Towards a precision oncology for cholangiocarcinoma patients guided by circulating tumor cells analyses

Cholangiocarcinoma (CCA) represents the second most common primary hepatobiliary cancer (1). This cancer comprises a heterogeneous group of pathologic subtypes which are anatomically classified as intrahepatic CCA (ICCA), perihilar CCA (pCCA), or distal CCA (dCCA) (2). CCA development is normally associated with an early lymph node and distant dissemination causing that only a low rate of patient scan be candidates for surgical curative resection. The standard of care in patients with unresectable tumors or metastatic disease is combined chemotherapy with gemcitabine and cisplatin, although targeted therapies are considered as a promising alternative to standard treatment (3). Nowadays one of the challenges to improve the management of patients with CCA is the identification of new prognostic markers to decide the appropriate therapeutic strategy; surgery only in patients with a localized disease, systemic chemotherapy in patients with locally advanced or metastatic disease and palliative or supportive treatment for patients with biliary obstruction, pain or declining performance status (3). At this scenario, the monitoring of circulating tumor cells (CTCs) in CCA patients emerges as valuable tool to improve the clinical intervention.