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Page 12 of 15                Allen et al. Hepatoma Res 2021;7:73  https://dx.doi.org/10.20517/2394-5079.2021.98

               ACTICCA-1 comparing capecitabine to gemcitabine and cisplatin, the current standard of care in advanced
               and metastatic disease. This trial has the added possibility of demonstrating benefit with chemoradiotherapy
               in R1 disease. While evidence exists suggesting systemic chemotherapy, either alone or in combination with
               radiotherapy, may downstage unresectable biliary tracts cancers resulting in surgery, the benefit of
               neoadjuvant therapy in resectable tumors is less clear. What is evident in reviewing the literature is that
               significant improvements in the management of potentially curable biliary tract cancers have not been
               eventuated and that more work needs to be done. Given the rarity and difficulty in performing large,
               statistically powered clinical trials, collaborations between research groups around the world are necessary
               to drive an improvement in patient outcomes.


               DECLARATIONS
               Acknowledgments
               The authors would like to acknowledge Kelly D for her review and input regarding the final draft.


               Authors’ contributions
               Research and manuscript design: Allen MJ
               Drafted the manuscript: Allen MJ
               Draft edits and final manuscript preparation: Allen MJ, Knox JJ

               Availability of data and materials
               Not applicable.


               Financial support and sponsorship
               None.


               Conflicts of interest
               Both authors declared that there are no conflicts of interest.


               Ethical approval and consent to participate
               Not applicable.


               Consent for publication
               Not applicable.


               Copyright
               © The Author(s) 2021.


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