A Global Perspective on Cholangiocarcinoma

Experts from around the world emphasized the global burden of cholangiocarcinoma (CCA) during a Keynote Panel, “A Global Perspective on CCA: Perspectives on Research and Treatment from the US, EU, Latin America, and Asia” at the 3rd Annual CCA Summit.

This panel included Milind M. Javle, MD (United States); Bruno Nervi, MD (Chile); Jesús M. Bañales, PhD (Spain); Juan W. Valle, MBChB, MSc (European Union); Do-Youn Oh, MD, PhD (Korea); Virote Sriuranpong, MD (Thailand); and Rheun Chuan Lee, MD (Taipei).

Dr Bañales began by discussing the importance of implementing the new ICD-11 codes to improve the understanding of CCA subtypes across the globe. He emphasized the need to expand surveillance programs and increase education and awareness of lifestyle factors that increase the risk for CCA.

Clinical registries currently involve 34 European institutions and 13 countries, as well as 10 Latin American institutions and 5 countries. Education and scientific collaborative activities are also ongoing.

According to Dr Nervi, there are interesting opportunities to collaborate in international research, including epidemiologic, clinical, and basic/translational research. There are 19 million people living in Chile, he said, which has the highest incidence of gallbladder cancer worldwide. A national cancer registry is planned to be launched in the near future.

Dr Bañales emphasized the need to encourage participation of other continents in mentoring those programs. As a result of the COVID-19 pandemic, people have learned to do more things virtually, which provides more opportunities for interactions and partnership with the Cholangiocarcinoma Foundation, reaching individuals beyond Europe and the United States—in Latin America, Asia, and Africa.

A consortium for African countries was recently created, offering multiple opportunities for collaboration. One of the primary goals is to try to expand the clinical trial registry.

Dr Sriuranpong noted that the incidence of liver flukes is high in the northeast region of Thailand. In this area, he said, the focus is on the elimination of traditional lifestyle factors associated with liver fluke infection, and the implementation of screening programs. This is likely to identify more cases of CCA at an early stage and reduce mortality.

Dr Oh explained that previously, the main cause of CCA in Korea was liver flukes, but now the causes are thought to be similar to that of Western countries. In general, not as many patients with CCA and FGFR fusions are seen in Korea, but the incidence of CCA with IDH1 mutation may be similar to that of Western countries. Approximately 33% of Korean patients with biliary tract cancer have gallbladder cancer, she said.

According to Dr Sriuranpong, access to medicine in Thailand is complicated, because of difficulties with reimbursement. Approximately 90% of the population rely on universal healthcare coverage. And according to Dr Nervi, approximately 20% of the population in Chile rely on universal healthcare coverage. Few targeted therapies of biologics are therefore easily accessible to patients in these countries.

Dr Bañales noted that experts in different disciplines are working together to enhance the understanding of how accurately models reflect the patients, and to be able to predict successful clinical trials. The friendly environment in this field is very helpful and unique, he said, and everyone needs to take advantage to move the field forward.

“In addition to having the scientists, clinicians, chemists all infused in trying to develop things for cholangiocarcinoma, we mustn’t forget the patient advocacy that’s really helped to support this work and helped to bring us all together,” said Dr Valle. “They’ve really been pivotal in making sure that the patient groups are galvanized, and are challenging us so that we step up, and we improve, and we accelerate the innovation for the benefit of patients.”