Biliary tract cancers: French national clinical practice guidelines for diagnosis, treatments and follow-up (TNCD, SNFGE, FFCD, UNICANCER, GERCOR, SFCD, SFED, AFEF, SFRO, SFP, SFR, ACABi, ACHBPT).

Thierry De Baere, Valérie Paradis, David Malka, Côme Lepage, Romain Coriat, Anthony Lopez, Anthony Turpin, Olivier Bouché, Cindy Neuzillet, Maxime Ronot, Astrid Lièvre, Loic Verlingue, Anne-Laure Bretagne-Bignon, Marine Camus-Duboc, Samy Horn, Valérie Laurent-Croise, Julie Meilleroux, Gilles Créhange, Antonio Sa Cunha, Gael S Roth, Matthieu Sarabi, Clarisse Dromain, Christelle de la Fouchardière, Olivier Soubrane, Christophe Louvet, Frédéric Prat, Maximiliano Gelli, Olivier Rosmorduc, Sylvain Manfredi, Jean-Frédéric Blanc, Boris Guiu, Karim Boudjema, Emmanuel Boleslawski, Julien Edeline

Journal: European journal of cancer (Oxford, England : 1990) 2024;202():114000

PMID: 38493667

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Abstract

INTRODUCTION

This document is a summary of the French intergroup guidelines of the management of biliary tract cancers (BTC) (intrahepatic, perihilar and distal cholangiocarcinomas, and gallbladder carcinomas) published in September 2023, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org).

METHODS

This collaborative work was conducted under the auspices of French medical and surgical societies involved in the management of BTC. Recommendations were graded in three categories (A, B and C) according to the level of scientific evidence until August 2023.

RESULTS

BTC diagnosis and staging is mainly based on enhanced computed tomography, magnetic resonance imaging and (endoscopic) ultrasound-guided biopsy. Treatment strategy depends on BTC subtype and disease stage. Surgery followed by adjuvant capecitabine is recommended for localised disease. No neoadjuvant treatment is validated to date. Cisplatin-gemcitabine chemotherapy combined to the anti-PD-L1 inhibitor durvalumab is the first-line standard of care for advanced disease. Early systematic tumour molecular profiling is recommended to screen for actionable alterations (IDH1 mutations, FGFR2 rearrangements, HER2 amplification, BRAF mutation, MSI/dMMR status, etc.) and guide subsequent lines of treatment. In the absence of actionable alterations, FOLFOX chemotherapy is the only second-line standard-of-care. No third-line chemotherapy standard is validated to date.

CONCLUSION

These guidelines are intended to provide a personalised therapeutic strategy for daily clinical practice. Each individual BTC case should be discussed by a multidisciplinary team.

Address: Univ. Grenoble Alpes / Hepato-Gastroenterology and Digestive Oncology department, CHU Grenoble Alpes / Institute for Advanced Biosciences, CNRS UMR 5309-INSERM U1209, Grenoble, France.; Medical Oncology Department, Centre Léon Bérard, 28 rue Laennec, Lyon, France.; Gastroenterology Department, Hopital privé Jean Mermoz, 69008 Lyon, France.; Digestive Oncology Unit, CHU Bordeaux, Bordeaux, France.; Univ. Lille, INSERM U1189, CHU Lille, Service de Chirurgie Digestive et Transplantations, Lille, France.; Département de chirurgie viscérale hépatobiliaire, CHU de Rennes, Rennes, France.; Hepatogastroenterology, CHU Caen, France.; Endoscopie digestive, Hôpital Saint-Antoine, AP-HP/Sorbonne Université, Paris France.; Service de gastroentérologie, d'endoscopie et d'oncologie digestive, Hôpital Cochin, APHP, Paris, France.; Radiation Oncology Department. Paris/Saint-Cloud/Orsay, Institut Curie. PSL Research University, Paris, France.; Département de Radiologie Interventionnelle, Gustave Roussy, 94805 Villejuif, France.; Medical Oncology Department, Institut Paoli Calmette, Marseille, France.; Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Universitaire Vaudois, Switzerland.; Medical Oncology, Centre Eugene Marquis, Rennes, France.; Département de Chirurgie Viscérale, Gustave Roussy, 94805 Villejuif, France.; Department of Radiology, St-Eloi University Hospital - Montpellier School of Medicine, Montpellier, France.; Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Pierre Benite, France.; Department of Radiology, Centre Hospitalier Universitaire de Nancy, Hôpital de Brabois, 54500 Vandœuvre-lès-Nancy, France.; Université de Bourgogne, CHU Dijon-Bourgogne, INSERM U1231. BP 87 900, 14 rue Paul Gaffarel, 21079 Dijon, France.; Department of Gastroenterology, Rennes University Hospital, University of Rennes 1, INSERM Unité 1242, Rennes, France.; INSERM U1256, NGERE, Faculty of Medicine, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France; Department of Hepatology and Gastroenterology, Nancy University Hospital, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France, NGERE, Faculty of Medicine, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France.; Pathology and Cytology Department, CHU Toulouse, IUCT Oncopole, Toulouse Cedex 9, France.; GI Oncology, Department of Medical Oncology, Institut Curie - Site Saint Cloud, Versailles Saint-Quentin University, Paris Saclay University, Saint-Cloud, France.; Université Paris Cité, APHP.Nord Sce d'Anatomie Pathologique Hôpital Beaujon, Clichy, INSERM UMR 1149, France.; Endoscopie digestive, Hôpital Beaujon, Clichy, France.; Department of Medical Imaging, Beaujon University Hospital, Clichy, France.; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, INSERM U1193, Université Paris-Saclay, FHU Hépatinov, France.; Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France.; Department of Medical Oncology, CNRS UMR9020, Inserm UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, University Lille, CHU Lille, Lille; GERCOR, Paris, France.; Department of Medical Oncology, Institute Mutualiste Montsouris, Paris, France.; Gastroenterology and Digestive Oncology Department, Robert-Debré University Hospital, Reims, France.; Department of Medical Oncology, Institute Mutualiste Montsouris, Paris, France. Electronic address: [email protected].

DOI: 10.1016/j.ejca.2024.114000