{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T10:40:40Z","timestamp":1786272040308,"version":"build-2736575974"},"reference-count":46,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:00:00Z","timestamp":1760918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UTHSC College of Medicine and the Department of Surgery"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Cholangiocarcinoma (CC) is a rare and aggressive malignancy that arises from the epithelial cells (cholangiocytes) of the biliary tree. Biliary tract cancers (BTC) include both CC and gall bladder cancer. Surgical resection is considered the only curative treatment. Recently, however, a fundamental shift in the understanding of the molecular profiles of these tumors has led to a molecular-targeted approach with improved survival rates in some patients with these tumors. In patients with local or limited regional disease, neoadjuvant therapies offer a way to downstage tumors, assess tumor biology, potentially achieve R0 resection, and potentially prevent both locoregional and distant recurrence by treating occult micrometastatic disease. Because BTC are rare and surgery is the standard of care for patients with non-metastatic disease, there is very little data evaluating neoadjuvant strategies in resectable disease. Immunotherapies and molecularly targeted agents originally developed for advanced disease in the adjuvant or palliative settings are now being considered for neoadjuvant use. This review aims to summarize the data and provide a rationale for the role of neoadjuvant treatment in patients with resectable BTC. While there is no high-level evidence, studies show that neoadjuvant therapy that incorporates targeted treatments and immunotherapies under multidisciplinary oversight benefits select patients and is a valuable tool in the treatment of BTC. We favor molecular testing to guide neoadjuvant therapy for patients with BTC, when feasible, to prevent unnecessary operations and minimize the risk of recurrence or metastasis.<\/jats:p>","DOI":"10.3390\/curroncol32100584","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T12:27:29Z","timestamp":1760963249000},"page":"584","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Neoadjuvant Strategies for Patients with Resectable Biliary Tract Cancers: A Review"],"prefix":"10.3390","volume":"32","author":[{"given":"Chelsea R.","family":"Olson","sequence":"first","affiliation":[{"name":"Department of Surgery, College of Medicine, The University of Tennessee Health Science Center, 910 Madison Ave., Suite 325, Memphis, TN 38163, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8392-1427","authenticated-orcid":false,"given":"Gabriela L.","family":"Aitken","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine, The University of Tennessee Health Science Center, 910 Madison Ave., Suite 325, Memphis, TN 38163, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Spinrad","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine, The University of Tennessee Health Science Center, 910 Madison Ave., Suite 325, Memphis, TN 38163, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5796-0542","authenticated-orcid":false,"given":"Evan S.","family":"Glazer","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine, The University of Tennessee Health Science Center, 910 Madison Ave., Suite 325, Memphis, TN 38163, USA"},{"name":"Center for Cancer Research, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"541","DOI":"10.6004\/jnccn.2021.0022","article-title":"Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology","volume":"19","author":"Benson","year":"2021","journal-title":"J. Natl. Compr. Canc. Netw."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"694","DOI":"10.6004\/jnccn.2023.0035","article-title":"NCCN Guidelines(R) Insights: Biliary Tract Cancers, Version 2.2023","volume":"21","author":"Benson","year":"2023","journal-title":"J. Natl. Compr. Canc. Netw."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"49","DOI":"10.4251\/wjgo.v3.i4.49","article-title":"Markers of bile duct tumors","volume":"3","author":"Malaguarnera","year":"2011","journal-title":"World J. Gastrointest Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"693","DOI":"10.4254\/wjh.v12.i10.693","article-title":"Neoadjuvant treatment strategies for intrahepatic cholangiocarcinoma","volume":"12","author":"Akateh","year":"2020","journal-title":"World J. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1245\/s10434-020-09493-4","article-title":"A Tool for Patient-Focused Care Regarding Neoadjuvant Chemotherapy for Intrahepatic Cholangiocarcinoma","volume":"28","author":"Cools","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6558","DOI":"10.1245\/s10434-023-13809-5","article-title":"NEO-GAP: A Single-Arm, Phase II Feasibility Trial of Neoadjuvant Gemcitabine, Cisplatin, and Nab-Paclitaxel for Resectable, High-Risk Intrahepatic Cholangiocarcinoma","volume":"30","author":"Maithel","year":"2023","journal-title":"Ann. Surg. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1056\/NEJMoa0908721","article-title":"Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer","volume":"362","author":"Valle","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.amjsurg.2018.08.024","article-title":"The role of preoperative therapy prior to pancreatoduodenectomy for distal cholangiocarcinoma","volume":"218","author":"Cloyd","year":"2019","journal-title":"Am. J. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"70","DOI":"10.21037\/cco-23-144","article-title":"Advancements in cholangiocarcinoma: Evolving strategies for diagnosis, treatment, and palliation over three decades","volume":"13","author":"Elias","year":"2024","journal-title":"Chin. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.ejso.2018.08.020","article-title":"The role of neoadjuvant chemotherapy or chemoradiotherapy for advanced gallbladder cancer\u2014A systematic review","volume":"45","author":"Hakeem","year":"2019","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Goetze, T.O., Bechstein, W.O., Bankstahl, U.S., Keck, T., Konigsrainer, A., Lang, S.A., Pauligk, C., Piso, P., Vogel, A., and Al-Batran, S.E. (2020). Neoadjuvant chemotherapy with gemcitabine plus cisplatin followed by radical liver resection versus immediate radical liver resection alone with or without adjuvant chemotherapy in incidentally detected gallbladder carcinoma after simple cholecystectomy or in front of radical resection of BTC (ICC\/ECC)\u2014A phase III study of the German registry of incidental gallbladder carcinoma platform (GR)- the AIO\/ CALGP\/ ACO-GAIN-trial. BMC Cancer, 20.","DOI":"10.1186\/s12885-020-6610-4"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1016\/j.suc.2024.04.003","article-title":"Cholangiocarcinoma","volume":"104","author":"Harrison","year":"2024","journal-title":"Surg. Clin. N. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1038\/nrclinonc.2017.157","article-title":"Cholangiocarcinoma\u2014Evolving concepts and therapeutic strategies","volume":"15","author":"Ilyas","year":"2018","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"114000","DOI":"10.1016\/j.ejca.2024.114000","article-title":"Biliary tract cancers: French national clinical practice guidelines for diagnosis, treatments and follow-up (TNCD, SNFGE, FFCD, UNICANCER, GERCOR, SFCD, SFED, AFEF, SFRO, SFP, SFR, ACABi, ACHBPT)","volume":"202","author":"Roth","year":"2024","journal-title":"Eur. J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1097\/SLA.0b013e3181e462e6","article-title":"Intrahepatic cholangiocarcinoma: Primary liver resection and aggressive multimodal treatment of recurrence significantly prolong survival","volume":"252","author":"Ercolani","year":"2010","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.jclinepi.2010.09.011","article-title":"GRADE guidelines: A new series of articles in the Journal of Clinical Epidemiology","volume":"64","author":"Guyatt","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1002\/jso.26714","article-title":"Neoadjuvant therapy trials in biliary tract malignancies","volume":"125","author":"Medin","year":"2022","journal-title":"J. Surg. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1007\/s10620-021-06967-7","article-title":"Impact of Neoadjuvant Chemotherapy and Pretreatment Biliary Drainage for Pancreatic Head Ductal Adenocarcinoma","volume":"67","author":"Saffo","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1007\/s11605-023-05606-y","article-title":"Neoadjuvant Chemotherapy for Intrahepatic, Perihilar, and Distal Cholangiocarcinoma: A National Population-Based Comparative Cohort Study","volume":"27","author":"Parente","year":"2023","journal-title":"J. Gastrointest Surg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Verma, S., Grindrod, N., Breadner, D., and Lock, M. (2024). The Current Role of Radiation in the Management of Cholangiocarcinoma-A Narrative Review. Cancers, 16.","DOI":"10.3390\/cancers16091776"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/S0002-9610(05)80612-9","article-title":"Management of proximal cholangiocarcinomas by surgical resection and radiotherapy","volume":"159","author":"Cameron","year":"1990","journal-title":"Am. J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1001\/jamaoncol.2025.1926","article-title":"Adjuvant Chemoradiation and Immunotherapy for Extrahepatic Cholangiocarcinoma and Gallbladder Cancer: A Randomized Clinical Trial","volume":"1","author":"Xiao","year":"2025","journal-title":"JAMA Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Yun, W.G., Chae, Y.S., Han, Y., Lee, I., Choi, G.W., Seo, Y., Cho, Y.J., Jung, H.S., Park, J.S., and Jang, J.Y. (Ann. Surg., 2025). Impact of Resection Margin Status on Recurrence and Possible Candidates for Adjuvant Radiotherapy in Resected Distal Cholangiocarcinoma, Ann. Surg., ahead of print.","DOI":"10.1097\/SLA.0000000000006712"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1245\/s10434-020-09478-3","article-title":"Neoadjuvant Chemotherapy for Intrahepatic Cholangiocarcinoma: A Propensity Score Survival Analysis Supporting Use in Patients with High-Risk Disease","volume":"28","author":"Utuama","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1001\/jamaoncol.2019.0270","article-title":"Gemcitabine, Cisplatin, and nab-Paclitaxel for the Treatment of Advanced Biliary Tract Cancers: A Phase 2 Clinical Trial","volume":"5","author":"Shroff","year":"2019","journal-title":"JAMA Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1016\/S0140-6736(23)00727-4","article-title":"Pembrolizumab in combination with gemcitabine and cisplatin compared with gemcitabine and cisplatin alone for patients with advanced biliary tract cancer (KEYNOTE-966): A randomised, double-blind, placebo-controlled, phase 3 trial","volume":"401","author":"Kelley","year":"2023","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"EVIDoa2200015","DOI":"10.1056\/EVIDoa2200015","article-title":"Durvalumab plus Gemcitabine and Cisplatin in Advanced Biliary Tract Cancer","volume":"1","author":"Oh","year":"2022","journal-title":"NEJM Evid."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e0743","DOI":"10.1097\/HC9.0000000000000743","article-title":"Intrahepatic cholangiocarcinoma: Insights on molecular testing, targeted therapies, and future directions from a multidisciplinary panel","volume":"9","author":"Gujarathi","year":"2025","journal-title":"Hepatol. Commun."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"104901","DOI":"10.3748\/wjg.v31.i15.104901","article-title":"Conversion treatment for advanced intrahepatic cholangiocarcinoma: Opportunities and challenges","volume":"31","author":"Liu","year":"2025","journal-title":"World J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3488","DOI":"10.1245\/s10434-025-16915-8","article-title":"Robotic Versus Open Placement of Hepatic Artery Infusion Pumps","volume":"32","author":"Schleimer","year":"2025","journal-title":"Ann. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1097\/01.sla.0000179678.13285.fa","article-title":"Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma","volume":"242","author":"Rea","year":"2005","journal-title":"Ann. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1034\/j.1600-6143.2002.20812.x","article-title":"Radiochemotherapy and transplantation allow long-term survival for nonresectable hilar cholangiocarcinoma","volume":"2","author":"Sudan","year":"2002","journal-title":"Am. J. Transpl."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1053\/j.gastro.2012.04.008","article-title":"Efficacy of neoadjuvant chemoradiation, followed by liver transplantation, for perihilar cholangiocarcinoma at 12 US centers","volume":"143","author":"Kim","year":"2012","journal-title":"Gastroenterology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.jamcollsurg.2015.01.064","article-title":"Is Liver Transplantation Appropriate for Patients with Potentially Resectable De Novo Hilar Cholangiocarcinoma?","volume":"221","author":"Croome","year":"2015","journal-title":"J. Am. Coll. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1097\/TP.0000000000003114","article-title":"Neoadjuvant Chemoradiotherapy and Liver Transplantation for Unresectable Hilar Cholangiocarcinoma: The Irish Experience of the Mayo Protocol","volume":"104","author":"Zaborowski","year":"2020","journal-title":"Transplantation"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/S0002-9610(97)00203-1","article-title":"Neoadjuvant chemoradiation for extrahepatic cholangiocarcinoma","volume":"174","author":"McMasters","year":"1997","journal-title":"Am. J. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.ijrobp.2008.07.008","article-title":"Concurrent chemoradiotherapy in resected extrahepatic cholangiocarcinoma","volume":"73","author":"Nelson","year":"2009","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3301","DOI":"10.3748\/wjg.v23.i18.3301","article-title":"Benefit of neoadjuvant concurrent chemoradiotherapy for locally advanced perihilar cholangiocarcinoma","volume":"23","author":"Jung","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.hpb.2018.03.008","article-title":"Outcome of neoadjuvant chemotherapy in \u201clocally advanced\/borderline resectable\u201d gallbladder cancer: The need to define indications","volume":"20","author":"Chaudhari","year":"2018","journal-title":"HPB"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3009","DOI":"10.1245\/s10434-016-5197-0","article-title":"Neoadjuvant Chemoradiation Followed by Surgery for Locally Advanced Gallbladder Cancers: A New Paradigm","volume":"23","author":"Engineer","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e028147","DOI":"10.1136\/bmjopen-2018-028147","article-title":"A phase III randomised clinical trial of perioperative therapy (neoadjuvant chemotherapy versus chemoradiotherapy) in locally advanced gallbladder cancers (POLCAGB): Study protocol","volume":"9","author":"Engineer","year":"2019","journal-title":"BMJ Open"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"105079","DOI":"10.1016\/j.esmoop.2025.105079","article-title":"Precision oncology in biliary tract cancer: The emerging role of liquid biopsy","volume":"10","author":"Bortolot","year":"2025","journal-title":"ESMO Open"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Nishida, N. (2025). Biomarkers and Management of Cholangiocarcinoma: Unveiling New Horizons for Precision Therapy. Cancers, 17.","DOI":"10.20944\/preprints202501.1720.v1"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Cammarota, A., Balsano, R., Pressiani, T., Bozzarelli, S., Rimassa, L., and Lleo, A. (2025). The Immune-Genomics of Cholangiocarcinoma: A Biological Footprint to Develop Novel Immunotherapies. Cancers, 17.","DOI":"10.3390\/cancers17020272"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"goaf005","DOI":"10.1093\/gastro\/goaf005","article-title":"Management of intrahepatic cholangiocarcinoma: A review for clinicians","volume":"13","author":"Colangelo","year":"2025","journal-title":"Gastroenterol. Rep."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1097\/SLA.0000000000002574","article-title":"Transplantation Versus Resection for Hilar Cholangiocarcinoma: An Argument for Shifting Treatment Paradigms for Resectable Disease","volume":"267","author":"Ethun","year":"2018","journal-title":"Ann. Surg."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/32\/10\/584\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T13:29:20Z","timestamp":1760966960000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/32\/10\/584"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,20]]},"references-count":46,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["curroncol32100584"],"URL":"https:\/\/doi.org\/10.3390\/curroncol32100584","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,20]]}}}