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Cancers of the Gallbladder and Biliary Ducts

Cancers of the Gallbladder and Biliary Ducts

Drs. Yee and colleagues have done an excellent job of
surveying the treatment of gallbladder cancer and cholangiocarcinomas. These
relatively uncommon tumors are among the more difficult encountered by surgical,
medical, and radiation oncologists, as evidenced by the lack of new therapies or
change in prognosis over the past several decades.

Progress in surgical intervention has been hampered by advanced disease stage
at presentation and lack of effective adjuvant therapy. Where results appear
more favorable, denominators tend to be small, selected, and uncontrolled.
Adjuvant chemotherapy and radiotherapy trials generally cannot be anticipated
because of the small and geographically dispersed population sample from which
eligible candidates could be selected. Moreover, the generally poor response
rates to chemotherapy in patients with disseminated disease provide little
enthusiasm for choosing an agent to be studied over the number of years it would
require to complete such trials.

How, then, do we attempt to make progress against this dismal backdrop?
Clearly, understanding the etiology of biliary tract cancers in order to
implement screening and detection of earlier disease would accomplish the most
in terms of enhancing cure and survival. Discovery of molecular etiologic clues
may also provide targets for future therapies that are more specific and,
therefore, potentially more effective in the treatment of these disease
entities.

Elucidating Molecular Pathogenesis

Microarray technology is in its infancy for the detection of genetic
abnormalities associated with specific tumor types. The goal is not only to
define the genetic pathway of disease development by comparing tumor and normal
tissue profiles in large numbers of samples, but also to define the timing and
specific mutations or deletions involved in tumorigenesis with the hope of
providing discrete targets for therapeutic intervention.[1]

Recent examples of this analytic approach have been seen with colorectal and
hepatocellular cancers.[2,3] Uncommon tumors for which there is little empiric,
effective therapy would seem ideal for examination in this fashion. Indeed,
currently available targeted therapies have been developed in cancers of lower
incidence (eg, acute promyelocytic leukemia, chronic myelogenous leukemia,
gastrointestinal stromal tumors) and in subsets of cancers with particular
molecular-biological markers (eg, c-erbB2 in HER2/neu-positive breast cancer).

Signal Transduction Targets

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