胆道恶性肿瘤的精准诊疗
DOI: 10.3969/j.issn.1001-5256.2023.09.001
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:范瑞林、丁宗仁负责查阅和归纳文献并撰写论文;曾永毅负责指导撰写与修改论文。
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摘要: 胆道恶性肿瘤是一种高度侵袭性的恶性肿瘤,近年来发病率逐年升高,大多数患者就诊时无手术机会,且传统全身化疗疗效有限。近年来,肿瘤精准治疗理念指导下的靶免治疗在晚期胆道恶性肿瘤中取得了显著进展,本文就胆道恶性肿瘤的精准诊疗进行述评,并对临床应用进行讨论。Abstract: Biliary tract carcinoma (BTC) is a highly invasive malignant tumor, and its incidence rate has been gradually increasing in recent years. Most patients have lost the opportunity for surgery at the time of diagnosis, and traditional systemic chemotherapy has limited efficacy. In recent years, significant progress has been made for targeted immunotherapy guided by the concept of the precise treatment of tumor. This article reviews the precise diagnosis and treatment of BTC and discusses its clinical application.
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Key words:
- Biliary Tract Neoplasms /
- Precision Medicine /
- Diagnosis /
- Therapeutics
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[1] ANDERSEN JB, SPEE B, BLECHACZ BR, et al. Genomic and genetic characterization of cholangiocarcinoma identifies therapeutic targets for tyrosine kinase inhibitors[J]. Gastroenterology, 2012, 142( 4): 1021- 1031. DOI: 10.1053/j.gastro.2011.12.005. [2] IYER P, CHEN MH, GOYAL L, et al. Targets for therapy in biliary tract cancers: The new horizon of personalized medicine[J]. Chin Clin Oncol, 2020, 9( 1): 7. DOI: 10.21037/cco.2019.12.11. [3] LEE AJ, CHUN YS. Intrahepatic cholangiocarcinoma: The AJCC/UICC 8th edition updates[J]. Chin Clin Oncol, 2018, 7( 5): 52. DOI: 10.21037/cco.2018.07.03. [4] VALLE JW, KELLEY RK, NERVI B, et al. Biliary tract cancer[J]. Lancet, 2021, 397( 10272): 428- 444. DOI: 10.1016/S0140-6736(21)00153-7. [5] GUO XR, SHEN WZ. Latest evidence on immunotherapy for cholangiocarcinoma[J]. Oncol Lett, 2020, 20( 6): 381. DOI: 10.3892/ol.2020.12244. [6] STROM BL, MAISLIN G, WEST SL, et al. Serum CEA and CA 19-9: Potential future diagnostic or screening tests for gallbladder cancer?[J]. Int J Cancer, 1990, 45( 5): 821- 824. DOI: 10.1002/ijc.2910450505. [7] TSUMURA T, DOI K, MARUSAWA H. Precision medicine of hepatobiliary and pancreatic cancers: Focusing on clinical trial outcomes[J]. Cancers, 2022, 14( 15): 3674. DOI: 10.3390/cancers14153674. [8] CSOMA SL, BEDEKOVICS J, VERES G, et al. Circulating cell-free DNA-based comprehensive molecular analysis of biliary tract cancers using next-generation sequencing[J]. Cancers, 2022, 14( 1): 233. DOI: 10.3390/cancers14010233. [9] ANGERILLI V, FORNARO L, PEPE F, et al. FGFR2 testing in cholangiocarcinoma: Translating molecular studies into clinical practice[J]. Pathologica, 2023, 115( 2): 71- 82. DOI: 10.32074/1591-951X-859. [10] KATOH M. Fibroblast growth factor receptors as treatment targets in clinical oncology[J]. Nat Rev Clin Oncol, 2019, 16( 2): 105- 122. DOI: 10.1038/s41571-018-0115-y. [11] NEUMANN O, BURN TC, ALLGÄUER M, et al. Genomic architecture of FGFR2 fusions in cholangiocarcinoma and its implication for molecular testing[J]. Br J Cancer, 2022, 127( 8): 1540- 1549. DOI: 10.1038/s41416-022-01908-1. [12] USON JUNIOR PLS, BORAD MJ. Precision approaches for cholangiocarcinoma: Progress in clinical trials and beyond[J]. Expert Opin Investig Drugs, 2022, 31( 1): 125- 131. DOI: 10.1080/13543784.2022.2017882. [13] HELSTEN T, ELKIN S, ARTHUR E, et al. The FGFR landscape in cancer: Analysis of 4, 853 tumors by next-generation sequencing[J]. Clin Cancer Res, 2016, 22( 1): 259- 267. DOI: 10.1158/1078-0432.CCR-14-3212. [14] ABOU-ALFA GK, SAHAI V, HOLLEBECQUE A, et al. Pemigatinib for previously treated, locally advanced or metastatic cholangiocarcinoma: A multicentre, open-label, phase 2 study[J]. Lancet Oncol, 2020, 21( 5): 671- 684. DOI: 10.1016/S1470-2045(20)30109-1. [15] JAVLE M, ROYCHOWDHURY S, KELLEY RK, et al. Infigratinib(BGJ398) in previously treated patients with advanced or metastatic cholangiocarcinoma with FGFR2 fusions or rearrangements: Mature results from a multicentre, open-label, single-arm, phase 2 study[J]. Lancet Gastroenterol Hepatol, 2021, 6( 10): 803- 815. DOI: 10.1016/S2468-1253(21)00196-5. [16] FENG YH, SU WC, OH DY, et al. Updated analysis with longer follow up of a phase 2a study evaluating erdafitinib in Asian patients(pts) with advanced cholangiocarcinoma(CCA) and fibroblast growth factor receptor(FGFR) alterations[J]. J Clin Oncol, 2022, 40( 4_suppl): 430. DOI: 10.1200/JCO.2022.40.4_suppl.430. [17] GOYAL L, MERIC-BERNSTAM F, HOLLEBECQUE A, et al. Futibatinib for FGFR2-rearranged intrahepatic cholangiocarcinoma[J]. N Engl J Med, 2023, 388( 3): 228- 239. DOI: 10.1056/NEJMoa2206834. [18] SUN PK, MA TF, ZHANG TL, et al. Molecular basis for the function of the αβ heterodimer of human NAD-dependent isocitrate dehydrogenase[J]. J Biol Chem, 2019, 294( 44): 16214- 16227. DOI: 10.1074/jbc.RA119.010099. [19] MOLENAAR RJ, MACIEJEWSKI JP, WILMINK JW, et al. Wild-type and mutated IDH1/2 enzymes and therapy responses[J]. Oncogene, 2018, 37( 15): 1949- 1960. DOI: 10.1038/s41388-017-0077-z. [20] ABOU-ALFA GK, MACARULLA T, JAVLE MM, et al. Ivosidenib in IDH1-mutant, chemotherapy-refractory cholangiocarcinoma(ClarIDHy): A multicentre, randomised, double-blind, placebo-controlled, phase 3 study[J]. Lancet Oncol, 2020, 21( 6): 796- 807. DOI: 10.1016/S1470-2045(20)30157-1. [21] WU MJ, SHI L, MERRITT J, et al. Biology of IDH mutant cholangiocarcinoma[J]. Hepatology, 2022, 75( 5): 1322- 1337. DOI: 10.1002/hep.32424. [22] FRIEDLAENDER A, SUBBIAH V, RUSSO A, et al. EGFR and HER2 exon 20 insertions in solid tumours: From biology to treatment[J]. Nat Rev Clin Oncol, 2022, 19( 1): 51- 69. DOI: 10.1038/s41571-021-00558-1. [23] HARDING JJ, PIHA-PAUL SA, SHAH RH, et al. Antitumour activity of neratinib in patients with HER2-mutant advanced biliary tract cancers[J]. Nat Commun, 2023, 14( 1): 630. DOI: 10.1038/s41467-023-36399-y. [24] HARDING J, CLEARY J, QUINN D, et al. Targeting HER2(ERBB2) mutation-positive advanced biliary tract cancers with neratinib: Results from the phase II SUMMIT‘basket’ trial[J]. J Clin Oncol, 2021, 39( 3_suppl): 320. DOI: 10.1200/JCO.2021.39.3_suppl.320. [25] JAVLE M, BORAD MJ, AZAD NS, et al. Pertuzumab and trastuzumab for HER2-positive, metastatic biliary tract cancer(MyPathway): A multicentre, open-label, phase 2a, multiple basket study[J]. Lancet Oncol, 2021, 22( 9): 1290- 1300. DOI: 10.1016/S1470-2045(21)00336-3. [26] MAIR MJ, BARTSCH R, LE RHUN E, et al. Understanding the activity of antibody-drug conjugates in primary and secondary brain tumours[J]. Nat Rev Clin Oncol, 2023, 20( 6): 372- 389. DOI: 10.1038/s41571-023-00756-z. [27] OHBA A, MORIZANE C, KAWAMOTO Y, et al. Trastuzumab deruxtecan(T-DXd; DS-8201) in patients(pts) with HER2-expressing unresectable or recurrent biliary tract cancer(BTC): An investigator-initiated multicenter phase 2 study(HERB trial)[J]. J Clin Oncol, 2022, 40( 16_suppl): 4006. DOI: 10.1200/JCO.2022.40.16_suppl.4006. [28] AVRUCH J, KHOKHLATCHEV A, KYRIAKIS JM, et al. Ras activation of the Raf kinase: Tyrosine kinase recruitment of the MAP kinase cascade[J]. Recent Prog Horm Res, 2001, 56: 127- 55. DOI: 10.1210/rp.56.1.127. [29] SUBBIAH V, LASSEN U, ÉLEZ E, et al. Dabrafenib plus trametinib in patients with BRAF(V600E)-mutated biliary tract cancer(ROAR): A phase 2, open-label, single-arm, multicentre basket trial[J]. Lancet Oncol, 2020, 21( 9): 1234- 1243. DOI: 10.1016/S1470-2045(20)30321-1. [30] ZUO S, CHEN Q, ZOU WL. Current status and prospect of immunotherapy for cholangiocarcinoma[J]. Chin J Dig Surg, 2022, 21( 7): 873- 879. DOI: 10.3760/cma.j.cn115610-20220506-00254.左石, 陈乾, 邹卫龙. 胆管癌免疫治疗的现状与展望[J]. 中华消化外科杂志, 2022, 21( 7): 873- 879. DOI: 10.3760/cma.j.cn115610-20220506-00254. [31] BAGCHI S, YUAN R, ENGLEMAN EG. Immune checkpoint inhibitors for the treatment of cancer: Clinical impact and mechanisms of response and resistance[J]. Annu Rev Pathol, 2021, 16: 223- 249. DOI: 10.1146/annurev-pathol-042020-042741. [32] CARLINO MS, LARKIN J, LONG GV. Immune checkpoint inhibitors in melanoma[J]. Lancet, 2021, 398( 10304): 1002- 1014. DOI: 10.1016/S0140-6736(21)01206-X. [33] XIE QF, WANG LD, ZHENG SS. Prognostic and clinicopathological significance of PD-L1 in patients with cholangiocarcinoma: A meta-analysis[J]. Dis Markers, 2020, 2020: 1817931. DOI: 10.1155/2020/1817931. [34] PIHA-PAUL SA, OH DY, UENO M, et al. Efficacy and safety of pembrolizumab for the treatment of advanced biliary cancer: Results from the KEYNOTE-158 and KEYNOTE-028 studies[J]. Int J Cancer, 2020, 147( 8): 2190- 2198. DOI: 10.1002/ijc.33013. [35] KIM RD, CHUNG V, ALESE OB, et al. A phase 2 multi-institutional study of nivolumab for patients with advanced refractory biliary tract cancer[J]. JAMA Oncol, 2020, 6( 6): 888- 894. DOI: 10.1001/jamaoncol.2020.0930. [36] LEE CK, CHON HJ, CHEON J, et al. Trastuzumab plus FOLFOX for HER2-positive biliary tract cancer refractory to gemcitabine and cisplatin: A multi-institutional phase 2 trial of the Korean Cancer Study Group(KCSG-HB19-14)[J]. Lancet Gastroenterol Hepatol, 2023, 8( 1): 56- 65. DOI: 10.1016/S2468-1253(22)00335-1. [37] BURRIS III HA, OKUSAKA T, VOGEL A, et al. Patient-reported outcomes for the phase 3 TOPAZ-1 study of durvalumab plus gemcitabine and cisplatin in advanced biliary tract cancer[J]. J Clin Oncol, 2022, 40( 16_suppl): 4070. DOI: 10.1200/JCO.2022.40.16_suppl.4070. [38] Guidelines Working Committee of Chinese Society of Clinical Oncology. Chinese Society of Clinical Oncology(CSCO) Guidelines for Diagnosis and Treatment of Biliary Tract Malignancies 2022[M]. Beijing: People’s Medical Publishing House, 2022.中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)胆道恶性肿瘤诊疗指南2022[M]. 北京: 人民卫生出版社, 2022. [39] KELLEY RK, UENO M, YOO C, et al. Pembrolizumab in combination with gemcitabine and cisplatin compared with gemcitabine and cisplatin alone for patients with advanced biliary tract cancer(KEYNOTE-966): A randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet, 2023, 401( 10391): 1853- 1865. DOI: 10.1016/S0140-6736(23)00727-4. [40] TANG ZH, CHEN JL, LIU SY, et al. Significance of combination of targeted therapy and immunotherapy in conversion therapy of biliary tract cancer[J]. Chin J Surg, 2022, 60( 4): 343- 350. DOI: 10.3760/cma.j.cn112139-20220110-00019.汤朝晖, 陈家璐, 刘深洋, 等. 靶免联合治疗在胆道恶性肿瘤转化中应用的意义[J]. 中华外科杂志, 2022, 60( 4): 343- 350. DOI: 10.3760/cma.j.cn112139-20220110-00019. [41] YARCHOAN M, COPE L, RUGGIERI AN, et al. Multicenter randomized phase II trial of atezolizumab with or without cobimetinib in biliary tract cancers[J]. J Clin Invest, 2021, 131( 24): e152670. DOI: 10.1172/JCI152670. [42] COUSIN S, CANTAREL C, GUEGAN JP, et al. Regorafenib-avelumab combination in patients with biliary tract cancer(REGOMUNE): A single-arm, open-label, phase II trial[J]. Eur J Cancer, 2022, 162: 161- 169. DOI: 10.1016/j.ejca.2021.11.012. -

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