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.

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.

Early Detection

Most bile duct cancers are diagnosed when it's already progressed to late stage, when it is unresectable (cannot be removed with surgery) and incurable. But researchers are studying ways to screen for bile duct cancer so that it can be diagnosed at an earlier and curable stage. Tests currently being studied check a person's blood or bile sample to look for bile duct cancer biomarkers or circulating tumor DNA that might mean cancer is present.

Treatment

Studies are also being done to find better ways of treating bile duct cancer.

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 the tumor is resectable (removable with surgery), but the person or their liver might not be healthy enough for the surgery. Studies looking at options for minimally invasive surgery are ongoing.

Better ways to use laparoscopic surgery are also being tested and compared to open surgery. Adjuvant and neoadjuvant treatments (treatments 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. Traditional radiation therapy uses photon or electron beams that release energy all along their path and can damage healthy tissues as well as cancer cells. Proton beams, however, release their energy at their destination (the tumor). 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.

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

Many drugs that target a specific change (mutation) in cancer cells have been FDA approved and are in use today. These include drugs that target mutations, including NTRK, RET, BRAF, FGFR2, IDH1, RET, KRAS, and HER2. Studies that look at other targetable mutations are ongoing.

Another area of active research is looking at how combining targeted therapy with other forms of therapy, such as chemotherapy, can better help kill bile duct cancer cells. Different drug combinations are being tested for use in treating bile duct cancer in clinical trials.

Photodynamic therapy (PDT)

During photodynamic therapy (PDT), a doctor gives an inactive form of a drug and then directs a special light at the tumor in the bile duct. This is done using an endoscope in a procedure similar to endoscopic retrograde cholangiopancreatography (ERCP). It causes a chemical change in the drug, activating it to eliminate the tumor cells where the light is directed.

PDT is currently used to relieve pain and symptoms, not to eliminate bile duct cancer. Doctors are also looking at whether PDT can reduce the risk of a stent becoming blocked by stopping the tumor from growing into it.