Innovations in Hepato-Pancreato-Biliary (HPB) Cancer: What's New?

Hepato-pancreato-biliary (HPB) cancer – which includes cancers of the liver, pancreas, gall bladder and bile ducts – is often a serious and complex type of cancer to treat.

However, significant advancements in the availability of treatment options in recent years have meant that treating these types of tumors with the hope of cure is more in reach.

Significant advancements include facilitating faster diagnoses of HPB cancers. This is crucial because quicker diagnosis means better chances for successful treatment and improved outcomes for patients with liver cancer, pancreatic cancer, gallbladder cancer and bile duct cancer.

Below are some of the most promising and innovative advances in HPB cancer diagnostics and treatments. It is important to note that these treatment options are not suitable for every patient, and the best course of treatment will depend on many factors, including the type of cancer, its stage, location, and the patient’s overall health.

Advanced imaging techniques

Medical imaging is crucial in not only the detection of cancer, but for staging the disease (how far has the cancer progressed), determining its exact location, and assessing the effectiveness of treatment. Advances in imaging technology are supporting earlier detection and more effective treatment pathways, which are enhancing patient outcomes and improving quality of life.

Medical imaging advancements include:

• Magnetic resonance cholangiopancreatography (MRCP): This is an imaging test used to look at the liver, gallbladder, bile ducts, pancreas, and pancreatic duct. Using a contrast dye, the non-invasive technique produces highly detailed images and is particularly useful for detecting small tumors. With the introduction of sophisticated imaging software, MRCP can provide important information about liver function and surgical simulation can be obtained. It is a valuable tool in the diagnosis of HPB cancers and to aid treatment planning.
• PET-CT scans: A combination of positron emission tomography (PET) and computed tomography (CT), this tool allows medical teams to accurately locate tumors and is crucial for staging (cancer progression), and treatment planning. It also helps to avoid unnecessary surgical intervention.
• Liquid biopsy techniques: By looking at a tumor’s DNA, or its cells which are circulating in the blood, doctors can understand its characteristics (called molecular profiling), eliminating the need for tissue biopsies. This minimally invasive method is a useful way of monitoring how cancer is responding to treatment.

Minimally invasive surgical techniques

With the introduction of minimally invasive surgical techniques like robotic surgery, the safety and recovery time for diagnostic procedures like biopsies and lymph node sampling has improved, supporting better outcomes for patients and improving quality of life.

Surgery for HPB cancers ranges from minimally invasive options through to the most invasive surgeries, such as liver resection and liver transplantation for eligible patients with advanced liver cancers.

To learn more about surgical options for HPB cancers, click here.

Targeted therapy

This treatment involves the use of drugs or other substances that target specific molecules involved in the growth, progression and spread of cancer cells. It is different from the approach of more traditional treatments, such as chemotherapy or radiation, which can affect both cancerous and healthy cells. Targeted therapies for HPB cancers focus on specific genetic and molecular changes in the tumors. The treatment can be more effective than other methods as it is tailored to the unique genetic profile of an individual's cancer. It also reduces side effects and damage to healthy cells.

Radiation therapy

Image guided radiation therapy (IGRT) for HPB cancers involves using high doses of radiation to kill cancer cells and shrink tumors while minimizing radiation dose to surrounding healthy tissue. It can be used as a primary treatment, or in combination with other treatments such as chemotherapy and surgery. Advanced techniques like stereotactic body radiation therapy (SBRT) and intensity-modulated radiation therapy (IMRT) offer more precise targeting, potentially leading to better outcomes and fewer side effects. Radiation therapy's effectiveness and use depend on the cancer's type, stage, and location, as well as the patient's overall health.

Immunotherapy

A significant advancement in cancer treatment, immunotherapy utilizes the body's own immune system to target and destroy cancer cells. Immunotherapy can be particularly effective for cancers traditionally resistant to conventional treatments like chemotherapy and radiation.

How effective immunotherapy is will depend on factors such as the cancer type and the patient’s genetic makeup. It is an exciting and rapidly evolving field, with ongoing research and clinical trials continually expanding treatment possibilities.

Immunotherapy options for patients with HPB cancers may include:

• Checkpoint inhibitors: Work by blocking the proteins that prevent our immune cells from attacking cancer cells. These medications alone or in combination with other immunotherapies, chemotherapies or targeted therapies are effective options for HPB cancers.

Other immunotherapies such as cancer vaccines and adoptive cells transfers remain in the research phase.

Loco-regional therapy

Loco-regional therapies are image-guided, minimally invasive treatments that are directly applied to the tumor or the surrounding area. This minimizes exposure to radiation by injecting radioactive beads into the blood vessel that is feeding the tumor. Examples of loco-regional therapies can include:

• Embolization: Minimally invasive procedures such as radioembolization (TARE-Y90) involves injecting small radioactive beads into the arteries that are supplying blood to the tumor, or to block blood flow and deliver chemotherapy or radioactive materials directly to the tumor. TARE-Y90 therapy is used to target and destroy cancer cells in the liver.
• Ablation therapies: Techniques like radiofrequency ablation (RFA) and microwave ablation (MWA) use heat to destroy cancer cells. Both are used to treat liver cancers and can be effective for patients who are not suitable for surgery or as a bridge to transplantation. They offer the benefit of targeting the tumor while preserving surrounding healthy tissue.