On the cusp of a sea change in biliary tract cancer

On the cusp of a sea change in biliary tract cancer "Full fathom five thy father lies; Of his bones are coral made; Those are pearls that were his eyes: Nothing of him that doth fade/But doth suffer a sea-change/Into something rich and strange".William Shakespeare, Tempest, 1610.Biliary tract cancers are uncommon in the Western world but represent a challenge, particularly in Southeast Asia.These cancers are associated with biliary obstruction, infections and liver failure making their management complex and multi-disciplinary.We are honored to publish this issue of Chinese Clinical Oncology, focused on the management of biliary tract cancers.Recently, great strides have been made, both from clinical care perspective as well as in our understanding of the molecular underpinnings of this cancer.Intrahepatic cholangiocarcinoma, in particular is enriched with numerous actionable mutations, perhaps more than any other gastrointestinal malignancy.These include FGFR, IDH1/2, HER2/neu, BRAF mutations along with DNA damage repair genetic aberrations.These molecular alterations have incentivized trials with targeted therapies and checkpoint inhibitors.We are now seeing an unprecedented research growth in this cancer, truly a 'sea change'.In this issue of CCO, international experts weigh in on the latest clinical and translational research in these cancers.Highlights of this issue include updates on clinical epidemiology, surgical, medical management of biliary tract cancers along with a focus on molecular and immunotherapy.The complicated nature of these cancers requires expertise in interventional radiology, radiation oncology, gastrointestinal endoscopy, specialized nursing care and advocacy.We are proud to have assembled a team of leaders in this field and look forward to international collaboration.We would like to thank the authors for their contribution and the reviewers for their excellent work.