intrahepatic CCA, may be difficult by imaging, the main differential diagnoses being hepatocellular carcinoma in cirrhotic patients, and metastases of adenocarcinoma of extrahepatic primary site. In localized BTCs, surgical resection should be considered whenever possible and discussed in a multidisciplinary team experienced in hepatobiliary surgery. After surgery, capecitabine adjuvant therapy for 6 months is considered a new standard since the publication of the results of the BILCAP Phase III study. The diagnosis is most often made at an advanced stage (70%), not accessible to surgery. Chemotherapy with gemcitabine plus cisplatin (CISGEM) and 5FU, folinic acid and oxaliplatin (FOLFOX) are the current standards in advanced BTCs respectively in first and second line. Management is currently evolving with the molecular dismemberment of these tumors for personalized medicine, in particular for intrahepatic CCAs. IDH and FGFR alterations, each identified in approximately 10%-20% of intrahepatic CCAs, are the two main “modern” therapeutic targets in BTCs with the most advanced clinical development.

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