A 75-Year-Old Man with Metastatic Cholangiocarcinoma - Episode 2
Reactions to the management of metastatic cholangiocarcinoma and prediction of patient response to treatments used in early lines of therapy.
Afsaneh Barzi, MD, PhD: Cholangiocarcinoma is a heterogeneous disease. We have patients who do well for a long time, and those who decline very quickly. Predicting how a patient will do based on the information we have is most of the time very difficult. One thing is critical, these patients need to be followed very closely. Although radiographic assessment for definition of the progression is and should be standard of care, if we notice any significant decline in organ function or a patient’s performance status and symptoms, it is reasonable to consider subsequent lines of therapy. This is even more relevant to the current time. Up until recently, cholangiocarcinoma did not have any established subsequent lines of therapy past the gemcitabine and cisplatin that we discussed earlier, although over the past 2.5 to 3 years, we’ve had multiple trials that have shown active agents in subsequent lines of therapy.
These include chemotherapy combinations such as FOLFOX [folinic acid, fluorouracil, oxaliplatin], which was studied in the ABC-06 trial, and more recently published, 5-FU [fluorouracil] and Onivyde [liposomal irinotecan] based on the NIFTY trial. Also, there are targeted therapies for selected populations, such as ivosidenib, which is FDA-approved for patients with IDH mutations. In addition, there are agents that target FGFR alterations, such as pemigatinib and infigratinib. Given that the number of options for this patient population is expanding, it’s really important to identify the patients who are intolerant or not benefiting from their frontline therapy, and appropriately transition them in a timely manner to subsequent lines of therapy. This allows them to see the benefit of the drugs that they’re not exposed to in the frontline setting.
Transcript edited for clarity.
Case: A 75-Year-Old Man with Metastatic Cholangiocarcinoma