July 01, 2020
About 8,000 people in the United States are diagnosed with gallbladder and bile duct cancers each year. The actual number of cases is likely to be higher, because these cancers can be difficult to diagnose. Anup Kasi, MD, MPH, holds clinical interests in gastrointestinal, pancreatic, colorectal, gastric, esophageal, liver and anal cancers as well as neuroendocrine tumors. His research efforts are focused on investigator-initiated clinical trials (IIT’s), developmental therapeutics and translational research. Below, Dr. Kasi shares his insights on these cancer types as well as what related research efforts are taking place.
Q: How do these two locations – gallbladder and bile duct – relate to one another?
A: The bile duct is a thin tube, about four to five inches long, that starts from the liver and opens into the small intestine. The main function of the bile duct is to carry the bile juice from the liver and gallbladder to the small intestine, where digestion of fat in food takes place. The gallbladder is a small organ that stores bile and is located about one-third of the way along the length of the bile duct. It communicates with the bile duct via a small tube called a ‘cystic duct.’
Q: Why is it important for the public to know about this type of cancer?
A: Though the incidence of gallbladder and bile duct cancer is low in the United States, it is associated with high mortality. For people with early-stage bile duct cancer, the 5-year survival rate is 15-30 percent. If it has spread to a distant part of the body, the 5-year survival rate is 2 percent.
Hence, detecting it early and molecular profiling of tumors could improve outcomes. Red flags to watch out for to seek evaluation include yellowing of the skin and/or eyes, clay-colored stools, itching, fever, loss of appetite and/or weight, and pain in the upper right abdomen that may radiate to the back.
Q: What research efforts are taking place regarding this type of cancer?
A: Molecular profiling, or identifying very specific information about the molecular and genetic makeup of the tumor, can help identify personalized treatment options.
Research has revealed that up to 40-50 percent of patients with gallbladder and/or bile duct cancer can harbor a number of mutations that are identified with molecular profiling. This has radically changed the treatment approach, as these mutations can be targeted by novel drugs. There have been a number of promising targeted therapies and immunotherapies that have been and that are currently being investigated in clinical trials.”
For example, one of my patients with gallbladder cancer was found to have an MSI high marker [meaning that there is a high amount of instability in a tumor], and we are treating her with immunotherapy. A follow-up CT scan showed resolution of cancer spots. She is receiving immunotherapy now for two years without any evidence of cancer.
Q: What efforts have been made here at The University of Kansas Cancer Center?
A: As an NCI-designated cancer center, we have the ability to carry out molecular profiling of gallbladder and bile duct tumors to identify actionable mutations, meaning mutations that can be targeted in therapy. We strongly recommend molecular profiling, so that we can personalize cancer treatment for each patient. In addition to standard chemotherapy, molecular profiling would open the door to other treatment options, including targeted therapies, immunotherapies, liver-directed therapies, such as chemoembolization, beads with or without chemo or radiation that can be released directly inside the liver, and ablation using microwaves, and access to clinical trials that are open at KU Cancer Center.
Q: Why is research on gallbladder and bile duct cancer important to you?
A: Patients with bile duct and gallbladder cancer have very poor prognoses and few standard treatment options. Hence, research and molecular profiling could provide additional personalized treatment options, including access to clinical trials that may provide these patients the chance to longer and maintained quality of life. Moreover, targeted therapies and immunotherapies could be less toxic than standard chemotherapy-based treatments.