Bile duct cancer research
This page is about research into the causes, prevention, and treatment of bile duct cancer (cholangiocarcinoma). You can find the following information
- A quick guide to what’s on this page
- Why we need research
- Clinical trials
- Tests to diagnose bile duct cancer
- Chemotherapy for bile duct cancer
- Chemotherapy for advanced bile duct cancer
Bile duct cancer research
All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so we can be sure they are safe. We also need to find out whether they work better than the treatments we already use. Treatments are developed and tested in laboratories, and then tested in people in clinical trials. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many clinical trials.
There are not many trials for bile duct cancer (cholangiocarcinoma) treatment in the UK because it is not a common cancer in this country. There is research into diagnosing bile duct cancer, using chemotherapy, photodynamic light therapy, radiofrequency ablation, and liver transplant.
You can view and print the quick guides for all the pages in the Treating bile duct cancer section.
All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that
- We can be sure they work
- We can be sure they work better than the treatments that are available at the moment
- They are known to be safe
First of all, treatments are developed and tested in laboratories. Cancer Research UK supports a lot of UK laboratory research into cancer. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS.
Tests in patients are called clinical trials. There are 4 phases of clinical trials. Cancer Research UK supports many clinical trials. If you are interested in taking part in a trial recruiting in the UK for bile duct and gallbladder cancer, visit our searchable database of clinical trials.
If there is a trial you are interested in, you can print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to refer you to the research team.
Because bile duct cancer is rare, there are fewer clinical trials than for more common types of cancer. It is hard to organise and run trials for rare cancers. It can take a long time to recruit the number of patients needed. Getting enough patients is critical to the success of a trial. If the trial is too small, the results won't be powerful enough to prove that one type of treatment is any better than another.
Here is a video on what it's like to take part in a clinical trial:
View a transcript of the video (Opens in a new window)
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.
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.
Below is a video about the trial and its results.
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). The researchers want to find out if this combination of chemotherapy is helpful, to learn more about the side effects, and to use blood and tumour samples to look at how this type of cancer can best be treated in the future.
A liver transplant is a major operation. Doctors 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. We know from research that people who have a transplant but have no other treatment have a high risk of their cancer coming back. 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 (chemoradiation) 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. A more recent American trial found that 4 out of 5 people who had chemotherapy and radiotherapy (chemoradiation) before surgery (80%) were alive at 5 years. However this treatment can cause many serious side effects. The researchers say 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.
The PHOTOSTENT 02 trial is looking at using PDT with a stent as a way of relieving the symptoms of advanced bile duct cancer. 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.
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. The doctors want to find out the best dose of Amphinex and laser light to use, to learn more about the side effects, and to see if PCI and chemotherapy is better than chemotherapy alone for bile duct cancer.
You can find out more about trials for bile duct on our clinical trials database.
Radiofrequency ablation uses heat made by radio waves to kill cancer cells. Radiofrequency is a type of electrical energy. Ablation means to completely destroy.
You have RFA through a probe that goes through your skin into the tumour. The probe produces electrical energy, which heats the tumour and kills the cancer cells.
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.
We have more detailed information about radiofrequency ablation on our website.
Biological therapies are treatments that act on processes in cancer cells. There is information about biological therapy in our cancer treatments section.
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.
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.
NICE has issued guidance about SIRT. They say that there is limited evidence about how well it works, but it may be helpful for some people. They say it can be a treatment option for people with intrahepatic bile duct cancer as long as they understand that doctors are still learning about how well it works and about side effects. They recommend doctors treating people with SIRT should be monitored and registered on the SIRT database.
SIRT is beginning to be used in a small number of hospitals in the UK. It is most often used to help with symptoms of cancer, rather than to cure it. It can also be used to treat cancer that has spread to the liver (liver metastases).
Read more about SIRT.
It is important to research how the symptoms of bile duct cancer and the side effects of treatment affect people's 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. It found that it could accurately measure patient’s quality of life. Now a larger international study is planned.
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