Report from the 26th Annual Western Canadian Gastrointestinal Cancer Consensus Conference on Hepatocellular and Biliary Tract Cancer, Saskatoon, Saskatchewan, 17–18 October 2024

TL;DR

This paper summarizes expert recommendations for treating hepatocellular and biliary tract cancers based on a consensus conference.

Contribution

The paper provides updated multidisciplinary treatment guidelines for hepatocellular and biliary tract cancers.

Findings

Multidisciplinary team assessment is recommended for all patients.

Combination therapy with bevacizumab and atezolizumab is preferred for advanced hepatocellular carcinoma.

Platinum, gemcitabine, and immunotherapy are optimal for biliary tract cancers.

Abstract

This paper provides recommendations for healthcare professionals involved in the care of patients with hepatocellular and biliary tract carcinoma based on current published criteria. Patients should be assessed by a multi-disciplinary team. Surgically, achievement of functional liver remnant with negative margins is important for all resection cases. Patients should be counselled prior to molecular testing as mutations may not be actionable. Actionable mutations for biliary tract cancer include HER2, BRAF V600E, NTRK fusion, and RAS. DNA mismatch repair (MMR) is recommended for all patients. Combination therapy (bevacizumab and atezolizumab) or immunotherapy are preferred first-line options for advanced hepatocellular carcinoma (HCC). Further studies are required to prove if a combination of local and systemic therapy can be utilized widely in patients with intermediate-risk HCC. For biliary cancers, a combination of platinum, gemcitabine, and immunotherapy with durvalumab or pembrolizumab is the optimal systemic treatment, if available.

The 26th annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Saskatoon, Saskatchewan, on 17–18 October 2024. The WCGCCC is an interactive multidisciplinary conference that was attended by healthcare professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with hepatocellular and biliary tract cancers. Specialists from the fields of medical and radiation oncology, interventional radiology, pathology and laboratory medicine, and general and hepatobiliary surgery participated in presentations and discussions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of hepatocellular and biliary tract cancers.