Cholangiocarcinoma remains a surgical disease, but even with a successful resection the recurrence rate is about 70%.
Rory L. Smoot, M.D., surgical oncologist at Mayo Clinic’s campus in Rochester, Minnesota, is an expert on cholangiocarcinoma and other biliary tract cancers. Hear Dr. Smoot discuss the systemic treatments and next-generation sequencing done at Mayo Clinic to extend patients’ lives while even more treatment discoveries are being made. there's more attention being paid to clinch a carcinoma ability tract cancers. And there's several kind of classifications that we use when we talk about bility tract cancers. We're talking about intra paddock, lanza carcinoma, extra petit clamart carcinoma which could be perry heiler or distal And then gallbladder cancer qualifies as well for classic Arsenal in general still remains what we call a surgical disease and that the only chance of cure is if we can take it all out and even in the setting of being able to take it out, the recurrence rates are about 70% over five years. And so what we're starting to understand is that and come to grips with I guess is that these probably already have spread at least microscopically by the time we meet a patient. And so more and more we understand the role of systemic therapies or standard chemotherapy approaches. And one of the newer options is what we call triplet therapy. So this combination there's a combination of jim side. I mean is this Platen which has been routinely used for these type of tumors. But um within the last two years there's been a Phase two study that was partially led by by Mayo Clinic showed that the addition of drug called nab paclitaxel, that combination had more efficacy for patients. They had a better a longer overall survival when they were on that. And there seemed to be more response. Um in those tumors it's a little bit more toxic. And so the patients have to be monitored carefully for blood counts and things like that. But it did provides more benefit to the patients. But once a teacher has been diagnosed we typically do recommend either at final pathology at the time of surgery or initially. Especially if somebody is in a candidate for surgery with a biopsy that they undergo next generation sequencing. What we're really looking is for some of these molecular subtypes because there are a few that have very specific targeted therapies. FGFR two fusion which is a fusion of the fiber blast growth factor receptor too. Um it fuses to another protein and um and then drives activity. And there's a very specific drug of very specific FGF. inhibitor that's now been approved for treatment of those patients. And then there's another one called I. D. H. One and two mutations. There's some treatments and trials that are ongoing with those medications. So it may may open up the possibility of a clinical trial for those patients. It is not uncommon now that we do treat some of these patients with certain types of the tumors especially probably gall bladder cancer and the inter Patrick Clancy carcinomas with some chemotherapy before we go to the operating room to try to get at that systemic disease before we narrow in on the on the on the main tumor. Well it gives me a lot of hope. There's a lot of unique targeting techniques that we're using now to try to understand in very very sophisticated ways the immune cells that are there in the U. S. I would say that most patients with these type of US should be evaluated here because we have options for not only surgical resection but liver transplant in some cases. Um and then um and then access to some of the newer clinical trials that are that are ongoing. Our cure rates are better than they have been. You know, and with the targeted therapies, we're extending people's lives dramatically. The real goal at this point is to is to shoot for a cure because the rate at which medical discoveries are being are being developed. If we can just push this down the road a little bit for the patient, then we have the option for new and better things to come along.