2021 CSCO Guidelines Conference|Professor Zhou Jun: Progress and Prospects of Diagnosis and Treatment of Biliary Tract Malignant Tumors

Malignant tumors of the biliary tract mainly include gallbladder cancer and cholangiocarcinoma, accounting for about 3% of all digestive system tumors, most of which are adenocarcinomas, which are aggressive and have a very poor prognosis.

At present, the incidence of biliary malignant tumors is increasing year by year, causing more and more attention.

Recently, the Chinese Society of Clinical Oncology (CSCO) Guidelines Conference was successfully held in Beijing.

During the meeting, Professor Zhou Jun from Peking University Cancer Hospital shared with you the updated points of the guidelines for diagnosis and treatment of biliary malignant tumors.

After the meeting, Yimaitong was fortunate to invite Professor Zhou Jun to interpret the new version of the guidelines for the diagnosis and treatment of biliary malignancies, discuss the future research hotspots and development directions of targeted and immunotherapy in the field of biliary malignancies, and share the challenges and solutions for diagnosis and treatment in the field of biliary malignancies.
Program.

Expert Profile Professor Jun Zhou, Deputy Chief Physician, Department of Digestive Oncology, Peking University Cancer Hospital, CSCO Pancreatic Cancer Expert Committee Member, CSCO Liver Cancer Expert Committee Member, CSCO Biliary Tumor Expert Committee Member, Chinese Anti-Cancer Association Pancreatic Cancer Professional Committee CSPAC Member, Chinese Society of Geriatrics Oncology Branch Director General Deputy Director General of the Chinese Geriatric Cancer Association Deputy Chairman of the Youth Committee of the Chinese Research Hospital Gastrointestinal Tumor Special Committee Member of the Chinese Research Hospital Association Precision Medicine and Tumor MDT Specialty Committee Member of the 2021 CSCO Biliary Malignant Tumor Diagnosis and Treatment Guidelines Interpretation of Professor Zhou Jun : The "2021 CSCO Guidelines for the Diagnosis and Treatment of Biliary Tract Malignancies" is under the leadership of the chairman, Professor Liang Houjie, and members of the expert group are currently revising the guidelines.
The guidelines announced at this meeting are preliminary revisions and the final guidelines will be finalized in the near future.

This update of the guidelines is mainly reflected in two aspects: radiotherapy and system therapy.

In terms of radiotherapy, based on a META analysis published in 2020 and combined with the original Phase II study data, the guidelines have added recommendations for postoperative adjuvant radiotherapy.

In terms of system therapy, the main updates are focused on targeted therapy and immunotherapy.

First of all, for BRAF V600E mutant biliary malignant tumors, a small foreign phase II clinical study confirmed that dabrafenib combined with trametinib has an effective rate of 47% and a survival period of 14 months.

Based on this, the guidelines have added a recommendation for the second-line treatment of dabrafenib combined with trametinib for advanced biliary malignancies with BRAF V600E mutation (recommended by level II experts).

Secondly, IDH1 inhibitors and FGFR2 inhibitors have made great progress in the clinical research of biliary malignant tumors.
However, due to the reasons that the current domestic drugs are not available, the guidelines list them as a level III expert recommendation.

In addition, a small sample size study of Sun Yat-Sen University showed that gemcitabine + oxaliplatin + lenvatinib + teriprizumab has an effective rate of up to 80%, and the disease control rate is close to 100%, so it is listed as First-line treatment for advanced biliary tumors (recommended by level III experts).

The future research hotspots and development directions of targeted therapy and immunotherapy in the field of biliary malignancies Professor Jun Zhou: Malignant tumors of the biliary tract are highly heterogeneous and can be divided into gallbladder cancer, intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma according to the location.
They have different molecular biological characteristics.

Therefore, the direction of targeted therapy for biliary malignant tumors in the future is precision therapy, that is, to identify a certain type of population through genomics or proteomics, and then conduct exploratory research on such populations.

Immune combination therapy is the current research hotspot, including immunotherapy combined with chemotherapy, targeted therapy, anti-vascular drugs or targeted therapy + chemotherapy.

It is believed that the research on targeting and immunotherapy of biliary malignant tumors will be more colorful in the future, and the patient population will also be more detailed.

Diagnosis and treatment challenges and solutions in the field of biliary malignancies Professor Jun Zhou: At present, there are many research hotspots in the field of biliary malignancies and the development direction is scattered.

In China, the diagnosis and treatment of malignant tumors of the biliary tract is facing the problem of standardization.

Compared with other large tumor types, the number of patients with biliary tract tumors is small, so it is difficult to carry out large-scale clinical research.

Under this premise, the diagnosis and treatment of malignant tumors of the biliary tract requires standardized multi-center and multi-disciplinary cooperation.

Secondly, the precise treatment of biliary malignancies is also a major challenge.

When clinically subdividing the biliary tract tumor population, the number of specific patients may be very small.
This requires the cooperation of domestic biliary tumor experts and various centers to achieve precise treatment of biliary tumors.