Unresectable biliary tract cancer: Current and future systemic therapy.

For decades, treatment of advanced biliary tract cancer (BTC) was confined to the use of chemotherapy. In recent years however, the number of therapeutic options available for patients with unresectable BTC have drastically increased, with immunotherapy and targeted treatment gradually joining the ranks of guideline-recommended treatment regimens. The aim of the present review is to summarise the current knowledge on unresectable BTC focusing on epidemiology, anatomical distribution and current strategies for systemic treatment. We further outline ongoing clinical trials and provide an outlook on future therapeutic interventions. In the realm of gastrointestinal malignancies, the increasing number of systemic treatment options for BTC is finally delivering on the longstanding commitment to personalised oncology. This emphasises the need for considering a comprehensive genomic-based pathology assessment right from the initial diagnosis to fully leverage the expanding array of therapeutic options that have recently become accessible.

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Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing interest DZ reported receiving honoraria from AstraZeneca, receiving research funding for the institution from Milteny and travel as well as accommodation expenses from AstraZeneca and Amgen. KD has received travel support from Servier, GSK and BMS, as well as honoraria from AstraZeneca. CBW has received honoraria from Amgen, Bayer, BMS, Chugai, Celgene, Falk, GSK, MSD, Merck, Janssen, Ipsen, Roche, Servier, SIRTeX and Taiho; served on advisory boards for Bayer, BMS, Celgene, Janssen, MSD, Servier, Shire/Baxalta, Rafael Pharmaceuticals, RedHill and Roche; has received travel support by Bayer, Celgene, Janssen, RedHill, Roche, Servier and Taiho and research grants (institutional) by Roche. MH reported receiving travel support from Servier and honoraria for scientific presentations from Falk Foundation. SO reported no conflict of interest. JN reported no conflict of interest. MS reported receiving lecture fees from AstraZeneca, Bayer Healthcare, Cook Medical, Sirtex Medical, LIAM GmbH, Balt and research grants from AstraZeneca, Roche, Bayer Healthcare, Sirtex Medical. JR reported reported no conflict of interest. EDT has served as a paid consultant for AstraZeneca, Bayer, BMS, EISAI, Eli Lilly & Co, MSD, Mallinckrodt, Omega, Pfizer, IPSEN, Terumo and Roche. He has received reimbursement of meeting attendance fees and travel expenses from Arqule, Astrazeneca, BMS, Bayer, Celsion and Roche and lecture honoraria from BMS and Falk. He has received third-party funding for scientific research from Arqule, AstraZeneca, BMS, Bayer, Eli Lilly and IPSEN and Roche. FK reported no conflict of interest. HA reported receiving consulting honoraria from Pfizer, Servier. TR reported being employee of Servier Deutschland GmbH. SB had a consulting and advisory role for Celgene, Servier, Incyte, Fresenius, Janssen-Cilag, AstraZeneca, MSD and BMS and received honoraria for scientific presentations from Roche, Celgene, Servier and MSD. VH received honoraria for talks and advisory board role for Merck, Amgen, Roche, Sanofi, Servier, Pfizer, Pierre-Fabre, AstraZeneca, BMS; MSD, Novartis, Terumo, On- cosil, NORDIC, Seagen, GSK. Research funding from Merck, Amgen, Roche, Sanofi, Boehringer-Ingelheim, SIRTEX, Servier.