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World J Gastrointest Oncol. Aug 15, 2022; 14(8): 1446-1455
Published online Aug 15, 2022. doi: 10.4251/wjgo.v14.i8.1446
Immunotherapy in biliary tract cancers: Current evidence and future perspectives
Pedro Luiz Serrano Uson Junior, Raphael LC Araujo
Pedro Luiz Serrano Uson Junior, Center for Personalized Medicine, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
Raphael LC Araujo, Department of Surgery, Universidade Federal de São Paulo, São Paulo 04039-002, Brazil
Raphael LC Araujo, Department of Oncology, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
Author contributions: Araujo RLC and Uson Junior PLS performed the literature review, collected all the data and wrote the manuscript; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raphael LC Araujo, MD, PhD, Adjunct Professor, Surgical Oncologist, Department of Surgery, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715, São Paulo 04039-002, Brazil. raphael.l.c.araujo@gmail.com
Received: February 12, 2022
Peer-review started: February 12, 2022
First decision: April 17, 2022
Revised: April 30, 2022
Accepted: July 6, 2022
Article in press: July 6, 2022
Published online: August 15, 2022
Abstract

Bile duct tumors are comprised of tumors that originate from both intrahepatic and extrahepatic bile ducts and gallbladder tumors. These are aggressive tumors and chemotherapy is still the main treatment for advanced-stage disease and most of these cases have a poor overall survival. Strategies are aimed at treatments with better outcomes and less toxicity which makes immunotherapy an area of ​​significant importance. Recent Food and Drug Administration approvals of immune checkpoint inhibitors (ICI) for agnostic tumors based on biomarkers such as microsatellite instability-high and tumor mutation burden-high are important steps in the treatment of patients with advanced bile duct tumors. Despite limited responses with isolated checkpoint inhibitors in later lines of systemic treatment in advanced disease, drug combination strategies have been demonstrating encouraging results to enhance ICI efficacy.

Keywords: Biliary tract cancer, Cholangiocarcinoma, Anti-programmed cell death protein-1, Anti-programmed death ligand-1, Microsatellite instability high, Tumor mutational burden high

Core Tip: Chemotherapy remains the main treatment for advanced bile duct tumors regardless of tumor aggressiveness and poor overall survival rates. The Food and Drug Administration has approved immune checkpoint inhibitors for agnostic tumors based on biomarkers such as microsatellite instability-high and tumor mutation burden-high. They are important steps in combined treatment with systemic chemotherapy for patients with advanced disease and show encouraging results.