Novel therapeutic avenues for cholangiocarcinoma treatment: A meta-analysis
Aljabban N, Aljabban J, Gurakar M, Khorfan K, Syed SA, Gayar A, Khan H, Hadley D, and Saberi B. Novel therapeutic avenues for cholangiocarcinoma treatment: A meta-analysis. J Clin Oncol 2020; 38(4).
J Clin Oncol
Background: Cholangiocarcinoma (CCA) is a rare cancer of the bile ducts but has been increasing in incidence. The mainstay of treatment of CCA is resection or chemoradiation for more advanced disease, with immunotherapy being an evolving field in treatment. A better understanding of CCA pathogenesis will pave new avenues for treatment. Methods: We employed our STARGEO platform to conduct a meta-analysis of public data from NCBI's Gene Expression Omnibus. We performed meta-analysis with 259 CCA tumor samples against 16 normal intrahepatic duct samples as a control. We then analyzed the signature in Ingenuity Pathway Analysis. Results:Our analysis revealed FXR/RXR and LXR/RXR activation as top canonical pathways. Top upstream regulators identified included HNF1A (with predicted inhibition) and ERBB2 (with predicted activation). The most upregulated genes included several extracellular matrix proteins implicated in cancer including COL1A1, LAMC2 (correlated with poor prognosis in CCA), KRT17 (a keratin implicated in various malignancies but not well described in CCA), and LAMB3 (exerts tumorigenesis through PI3k/Akt signaling). Additionally, we found stark upregulation of the immunophillin FKPBP1A, which is involved in mTOR activation. We also noted upregulation of ubiquitin-associated gene UBASH3B, which inhibits endocytosis in EGFR and has been described in breast cancer but not CCA. From our investigation of immune checkpoint inhibitors, we found upregulation of classically described inhibitors such as CTLA4, TIGIT, and BTLA. In addition, we found upregulation of SIGLEC7, which has been recently shown to suppress immune function by binding to terminal sialic acid on glycans on the surface of immune cells. Conclusions: Our analysis highlights the possible role of ERBB2 and several extracellular genes in the pathogenesis of CCA. We also identify the role of genes not previously described in CCA such as FKBP1A and UBASH3B. Lastly, our results promote the promise of immunotherapy in CCA treatment.