From 10 to 14 April Vienna was the venue for the International Liver Congress, the annual congress of the European Association for the Study of the Liver (EASL) dedicated to all liver diseases (such as steatosis, hepatitis, cirrhosis), including oncological diseases.

As part of this event was also held a symposium organized by EASL and ESMO (European Society for Medical Oncology) dedicated to cancers of the biliary tract which was also attended by Dr. Lorenza Rimassa, Deputy Head of the Operative Unit of Medical Oncology and Head of the Cancer section of Gastroenteric Apparatus of Humanitas, with a presentation on cholangiocarcinoma entitled “Multidisciplinary Approach to Cholangiocarcinoma. From Diagnosis to Treatment According to Patient Profile”.

Cholangiocarcinoma represents 10-15% of primary liver cancers and in about 60-70% of patients the diagnosis is made when the tumor is at an advanced stage.

The medical therapies in clinical practice

Patients with cholangiocarcinoma are often diagnosed at an advanced stage and only 20% are operable. After surgery, in many cases the tumor tends to recur and the patients are therefore subjected to post-operative or adjuvant chemotherapy.

“As the BILCAP study showed, the treatment with capecitabine (a drug already in use for other cancers) after surgery improves the prognosis in terms of lengthening survival and decreasing recurrences. Patients with advanced, relapsing or metastatic disease, on the other hand, are treated with a combination of gemcitabine and cisplatin, an effective treatment scheme that has been the standard of care for ten years. Where the disease progresses, however, although the clinical practice has additional drugs, we can not talk about a real standard of care,” stressed Dr. Rimassa.

Ongoing medical treatments

There are several research programs dedicated to biological therapies for advanced disease.

“In the last few years, molecular alterations of bile duct tumors, especially intrahepatic ones, have been studied. Examples include translocations of the FGFR-2 receptor and IDH-1 mutations. Humanitas is active in two international multicentre studies with two new drugs targeting FGFR-2 receptor translocations. One of the two studies is evaluating the efficacy of derazantinib in patients already treated with chemotherapy. The second is a phase III study with pemigatinib in patients not previously treated with chemotherapy, which could lead to the inclusion of the molecule in clinical practice, if the good results obtained so far are confirmed. We also participated in the ClarIDHy study, a phase III study in patients with IDH-1 mutation.

Finally, other drugs such as regorafenib and BRAF and MEK inhibitors are being studied and work is also underway on immunotherapy, although the results obtained so far with the latter are mixed,” concluded Dr. Rimassa.