This document discusses biliary tract cancers, including key statistics and the current treatment landscape. It notes that biliary tract cancers are a heterogeneous group of cancers where the majority present at an advanced stage. While best supportive care was previously the main treatment approach, recent clinical trials have shown improved outcomes with early systemic therapies. Gemcitabine-cisplatin is now standard first-line therapy but with modest survival gains, so adding immunotherapies like durvalumab are being explored. Overall, it presents biliary tract cancer as an orphan disease that is highly lethal where significant improvements in treatment and understanding are still needed.

1. BTC: Patient Journey and Current
Unmet needs in management
Mohamed Abdulla M.D.
Prof. of Clinical Oncology
Cairo University

2. Speaker
Disclosures:
Member of Advisory Board,
Consultant, and Speaker for:
Amgen, Astellas, AstraZeneca, Hoffman la
Roche, Janssen Cilag, Merck, Novartis,
Mundipharma, MSD, Ely Lilly, Sanofi-
Genzyme, Servier, Bayer, BMS, NewBridge,
Sandoz

3. Biliary tract cancers are a heterogenous group of cancers
40% of all Biliary
Cancers
Klatskin
Tumors Ampulla of Vater
Banales et al. NATURE Reviews. GASTROENTEROLOGY & HEPATOLOGY
volume 17. September 2020. 557

4. Incidence: 2020 data:
Global Reported Cases
115494
Global Mortality Cases
84695
5-Year OAS
20%
Majority Advanced at
Presentation
Banales et al. EXPERT CONSENSUS DOCUMENT. NATURE
REVIEWS, GASTROENTEROLOGY & HEPATOLOGY.
VOLUME 13. MAY 2016, 261.

5. Mortality: 2020 – 2022 Data
Mirallas et al. ESMO Open.
Volume 7 - Issue 3 - 2022

6. Biography Biliary Cancer
Curtesy of Prof. Mohamed Abdulla

7. Having a Case of BTC is ….

8. Cowzer & Harding. Cancers 2022, 14, 1800.
Before 1990

9. mOAS = 6 vs 2.5 ms. P = <0.01
FLv +/- Etoposide

10. Cowzer & Harding. Cancers 2022, 14, 1800.
Before 1990

11. N Engl J Med 2010;362:1273-81.
11.7 ms
8.1 ms 8 ms
5 ms
1st Line Treatment

12. Cowzer & Harding. Cancers 2022, 14, 1800.
Before 1990

14. Cowzer & Harding. Cancers 2022, 14, 1800.
Before 1990

15. Survival FOLFOX + BSC BSC
mOAS 6.2 ms 5.3 ms
6 m OAS Rate 50.6% 35.5%
12 m OAS Rate 25.9 11.4% Lancet Oncol 2021; 22: 690–701
2nd Line Treatment

16. Cowzer & Harding. Cancers 2022, 14, 1800.
Before 1990

17. Lancet Oncol 2021; 22: 1560–72
mPFS: 7.1 vs 1.4 ms

18. Lancet Oncol 2021; 22: 1560–72

19. Cowzer & Harding. Cancers 2022, 14, 1800.
Before 1990

20. e194 2016 ASCO EDUCATIONAL BOOK | asco.org/edbook

21. Cowzer & Harding. Cancers 2022, 14, 1800.
Before 1990

22. 3 – 5%

23. Int. J. Cancer. 2020;147:2190–2198.
KN
158
KN
028

24. British Journal of Cancer (2020) 123:1047–
1059

25. Cowzer & Harding. Cancers 2022, 14, 1800.
Before 1990
2023

26. Biliary Cancer:
• An Orphan Disease & Heterogenous Disease.
• Advanced at Presentation & Highly Lethal.
• BSC was the Main Therapeutic Platforme for Decades.
• Early Systemic Therapies Trials Offered Improved Outcome
• Better Understanding of Disease Back-Stage Paved The Way for
Subsequent and More Treatment Lines.
• Gem-Cis is the standard 1st Line Therapy, but with modest Survival
Gain, Looking Forward to Improve; ADDING ANOTHER BACKBONE AS
DURVALUMAB.
• …. Many Questions and Improvements are Awaited.