Hépato-Gastro & Oncologie Digestive


Medical therapy for advanced biliary tract cancers Volume 27, supplement 6, Décembre 2020


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1 CHRU de Besançon, Service d’oncologie médicale, 3 Boulevard Alexandre Fleming, 25030 Besançon
2 Institut Curie, Université Versailles Saint-Quentin, Département d’oncologie médicale, 35 rue Dailly, 92210 Saint-Cloud
* Correspondance

Biliary tract cancers (BTC) are a heterogeneous group of epithelial neoplasms, with a poor prognosis, with therapeutic evolutions in recent years. In this review, we provide an overview of the treatment options that can be proposed in advanced BTC and their application in clinical practice. A large number of patients cannot receive specific treatments and are only treated with supportive care (including biliary drainage), which is central to the management of BTC. Gemcitabine and platinum-based chemotherapy is the standard first-line therapy in advanced BTC. Recently, FOLFOX (5-fluorouracil, folinic acid plus oxaliplatin) regimen became the only second-line therapy to be prospectively validated beyond failure of gemcitabine plus cisplatin combination in a phase III study, even though chemotherapy yielded modest survival improvement over best supportive care. The question of the best second-line treatment to offer and the selection of patients likely to benefit the most from these treatments remains unresolved. Since 2015, knowledge about the molecular heterogeneity of BTC has considerably increased with the advent of large-scale genomic and transcriptomic analyzes, opening up new perspectives for so-called targeted therapies. Patients with BTC may be particularly good candidates for biomarker-driven strategies in clinical practice. Among the ongoing developments, the targeting of fibroblast growth factor receptor (FGFR) and isocitrate dehydrogenase (IDH) gene alterations are the most promising avenues, and immunotherapies are being evaluated in clinical trials.