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    Medical treatment for cholangiocarcinoma

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    Authors
    Adeva, J
    Sangro, B
    Salati, M
    Edeline, J
    La, C
    Bittoni, A
    Berardi, R
    Bruix, J
    Valle, Juan W
    Affiliation
    Department of Medical Oncology, Hospital Universitario, 12 de Octubre, Madrid, Spain
    Issue Date
    2019
    
    Metadata
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    Abstract
    Most of patients with cholangiocarcinoma (CCA) present with advanced (inoperable or metastatic) disease, and relapse rates are high in those undergoing potentially-curative resection. Previous treatment nihilism of patients with advanced disease has been replaced by active clinical research with the advent of randomized clinical trials (RCTs) and a much greater effort at understanding molecular mechanisms underpinning CCA. Three RCTs have recently been reported evaluating adjuvant chemotherapy following curative resection; only one of these has the potential to change practice. The BILCAP study failed to meet its primary endpoint by intention-to-treat (ITT) analysis; however, a survival benefit was seen in a pre-planned sensitivity analysis (predominantly adjusting for lymph nodes status). This, along with the numerical difference in median overall survival has led to uptake of adjuvant capecitabine by many clinicians. In patients with advanced disease, the only level 1 data available supports the use of cisplatin and gemcitabine for the first-line treatment of patients with advanced disease; there is no established second-line chemotherapy. Previous forays into targeted therapy have proven unfruitful (namely targeting the epithelial growth factor receptor [EGFR] and vascular endothelial growth factor [VEGF] pathways). An increasing number of genomic subtypes are being defined; for some of these on-target therapeutic options are under active investigation. The most developed are studies targeting IDH-1 (isocitrate dehydrogenase) mutations and FGFR-2 (fibroblast growth factor receptor) fusions, with promising early results. Several other pathways are under evaluation, along with early studies targeting the immune environment; these are too premature to change practice to date. These emerging treatments are discussed.
    Citation
    Adeva J, Sangro B, Salati M, Edeline J, La Casta A, Bittoni A, et al. Medical treatment for cholangiocarcinoma. Liver Int. 2019.
    Journal
    Liver International
    URI
    http://hdl.handle.net/10541/621773
    DOI
    10.1111/liv.14100
    PubMed ID
    30892822
    Additional Links
    https://dx.doi.org/10.1111/liv.14100
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1111/liv.14100
    Scopus Count
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