Authors
Gagandeep Brar, Juan W Valle
Published in
Expert review of gastroenterology & hepatology. Jul 12, 2026. Epub Jul 12, 2026.
Abstract
Biliary tract cancers (BTC) are highly immunosuppressive 'cold' tumors with limited treatment options. In unresectable or advanced stage disease, the combination of immune checkpoint inhibition with chemotherapy resulted in a modest survival benefit over chemotherapy.
In this review, current obstacles, and strategies to improve the benefit of immunotherapy are highlighted. This includes challenges in optimizing patient selection, understanding the tumor microenvironment and interactions with the gut microbiome, and improving on combination treatment strategies, whether it be with targeted agents, locoregional therapies, or other evolving immune therapies. For this review, we performed a PubMed database search and summarized all relevant clinical studies utilizing ICI in biliary tract cancers from 2019 to current.
Checkpoint inhibition plus chemotherapy is established as a new standard of care for patients with advanced BTC, with a clinically meaningful subset of patients now achieving durable long-term survival that was previously rare in this disease. The next challenge is to broaden that benefit through biomarker-driven patient selection, use of immunotherapy in earlier stages of disease, and through rational combination strategies. Importantly, these approaches should be grounded in a better understanding of tumor biology as well as the host immune microenvironment.
PMID:
42437561
Bibliographic data and abstract were imported from PubMed on 13 Jul 2026.
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