Advanced/Metastatic Cholangiocarcinoma Treatment Landscape - Episode 4

Cholangiocarcinoma: Adverse-Event Management

Focused discussion on the adverse events that may occur when managing cholangiocarcinoma with targeted therapies.


Anthony B. El-Khoueiry, MD: What about the tolerability of these targeted agents in cholangiocarcinoma? Let’s talk about the FGFRinhibitors as a class. The most common toxicity—and it’s a class effect, which makes sense mechanistically—is hyperphosphatemia. This is seen commonly with these agents, and it’s frequently mild. Sometimes if the elevations of phosphorus are significant, 1 may have to recommend a low phosphorus diet and use some of the phosphorus-binding agents, such as sevelamer hydrochloride, to manage that. Stomatitis would be another relatively common adverse effect. Other things to watch for would be GI [gastrointestinal] toxicity, including nausea, vomiting, diarrhea, and rashes.

A less common adverse effect would be ocular toxicity with subretinal fluid accumulation, such as central serous retinopathy. These patients should have an eye exam at baseline. If they have a history of retinal diseases, they should be evaluated. Frequently this subretinal fluid is self-limited and low grade, and it tends to improve on its own. But it’s something to be conscious about and monitor. With IDH inhibitors, there similar toxicities of fatigue, GI toxicity, nausea, vomiting, diarrhea, rashes, and mucositis at times. These are the types of toxicities to keep in mind.

Transcript edited for clarity.