Intrahepatic cholangiocarcinoma: current management and emerging therapies.
Intrahepatic cholangiocarcinoma (iCCA) is a malignancy with an increasing incidence and a high-case fatality. While surgery offers the best hope at long-term survival, only one-third of tumors are amenable to surgical resection at the time of the diagnosis. Unfortunately, conventional chemotherapy offers limited survival benefit in the management of unresectable or metastatic disease. Recent advances in understanding the molecular pathogenesis of iCCA and the use of next-generation sequencing techniques have provided a chance to identify 'target-able' molecular aberrations. These novel molecular therapies offer the promise to personalize therapy for patients with iCCA and, in turn, improve the outcomes of patients. Area covered: We herein review the current management options for iCCA with a focus on defining both established and emerging therapies. Expert commentary: Surgical resection remains as an only hope for cure in iCCA patients. However, frequently the diagnosis is delayed till advanced stages when surgery cannot be offered; signifying the urge for specific diagnostic tumor biomarkers and targeted therapies. New advances in genomic profiling have contributed to a better understanding of the landscape of molecular alterations in iCCA and offer hope for the development of novel diagnostic biomarkers and targeted therapies.
a Department of Surgery , University of Washington Medical Center , Seattle , WA , USA.
Amir A
AA
Rahnemai-Azar
b Department of Surgery , The Ohio State University Wexner Medical Center , Columbus , OH , USA.
Allison B
AB
Weisbrod
b Department of Surgery , The Ohio State University Wexner Medical Center , Columbus , OH , USA.
Mary
M
Dillhoff
b Department of Surgery , The Ohio State University Wexner Medical Center , Columbus , OH , USA.
Carl
C
Schmidt
b Department of Surgery , The Ohio State University Wexner Medical Center , Columbus , OH , USA.
Timothy M
TM
Pawlik
D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000235:genetics / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D018281:Cholangiocarcinoma / Q000235:genetics / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D020022:Genetic Predisposition to Disease; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects; D025202:Molecular Diagnostic Techniques; D058990:Molecular Targeted Therapy; D010641:Phenotype; D057285:Precision Medicine; D011237:Predictive Value of Tests; D015398:Signal Transduction / Q000187:drug effects
D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor
Biliary tract cancer; genomics; intrahepatic cholangiocarcinoma; molecular pathogenesis; molecular targeted therapies; systemic therapy