PTENES
← All articles

From my research · Biliary tract

45 years of biliary tract cancer research: what has changed and what is still missing

We analyzed every clinical trial on biliary tract cancer published over 45 years. The conclusion: precision medicine has begun to change a story that had made very little progress.

Dr. Maria Fernanda Teixeira · Translational Gastroenterology and Hepatology, 2026

What we did

In this systematic review, an international group of researchers gathered 427 clinical trials, involving more than 23,000 patients with biliary tract cancer, and analyzed how these trials were designed and what they achieved over 45 years.

What we found

~12 monthstypical survival in advanced disease, almost unchanged over the years
2×higher chance of response with treatments guided by the genetic profile
  • In first-line trials for advanced disease, typical survival stayed at around 12 months, despite ever-larger trials.
  • When treatment was chosen based on a genetic change in the tumor, the chance of the tumor responding nearly doubled, even in patients who no longer responded to other treatments.
  • Trials of immunotherapy and of genetic markers more than doubled between 2020 and 2023.
  • The patients studied poorly reflect real-world diversity: race was reported in fewer than one-fifth of the trials, and when it was, about 80% of participants were white and fewer than 5% were Black.
White: about 80%Black: under 5%Other groups: about 15%
Participants in the trials that reported race (fewer than one-fifth of the total). Chart based on data from the paper.

What this means for you

If you have biliary tract cancer, genetic testing of the tumor should be done early, because it is what opens the door to the treatments that have done the most to change outcomes. It is also worth asking about clinical trials: they are often the way to access the newest treatments.

What is still missing

We need trials that include people of all backgrounds and regions, including Brazil, and that follow more consistent standards, so that the results apply to all patients.

Reference

  1. Uson Junior PLS, et al., Teixeira MF, et al. Landscape of clinical trials and impact of precision medicine in biliary tract cancers in the last 45 years: a systematic review and meta-analysis of biomarker-driven trials. Translational Gastroenterology and Hepatology, 2026. doi.org/10.21037/tgh-2026-0015

For information only. It does not replace an individual medical assessment.