Advanced/Metastatic Cholangiocarcinoma Treatment Landscape - Episode 5

Sequencing Therapy in the Current Treatment Landscape of Cholangiocarcinoma

Anthony El-Khoueiry, MD, provides a brief review of sequencing therapy for patients with cholangiocarcinoma in the modern treatment landscape.


Anthony B. El-Khoueiry, MD: In summary, the treatment of cholangiocarcinoma has evolved significantly. It’s important to remember the heterogeneity of this disease based on site of origin but also molecular alterations. This is a disease that’s broken down into molecular subtypes. Testing early is important. We have the option of sequencing therapies. Frequently, we start with chemotherapy in the first line. Down the road, we may be doing chemotherapy plus PD-L1 with durvalumab, based on the TOPAZ-1 study. We have second-line options, both chemotherapy, such as FOLFOX [5-fluorouracil, leucovorin, oxaliplatin]. But we also have all the targeted therapies that could be used in the second or third line. If we’re going to use a targeted therapy, my bias is to use it earlier in the second line and leave the chemotherapy options, such as FOLFOX [5-fluorouracil, leucovorin, oxaliplatin], for the third line if possible, because the targeted agents can be quite effective. The earlier they’re used, the more benefit the patient is likely to thrive. In general, this is a disease where we’re actively learning whenever the opportunity arises, with significant recent developments. Please refer patients for clinical trials because these are critical for advancing the treatment of this disease, which is still quite rare. Thank you for your attention.

Transcript edited for clarity.