Development of Combination Therapies for Biliary Tract Cancers: A Rational Approach

A rare group of gastrointestinal malignancies with a significant morbidity and death rate are biliary tract tumors. Most patients arrive with a locally progressed or metastatic illness that is incurable. It was possible to directly benefit from the pathophysiology of biliary tract cancer, and as a result, chemotherapy, precision medicine, immunotherapy, and combination therapies were used as both standard-of-care and experimental therapies. 

Recent studies demonstrated that the immune-based chemotherapy combination of durvalumab with gemcitabine and cisplatin offered better survival than chemotherapy alone in the first-line context. Patients with specific genetic changes in IDH1, FGFR2, KRAS, BRAF, ERBB2, NTRK, ROS, RET, mismatch repair deficiency, or microsatellite instability can be treated using precision medicine in the second line. Fluoropyridine doublets only modestly improved results in those individuals who did not have gene changes. 

To better understand the genetic pathways behind resistance, next-generation sequencing was crucial for both clinical practice and research. For a study, researchers sought to offer an update on developing standards of care and continuing investigational drugs, limits to existing therapies, and a framework for efficient combination medication development for the future. Currently, several clinical studies at various stages are ongoing.

Reference: journal-of-hepatology.eu/article/S0168-8278(22)03078-1/fulltext

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