RORY SMOOT: There's more attention being paid to cholangiocarcinoma, or biliary tract cancers. And there's several classifications that we use when we talk about biliary tract cancers. We're talking about intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, which could be perihilar or distal. And then gallbladder cancer qualifies as well.
For cholangiocarcinoma in general, still remains what we call a surgical disease. In that, the only chance of cure is if we can take it all out. And even in the setting of being able to take it out, the recurrence rates are about 70% over five years. And so what we're starting to understand is that, and come to grips with, is that these probably already have spread, at least microscopically, by the time we meet a patient. And so more and more we understand the role of systemic therapies, or standard chemotherapy, approaches.
And one of the newer options is what we call triplet therapy. So this combination-- there's a combination of Gemcitabine and Cisplatin, which has been routinely used for these type of tumors. But within the last two years, there's been a phase II study that was partially led by Mayo Clinic.
It showed that the addition of a drug called Nab-paclitaxel. That combination had more efficacy for patients. They had a longer overall survival when they were on that. And there seemed to be more response in those tumors. It's a little bit more toxic and so the patients have to be monitored carefully for blood counts and things like that. But it did provide more benefit to the patients.
Once a tumor has been diagnosed, we typically do recommend, either at final pathology at the time of surgery or initially, especially if somebody isn't a candidate for surgery with a biopsy, that they undergo next generation sequencing. What we're really looking is for some of these molecular sub-types because there are a few that have very specific targeted therapies. FGFR2 fusion, which is a fusion of the fibroblast growth factor receptor 2. It fuses to another protein and then drives activity. And there's a very specific drug, a very specific FGFR 2 inhibitor, that's now been approved for treatment of those patients.
And then there's another one called IDH1 and IDH2 mutations. There's some treatments and trials that are ongoing with those medications. So it may open up the possibility of a clinical trial for those patients. It is not uncommon now that we do treat some of these patients with certain types of the tumors, especially probably gallbladder cancer in the intrahepatic cholangiocarcinoma, with some chemotherapy before we go to the operating room. To try to get at that systemic disease before we narrow in on the main tumor.
Well it gives me a lot of hope. There's a lot of unique targeting techniques that we're using now to try to understand in very, very sophisticated ways the immune cells that are there in these tumors. I would say that most patients with these type of tumors should be evaluated here because we have options for, not only surgical resection, but liver transplant in some cases. And then access to some of the newer clinical trials that are ongoing.
Our cure rates are better than they have been. And with the targeted therapies we are extending people's lives dramatically. The real goal, at this point, is to shoot for a cure. Because the rate at which medical discoveries are being developed-- if we can just push this down the road a little bit for the patient, then we have the option for new and better things to come along.