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Cholangiocarcinoma - evolving concepts and therapeutic strategies
#MMPMID28994423
Ilyas SI
; Khan SA
; Hallemeier CL
; Kelley RK
; Gores GJ
Nat Rev Clin Oncol
2018[Feb]; 15
(2
): 95-111
PMID28994423
show ga
Cholangiocarcinoma is a disease entity comprising diverse epithelial tumours with
features of cholangiocyte differentiation: cholangiocarcinomas are categorized
according to anatomical location as intrahepatic (iCCA), perihilar (pCCA), or
distal (dCCA). Each subtype has a distinct epidemiology, biology, prognosis, and
strategy for clinical management. The incidence of cholangiocarcinoma,
particularly iCCA, has increased globally over the past few decades. Surgical
resection remains the mainstay of potentially curative treatment for all three
disease subtypes, whereas liver transplantation after neoadjuvant chemoradiation
is restricted to a subset of patients with early stage pCCA. For patients with
advanced-stage or unresectable disease, locoregional and systemic
chemotherapeutics are the primary treatment options. Improvements in
external-beam radiation therapy have facilitated the treatment of
cholangiocarcinoma. Moreover, advances in comprehensive whole-exome and
transcriptome sequencing have defined the genetic landscape of each
cholangiocarcinoma subtype. Accordingly, promising molecular targets for
precision medicine have been identified, and are being evaluated in clinical
trials, including those exploring immunotherapy. Biomarker-driven trials, in
which patients are stratified according to anatomical cholangiocarcinoma subtype
and genetic aberrations, will be essential in the development of targeted
therapies. Targeting the rich tumour stroma of cholangiocarcinoma in conjunction
with targeted therapies might also be useful. Herein, we review the evolving
developments in the epidemiology, pathogenesis, and management of
cholangiocarcinoma.