Hepato-Pancreatic-Biliary Tract Cancers

Dear Colleagues,

Hepato-pancreato-biliary (HPB) medicine is a branch of medicine consisting of a wide range of services in the diagnosis and treatment of conditions of the liver, pancreas, gall bladder and bile ducts.

As HPB conditions and diseases typically have common symptoms, the medical expertise required usually encompasses the areas of the liver, pancreas, gall bladder and bile ducts, and it is delivered via a network model in the MDT (multidisciplinary) approach.

Hepatobiliary pancreatic (HPB) cancers include bile duct/gall bladder, pancreas and secondary (metastatic) liver cancers.

Liver disease is one of the top five causes of premature death in England, and HCA UK is uniquely positioned to respond to HPB needs, given the scale of our facilities, the calibre of our consultants and the vast reach of our network.

Biliary–pancreatic medicine is a branch of medicine specialized in diseases of the pancreas and biliary tract (gallbladder and bile duct). Examples of the pancreatic diseases handled by the group are malignant diseases such as pancreatic cancer and pancreatic neuroendocrine tumours (P-NET) and benign diseases such as acute/chronic pancreatitis. In terms of gallbladder diseases, there are malignant diseases such as bile duct cancer, gallbladder cancer, and cancer of the duodenal papilla, as well as benign diseases such as cholelithiasis and acute cholecystitis.

Pancreatic cancer and biliary carcinoma are difficult to diagnose and treat and are known for having poor treatment outcomes compared to other cancers. In order to overcome these cancers, we emphasize the enhancement of testing technologies and treatment technologies with the aim of increasing early detection and enhancing treatment outcomes.

Bile-tract cancers are a group of rare solid tumours that originate from the biliary system. A commonly used anatomical classification subdivides BTCs into intra-hepatic and extra-hepatic, originating, respectively, from the biliary tree within and outside the liver parenchyma. Each subtype is characterized by specific molecular and epidemiological features. Epidemiologic studies have suggested an increasing incidence of intra-hepatic BDC in most parts of the world. Globally, the incidence and mortality rates of BDC show substantial geographical variations, which reflect, at least partially, differences in geo-graphical, environmental, and genetic risk factors.

HPB cancers are mainly characterized by a poor prognosis and a survival time limited to a few months. The determinants of the terribly poor prognosis are essentially late diagnoses, the absence of efficient therapies and drug resistance. International practice guidelines recommend surgical resection followed by adjuvant therapy as the standard curative approach. Moreover, a large portion of patients are diagnosed at an advanced stage and are not suitable for surgical treatment. However, the response rate is frequently characterized by a progressive disease associated with a poor clinical outcome.

In recent years, the scientific community has put a great deal of effort into the discovery of new therapeutic approaches for HPB cancers and into the identification of novel diagnostic, prognostic and predictive biomarkers. The successful applications of genomic technology to HPB molecular pathology led to the discovery of targeted therapy as a promising therapeutic approach. For example, next-generation sequencing platforms allowed us to identify actionable drivers in BDC, including genetic alterations in IDH (Isocitrate Dehydrogenase), FGFR2 (Fibroblast Growth Factor Receptor 2) and RAF genes. Pemigatinib was the first therapeutic agent
targeting the FGFR2 to be approved in BDC, while other drugs targeting IDH and RAF are under investigation in clinical trials. Immunotherapy, alongside immune checkpoint inhibitors and tumour vaccines, is an emerging therapeutic strategy currently undergoing clinical trials.

This Special Issue invites the submission of original papers, case reports and clinical trials regarding molecular and clinical aspects of HPB, in addition to reviews of new therapies, including combinations of existing therapies. We are also looking
for new diagnostic modalities and new biomarkers directly related to treatment. We hope that this will lead to higher therapeutic efficacy in the treatment in the future.
Potential topics include, but are not limited to:

• New surgical methods (including resection methods, approaches and anaesthesia);
• New drug therapies (including chemotherapy, gene therapy and immunotherapy);
• New cell therapies (including immune cell therapy);
• Other new treatment methods;
• Combination of existing treatments;
• Novel diagnostic modalities;
• Novel biomarkers;
• Molecular and genetic basis of HPB;
• New biomarkers predicting the effects of the targeted therapy or immunotherapy of hepatic–biliary–pancreatic cancers;
• New drug targets for the targeted therapy or immunotherapy of hepatic–biliary–pancreatic cancers;
• New targeted drugs or immunotherapeutic drugs for the treatment of hepatic–biliary–pancreatic cancers.

Dr. Pietro Carotenuto
Dr. Massimiliano Salati
Guest Editors

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• pancreatic cancer
• biliary tract cancer
• cholangiocarcinoma
• hepato-biliary tract cancer
• biomarkers
• resistant cancer therapy
• target therapy
• precision medicine