Search

Biliary tract cancer is an uncommon cancer in developed countries. In localized stages, surgery is the cornerstone of treatment with curative purpose. Conversely in advanced stages, chemotherapy with platinum-gemcitabine combination is the standard of care. Biliary tract cancers are a biologically heterogeneous group of malignancies, which perhaps explains the failure of targeted therapies in unselected patient populations to demonstrate benefit in advanced disease, although there are promises in selected populations (e.g. PD1/PD-L1 positive, BRAFV600E-mutated or IDH1-mutant). In view of the limited benefit of second line therapies in metastatic biliary tract cancer, various targeted agents have been tested in progressive disease. Furthermore, several ongoing trials are using next-generation sequencing of multiple genes to identify molecular abnormalities in the tumors of patients with refractory cancers that may potentially be used in pretreated disease (e.g. FGFR or IDH genes). Immunotherapy with immune checkpoint inhibitors may be interesting for patients whose tumors have programmed cell death 1 ligand 1 (PD-L1) overexpression. Ongoing and future trials will further advance our knowledge toward the optimal treatment strategy for the management of biliary tract cancer in its different stages, starting from metastatic and then reaching early stages of disease. We here provided an overview of these novel treatment strategies for advanced biliary tract cancers not amenable of curative treatment modalities.

Menaquinone is one of the essential components of the electron transport chain in many pathogens and consequently enzymes in its biosynthesis pathway are potential drug targets for the development of novel antibacterial agents. Few years ago, Li et al.1 identified several 1,4-benzoxazine-2-one derivatives, targeting MenB (1,4-dihydroxy-2-naphtoyl-CoA synthase), endowed with high antibacterial activity against Mycobacteria tuberculosis H37Rv with MIC values of 0.6 μg/ml. By these assumptions, we designed and synthesized some analogous compounds in order to investigate the SAR and to discover new potent antimycobacterial derivatives. First of all, we tried to check the activity of several benzoxazine-3-one isosters and, in our case, the derivative showed low antimycobacterial activity (32->64 μg/ml) contradicting the bioisosterism principle. Then, we tried to modify the substituents on the original 1,4-benzoxazin-2-one core and we found some interesting data that will be presented. Moreover, we synthesized some 2-(arylamino)-4-oxobut-2-enoate derivatives as analogues of O-Succinyllbenzoate (OSB), a precursor in the menaquinone biosynthetic pathway. Details on antitubercular activity will be presented.