New frontiers in the pharmacological management of biliary tract carcinomas: the emerging role of drug conjugates.

Abstract

Introduction: Biliary tract cancer (BTC) is a human malignancy with a poor prognosis. However, significant progress has been made in understanding the molecular mechanisms of carcinogenesis, leading to the development of targeted therapy strategies in recent years. The challenge now is to develop new therapeutic concepts to further increase the efficacy of BTC treatments in the coming years.

Areas covered: This review covers the emerging and advanced approaches of highly sophisticated antibody-drug conjugates (ADCs) and non-ADCs, particularly in relation to BTC. Additionally, the potential advantages and disadvantages of ADCs and non-ADCs regarding toxicities, bioavailability, and efficacy are presented and discussed.

Expert opinion: Given the poor prognosis of BTCs, new targeted and precision therapy strategies using drug conjugates - with and without antibodies as drug carriers - have the potential to overcome the limitations of conventional chemotherapy by improving treatment specificity and efficacy while reducing systemic toxicity. However, several open questions remain regarding ADCs and non-ADCs, including chemical design, drug delivery, related diagnostic and therapeutic biomarkers, and combinatory application strategies.