What neoadjuvant strategies do you utilize for initially unresectable biliary tract cancer?  

Great question. While there is not prospective data, I tend to use the triplet chemo regimen of gem/cis/nab-paclitaxel based on the 20% conversion rate seen in this phase 2 study. There is an ongoing neoadjuvant study in IHCC that is investigating the triplet, but this is only open at select centers...

Primary biliary adenocarcinoma (cholangicarcinoma) occurs in 5 forms. Intrahepatic, hilar, hilar and intrahepatic combined, mid bile duct, and periampullary. Periampullary (distal bile duct) should be managed by an algorithm suitable for pancreatic cancer. The other 4 presentations are less common a...