GASTROINTESTINAL TRACT: Edited by Alain Hendlisz and Francesco SclafaniAdjuvant chemotherapy in biliary tract cancer: state of the art and future perspectivesAkhoundova Sanoyan, Dilaraa; McNamara, Mairéad G.b,c; Lamarca, Angelac; Valle, Juan W.b,cAuthor Information aDepartment of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland bDivision of Cancer Sciences, University of Manchester cDepartment of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK Correspondence to Juan W. Valle, Division of Cancer Sciences, University of Manchester & Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, M20 4BX, UK. Tel: +44 161 446 3469; fax: +44 161 446 3469; e-mail: [email protected] Current Opinion in Oncology: July 2020 - Volume 32 - Issue 4 - p 364-369 doi: 10.1097/CCO.0000000000000643 Buy Metrics Abstract Purpose of review Biliary tract cancers (BTCs) have a poor prognosis; most patients present with advanced disease and, even after surgical resection for early-stage disease local and distant relapses are frequent. Involved resection margins and lymph node involvement are the most relevant known adverse prognostic factors. Historically clinicians have made clinical decisions based on data from institutional series and uncontrolled studies, with their inherent limitations. In this review, data from recently-reported prospective randomized trials are reviewed and clinical implications discussed. Recent findings Results from prospective randomized phase III trials (namely BILCAP, PRODIGE-12, and BCAT) are reviewed: none of the studies met their primary endpoint by intention-to-treat analysis. However, following a per-protocol sensitivity analysis of the BILCAP study, adjuvant capecitabine (for 6 months) showed a clinically-relevant improvement in overall survival and provides reference data for future clinical trials. Summary Adjuvant chemotherapy with capecitabine should be considered following curative resection of BTC. Identification of benefit in anatomical subgroups is ongoing and future trials should also consider the implication of molecular subtypes of BTC (for prognostic impact and on-target therapeutic options). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.