1. Evaluating the Therapeutic Potential of Durvalumab in Adults with Locally Advanced or Metastatic Biliary Tract Cancer: Evidence to Date
- Author
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Storandt MH, Jin Z, and Mahipal A
- Subjects
durvalumab ,immunotherapy ,cholangiocarcinoma ,bile duct cancers ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Michael H Storandt,1 Zhaohui Jin,2 Amit Mahipal3 1Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA; 3Department of Medical Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USACorrespondence: Amit Mahipal, University Hospitals Seidman Cancer Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA, Tel +1 216-844-3951, Email Amit.mahipal@UHhospitals.orgAbstract: Advanced biliary tract cancers (BTCs) have historically been managed with chemotherapy but, in recent years, this treatment paradigm has begun to shift with the introduction of immune checkpoint inhibitors in addition to standard of care chemotherapy. The tumor microenvironment of BTC may be enriched with regulatory T lymphocytes and immune checkpoint expression in some patients. Durvalumab, an anti-programmed death ligand-1 (PD-L1) antibody, in combination with gemcitabine and cisplatin, has now received United States Food and Drug Administration approval for treatment of advanced BTC. Regulatory approval was based on the Phase III, randomized TOPAZ-1 trial that demonstrated survival benefit with addition of durvalumab to gemcitabine plus cisplatin compared to chemotherapy alone. The combination of chemotherapy and immunotherapy was well tolerated, and a subset of patients were able to achieve a durable response, with a 2-year overall survival rate of 23.6%. However, limitations remain in identifying which patients are most likely to benefit from immune checkpoint inhibition. Future study should aim to identify biomarkers predictive of substantial benefit, as well as the role of immune checkpoint inhibition in combination with targeted therapies and radiotherapy in the management of advanced BTC.Keywords: durvalumab, immunotherapy, cholangiocarcinoma, bile duct cancers
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- 2024