The latest UK research and clinical trials looking at bile duct cancer (cholangiocarcinoma).
Tests to diagnose
The TRANSBIL trial is looking into a new way of diagnosing bile duct cancer. Researchers have developed a new test which looks for a protein called Mcm5. Mcm5 stands for mini chromosome maintenance protein 5. This protein is involved in cell growth and division.
The research so far suggests that it is an accurate test. For this trial the researchers take a biopsy from your bile duct and test it for the Mcm5 protein. You can only join this trial if your doctors think you may have a disease of the bile duct.
Chemotherapy after surgery can help to stop some types of cancer coming back. Doctors think that capecitabine (Xeloda) may help to stop bile duct cancers coming back after surgery but they are not sure yet.
The BILCAP trial is comparing surgery and capecitabine with surgery alone. The researchers also want to find out more about side effects of capecitabine. This trial has now closed and we are waiting for the results.
ABC 02 trial
Researchers have been looking for the best type of chemotherapy for people with advanced bile duct cancer. The ABC 02 trial compared gemcitabine on its own with gemcitabine and cisplatin.
The trial found that people who had both drugs lived for 11 months. The people who had just gemcitabine lived on average for 8 months. The researchers also compared the side effects. The people who had both drugs were more likely to have a drop in the number of blood cells but otherwise the side effects were similar.
ABC 06 trial
Chemotherapy can shrink or slow down the growth of an advanced cancer, but after a while it can get worse again. When this happens, the main priority is to control your symptoms as much as possible. This is called active symptom control.
Researchers for the ABC 06 trial want to see if having another type of chemotherapy as well as active symptom control helps people in this situation. They are looking at the chemotherapy drugs oxaliplatin and fluorouracil (5FU) for people with advanced bile duct cancer or gall bladder cancer (billiary tract cancers).
Liver transplant research
Researchers in America are looking into transplants for people with intrahepatic and hilar bile duct cancers that have not spread. Sometimes a bile duct tumour affects both lobes of the liver or is not possible to remove with surgery.
In this situation your surgeon may suggest a transplant. This type of surgery is not an option for many people. Even if a transplant is possible, it can be very difficult to get a new liver.
With liver transplant surgery there is a risk of the cancer coming back afterwards. About 1 in 5 people who have surgery on its own (20%) are alive 5 years later.
More recent research showed that having a combination of chemotherapy and radiotherapy (chemoradiotherapy) before transplant surgery can lower the risk of the cancer coming back. A trial found that nearly half of the people who had this treatment (50%) were alive 5 years after surgery.
Another study found that 4 out of 5 people who had chemotherapy and radiotherapy (chemoradiotherapy) before surgery (80%) were alive at 5 years. However this treatment can cause many serious side effects. It is a treatment option for only a very small number of people with early cancer that has not spread. It is not available in the UK at the moment.
Photodynamic therapy (PDT) uses light to kill cancer cells. First you take a drug that is taken up by the cancer cells and makes them sensitive to light. Then the doctor shines a very bright light onto the cancer. The light activates the drug and kills the cells.
PHOTOSTENT 02 trial
A stent is a small tube put into the bile duct to relieve a blockage, so that bile can flow normally into the bowel. A phase 2 trial found that there were very few problems with doing this.
The PHOTOSTENT 02 trial aims to find out if having PDT and a stent works better than a stent on its own. Early results don’t show that it works better than having a stent alone. The trial has now closed and we are waiting for the full results.
The drug that you have with PDT is broken down by the body. But doctors think that up to a quarter of it could still be in the body a month after treatment. This could mean that the drug builds up in the body if you have a second treatment. A phase 4 trial is going on to find out how quickly the drug is lost from the body and if there is a build up that could cause side effects in people who have a second dose.
Photochemical internalisation (PCI) trial
An early trial is looking at a new treatment called photochemical internalisation (PCI) for bile duct cancer that cannot be removed with surgery. For this treatment, you have 2 drugs - Amphinex (which makes body tissue sensitive to light) and gemcitabine chemotherapy.
After having these drugs, the doctor directs a laser light on to the cancer. The light activates the Amphinex, which then helps the gemcitabine to get into the cancer cells and kills them.
Biological therapies are treatments that act on processes in cancer cells.
ABC 04 trial
A phase one trial called ABC 04 is looking at whether adding the biological therapy selumetinib to gemcitabine and cisplatin works better than these 2 drugs alone. This trial has now closed and we are waiting for the results.
Radiofrequency ablation uses heat made by radio waves to kill cancer cells. Radiofrequency is a type of electrical energy. Ablation means to completely destroy.
Early research suggests that RFA is safe and can help to control bile duct cancers that start in the liver and can’t be removed with an operation. Researchers in Asia have found that it can also control bile duct cancers in the liver that come back after surgery.
Internal radiotherapy is a new treatment researchers are looking into for bile duct cancers in the liver. Millions of tiny beads (sometimes called microspheres) are fed into the hepatic artery, the main blood vessel which supplies the liver.
These beads block the supply of blood to the cancer. They contain a radioactive substance called yttrrium-90, so they also work by sending out radiation. This helps to kill off the cancer cells. This treatment is called selective internal radiation therapy (SIRT) or radioembolisation.
SIRT is beginning to be used in a small number of hospitals in the UK.
Quality of life
Treatment trials for cancer now nearly always include studies of quality of life as part of the main study.
A small study recently tested a quality of life questionnaire for people who have gallbladder or bile duct cancer.