Bile Duct Cancer Treatment

Treatment for bile duct cancer depends on:

• Where the tumor began

• Cancer stage

• Whether it can be completely removed

• Whether cancer has spread

• Biomarker results

• Liver function

• Overall health

• Previous treatments

Because cholangiocarcinoma is rare and treatment can be complex, patients may benefit from evaluation at a cancer center with experience treating bile duct cancer.

Surgery

Surgery is generally the preferred treatment when bile duct cancer can be completely removed. The exact procedure depends on where the tumor is located.

Intrahepatic bile duct cancer surgery

Treatment may involve a partial hepatectomy, in which the surgeon removes the part of the liver containing the tumor. Nearby lymph nodes may also be removed.

Perihilar bile duct cancer surgery

Surgery may involve removing:

• The affected bile ducts

• Part of the liver

• Nearby lymph nodes

• Sometimes the gallbladder

The remaining bile ducts are then reconstructed.

Distal bile duct cancer surgery

Distal bile duct cancers are often treated with a Whipple procedure, also called pancreaticoduodenectomy. This surgery can involve removing:

• Part of the pancreas

• The distal bile duct

• The gallbladder

• Part of the small intestine

• Sometimes part of the stomach

• Nearby lymph nodes

Liver transplant

A liver transplant may be an option for a carefully selected group of patients with certain perihilar bile duct cancers. Patients usually undergo specialized treatment before transplantation and must meet strict eligibility criteria.

Chemotherapy after surgery

Chemotherapy may be recommended after surgery to lower the risk that cancer will return. This is called adjuvant chemotherapy. Capecitabine is commonly used after resection in appropriate patients.

Treatment for advanced bile duct cancer

For unresectable or metastatic biliary tract cancer, chemotherapy combined with immunotherapy has become an important first-line approach. Options can include:

• Durvalumab plus gemcitabine and cisplatin

• Pembrolizumab plus gemcitabine and cisplatin

Targeted therapy

Targeted therapies attack specific molecular changes within cancer cells. This is one reason comprehensive biomarker testing is particularly important in advanced cholangiocarcinoma.

FGFR2 fusions or rearrangements

Some intrahepatic bile duct cancers have alterations involving FGFR2. Targeted drugs can include:

• Pemigatinib

• Futibatinib

These therapies may be options for certain previously treated cancers with qualifying FGFR2 alterations.

IDH1 mutations

Some cholangiocarcinomas contain an IDH1 mutation. Ivosidenib is a targeted therapy for certain previously treated locally advanced or metastatic cholangiocarcinomas with an IDH1 mutation.

HER2-positive biliary tract cancer

Some bile duct cancers overexpress or amplify HER2. HER2-targeted treatment may be an option for selected patients with advanced disease.

Other molecular changes

Additional alterations can sometimes provide targeted treatment options or clinical trial opportunities, including:

• BRAF V600E

• NTRK fusions

• RET alterations

• MSI-high or mismatch repair deficient tumors

Radiation therapy

• Radiation therapy may be used:

• After surgery in selected cases

• For locally advanced disease

• To help control tumors that cannot be removed

• To relieve pain or other symptoms

Radiation may sometimes be combined with chemotherapy.

Biliary drainage and stents

If a tumor blocks the bile duct, restoring bile flow may be an important part of treatment. Doctors may use:

• Endoscopic stents

• Percutaneous drainage

• Biliary bypass surgery

Improving bile drainage can relieve jaundice and itching and may improve liver function enough for other cancer treatments to begin.

Palliative and supportive care

Palliative care is appropriate at any stage of cancer. It can help manage:

• Pain

• Jaundice

• Itching

• Nausea

• Fatigue

• Loss of appetite

• Weight loss

• Emotional distress

• Treatment side effects

Palliative care can be provided while you are receiving active cancer treatment.