What’s new in bile duct cancer research and treatment?
Bile duct cancer is an uncommon cancer, which in some ways makes it harder to study than more common cancer types. But research into the causes, diagnosis, and treatment of bile duct cancer is currently being done in many medical centers throughout the world.
Doctors are constantly improving the surgical techniques used to treat bile duct cancers and looking for ways to make more people eligible for surgery. One potential option, a liver transplant, was discussed in the section “Surgery for bile duct cancer.”
Other options are also being explored. For example, sometimes surgery to remove the cancer might technically be possible, but it can’t be done because it might not leave enough healthy liver behind after the operation. One option might be to cut off the blood supply to the part of the liver that’s going to be removed (known as portal vein embolization). As this part of the liver shrinks, the other part of the liver grows to compensate. After several weeks, there might be enough healthy liver on this side to go ahead with the operation to remove the tumor.
Radiation therapy and chemotherapy
Researchers are looking at newer ways of increasing the effectiveness of radiation therapy. Some techniques, such as three-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), and stereotactic body radiation therapy (SBRT), are widely available and allow doctors to better aim radiation to affect only the tumor and to spare nearby normal tissues. Other radiation techniques such as intra-operative radiation therapy (IORT) and proton beam radiation therapy may be helpful but are not widely available.
Other forms of radiation therapy are also being studied. For example, doctors are looking at whether radioactive stents placed inside bile ducts might help shrink tumors and keep the ducts open longer than standard stents. Another approach being studied is the injection of tiny radioactive beads into the hepatic artery (known as radioembolization). The beads lodge in the blood vessels near the tumor, where they give off small amounts of radiation.
Doctors are also testing different combinations of chemotherapy (chemo) drugs with radiation therapy, both on their own and before and after surgery.
In general, the effects of chemo against bile duct cancer have been found to be limited, but newer drugs and combinations of drugs are being tested. Newer ways to give chemo are also being studied. For example, trans-arterial chemoembolization (TACE) combines embolization (blocking off blood vessels supplying the tumor) with chemotherapy. Most often, this is done by using tiny beads that give off a chemo drug to plug up the hepatic artery.
Newer drugs are being developed that work differently from standard chemo drugs. These drugs target specific parts of cancer cells or their surrounding environments.
One target of several newer drugs is tumor blood vessels. Bile duct tumors need new blood vessels to grow beyond a certain size. Sorafenib (Nexavar®), bevacizumab (Avastin®), pazopanib (Votrient®), and regorafenib (Stivarga®) are examples of drugs that target blood vessel growth and are being studied against bile duct cancer.
Other new drugs have different targets. For example, EGFR, a protein that helps cells grow, is found in high amounts on some cancer cells. Drugs that target EGFR have shown some benefit against several types of cancer. Some of these drugs, such as cetuximab (Erbitux®) and panitumumab (Vectibix®) are now being studied for use in people with bile duct cancer, usually in combination with chemotherapy or other targeted drugs.
Drugs known as MEK inhibitors, such as trametinib (Mekinist®), are also being studied for use against bile duct cancer.
Last Medical Review: 11/01/2014
Last Revised: 11/01/2014