What's New in Bile Duct Cancer Research?

Because bile duct cancer is rare, it's been hard to study. Most experts agree that treatment in a clinical trial should be considered for any type or stage of bile duct cancer. This way people can get the best treatment available now and may also get the treatments that are thought to be even better.

Research on bile duct cancer is taking place in many university hospitals, medical centers, and other institutions around the world. Each year, scientists find out more about what causes the disease, how to prevent it, and how to better treat it. The new and promising treatments discussed here tend to only be available in clinical trials.

Surgery

Doctors are constantly improving the surgical techniques used to treat bile duct cancers and looking for ways to make surgery possible for more people.

For instance, sometimes surgery to remove the cancer might be possible, but it can’t be done because it might not leave enough healthy liver behind. One option being studied is 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. Over time, there might be enough healthy liver to go ahead with the operation to remove the part of the liver with the tumor.

Better ways to use laparoscopic surgery are also being tested and compared to open surgery. Adjuvant and neoadjuvant treatments, those used before and after surgery, are also active areas of research interest. Doctors are looking for ways to combine other treatments with surgery to improve outcomes.

Radiation therapy

Researchers are looking at better ways to use radiation therapy. One example is using a different type of radiation called proton beam radiation therapy. This form of radiation uses proton beams instead of the usual photon or electron beams. Protons are parts of atoms that cause little damage to tissues they pass through but are very good at killing cells at the end of their path. This means that proton beam radiation may be able to deliver more radiation to the tumor while reducing side effects on normal tissues.

Other ways to use 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 widely studied is the injection of tiny radioactive beads into the hepatic artery, which carries blood to the area of the cancer. The beads lodge in the blood vessels near the tumor, where they give off small amounts of radiation. This is called transarterial radioembolization or TARE. So far, studies have shown good results with TARE, but more research is needed.

Chemotherapy

In general, the effects of chemo against bile duct cancer have been found to be limited, but new drugs and new combinations of drugs are being tested. Studies are also looking for better ways to combine chemo with other treatments, like surgery, radiation, and liver transplant.

There's a lot of research interest in combining chemotherapy and targeted therapy.

Targeted therapy

Drugs have been developed that work differently from standard chemo drugs. These drugs can target specific changes in cancer cells that help them grow and survive. They can also change certain proteins made by the cancer cells to cause the cells to die. Targeted drugs can work with the immune system to help it find and kill cancer cells, too. Many of these drugs are being tested for use in treating bile duct cancer.

Many other kinds of cancers are already treated with targeted therapy. As researchers learn more about the changes in bile duct cells that cause them to become cancer, they're looking to use targeted drugs that focus on killing the cells with these changes.

For instance, some of these drugs target tumor blood vessels. Bile duct tumors need new blood vessels to grow beyond a certain size. Bevacizumab (Avastin®), erlotinib (Tarceva®), ramuciruman (Cyramza ®), and regorafenib (Stivarga®) are examples of drugs that target blood vessel growth and are being studied against bile duct cancer.

Other 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 many 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, often in combination with chemotherapy or other targeted drugs.

Other types of targeted therapy, such as MEK inhibitors (like tivantinib ) and anti-PD1 drugs (like pembrolizumab [Keytruda®]), are also being studied for use against bile duct cancer.

Again, this is an active area of research, but a lot more research is needed to find out if targeted therapy works and which drugs work best in treating bile duct cancer.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: July 3, 2018 Last Revised: July 3, 2018

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