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    New horizons for precision medicine in biliary tract cancers.

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    Authors
    Valle, Juan W
    Lamarca, Angela
    Goyal, L
    Barriuso, Jorge
    Zhu, A
    Issue Date
    2017-08-17
    
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    Abstract
    Biliary tract cancers (BTC), including cholangiocarcinoma and gallbladder cancer, are poor-prognosis and low-incidence cancers, although the incidence of intrahepatic cholangiocarcinoma is rising. A minority of patients present with resectable disease but relapse rates are high; benefit from adjuvant capecitabine chemotherapy has been demonstrated. Cisplatin/gemcitabine combination chemotherapy has emerged as the reference first-line treatment regimen; there is no standard second-line therapy. Selected patients may be suitable for liver-directed therapy (e.g., radioembolization or external beam radiation), pending confirmation of benefit in randomized studies. Initial trials targeting the epithelial growth factor receptor and angiogenesis pathways have failed to deliver new treatments. Emerging data from next-generation sequencing analyses have identified actionable mutations (e.g., FGFR fusion rearrangements and IDH1 and IDH2 mutations), with several targeted drugs entering clinical development with encouraging results. The role of systemic therapies, including targeted therapies and immunotherapy for BTC, is rapidly evolving and is the subject of this review.Significance: The authors address genetic drivers and molecular biology from a translational perspective, in an intent to offer a clear view of the recent past, present, and future of BTC. The review describes a state-of-the-art update of the current status and future directions of research and therapy in advanced BTC. Cancer Discov; 7(9); 1-20. ©2017 AACR.
    Citation
    New horizons for precision medicine in biliary tract cancers. 2017 Cancer Discov
    Publisher
    Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK
    Journal
    Cancer Discovery
    URI
    http://hdl.handle.net/10541/620530
    DOI
    10.1158/2159-8290.CD-17-0245
    PubMed ID
    28818953
    Type
    Article
    Language
    en
    ISSN
    2159-8290
    ae974a485f413a2113503eed53cd6c53
    10.1158/2159-8290.CD-17-0245
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