What is the future of cholangiocarcinoma?
Genetic and molecular profiling is a fast expanding area of interest across all cancers. Patients with the same type of cholangiocarcinoma will not have the same genetic mutations in their cancer cells, as no two tumors are the same. Molecular profiling looks at the mutations present within the patient’s cancerous cells and so far, in cholangiocarcinoma, several genetic mutations and other genetic abnormalities have been identified2,9:
- ARID1A/B and ARID2
Some mutations can be more common in certain subsets of cholangioncarcinoma than in others. Knowing the molecular profile of the tumor can help identify the optimal treatment because the specific mutation(s) affect how, and if, they will respond to treatment. There are some targeted therapies currently under investigation in cholangiocarcinoma and moving forwards it will become more important that patients are biopsied and screened at diagnosis to identify the best treatment approach as quickly as possible.9
When developing a new drug or treatment approach, it is important to prove that it is safe and effective in the patients who will be treated. Clinical trials aim, ultimately, to develop new treatments to improve survival rates or quality of life for patients. There are many ongoing clinical trials in cholangiocarcinoma internationally. The main trials are currently looking at: chemotherapy regimens, targeted therapy (based on genetics), immunotherapy (using the immune system to fight cancer), radiation therapy, other novel treatments (new approaches), and second line treatments (when the first treatment has not worked).
It is recommended that cholangiocarcinoma patients are seen in dedicated centres with multidisciplinary treatment teams, where diagnosis and management can be personalized. At-risk populations (such as those in areas where liver flukes are present) should also be identified, educated about the risk of eating raw fish, and followed-up so that diagnosis occurs as early as possible.5