Concluding his reflection on novel therapies in patients with cholangiocarcinoma, Milind Javle, MD, provides closing thoughts and practical advice for his community colleagues.
Milind Javle, MD: A key takeaway point for my colleagues in community oncology is, cholangiocarcinoma is a diagnosis of exclusion; it requires careful pathology, and it requires multidisciplinary care. It does not necessarily need a lot of aggressive investigations to narrow down the diagnosis. Molecular profiling has been transformative in this disease, and it’s important to consider molecular profiling as early as possible during the disease course. The access to targeted therapies, such as with infigratinib with FGFR2 fusions, has truly changed the course of this disease. I would encourage my colleagues in the community to consider these types of treatments that I’ve described, targeting FGFR, IDH1, and others. However, the key would be to get a good biopsy specimen for molecular profiling or perhaps with ctDNA [circulating tumor DNA] so we can help our patients beyond the standard systemic chemotherapy.
One of the reasons that I’ve advocated early molecular diagnosis was from our own experience with the infigratinib study. Patients who received infigratinib in the second line had a higher response rate than those who received infigratinib in subsequent lines of therapy. We are expecting now that when these targeted drugs are used in the first line during the investigational trial, perhaps we’ll see an even stronger signal. I hope the time will come when we don’t have to use chemotherapy anymore for these patients and spare these unnecessary toxicities. That time is not here yet, but I think we will get there with appropriate and early use of molecular profiling.
Transcript edited for clarity.
Case: A 61-Year-Old Woman with Metastatic Cholangiocarcinoma