Biliary cancer is a rare but aggressive type of cancer that forms in the tubes that carry digestive fluid — or bile — through the liver. The cancer claims the lives of more than 700 Australians every year, and several thousands in parts of Asia, particularly North East Thailand.

But a three-year NHMRC grant awarded in 2020 and the power of international collaboration are hoping to change these statistics, with a study that is investigating novel immunotherapy treatments and expanding our knowledge of this poorly understood disease.

“Cancers of the biliary tract are often diagnosed very late,” says Professor John Mariadason, study lead and Head of ONJCRI Gastrointestinal Cancers Program and Oncogenic Transcription Laboratory

“These cancers are also relatively rare, making them difficult to study and understand. For patients, this contributes to their poor prognosis and few effective treatment options. We’re hoping to change that with our research.”

The research grant builds on existing collaborative research with scientists from La Trobe University School of Cancer Medicine, Australia; Khon Kaen University, Thailand; and Keio University, Japan.

John and his Lab have been collaborating with the international researchers for the past four years, publishing a breakthrough paper in 2019, identifying specific genetic changes in 25 biliary cancer cell lines that could inform personalised treatment plans.

The team which includes medical oncologist Oliver Klein and translational scientist A/Prof Andreas Behren at the ONJCRI then discovered that some biliary cancer patients respond to immunotherapy. They also found that the biology of biliary tumours could be broken down into two main groups — the first is when the cancer cells still resemble the normal cells, and the second is when the cells have changed their shape quite considerably.

Using this information, the international team are now exploring novel immunotherapies for biliary tract cancer and seeking to understand why only some patients respond to these treatments. They will also conduct hypothesis-driven drug screening to target the two groups of biliary cancers.

“The Thai and Japanese teams see a lot of biliary tract cancer patients as they’ve worked with this cancer for a long time and have developed expertise in this area,” says John.

Because biliary cancer is rare, the team will combine tumour samples from Australia, Japan and Thailand to discover trends that can inform cancer behaviour and response to treatment.