Medical Oncology

Cholangiocarcinoma

Questions discussed in this category

In patients with cholangiocarcinoma who qualify for HAIP therapy, would you recommend treating with chemotherapy and immunotherapy?

PUMP-2 trial combined FUDR via HAIP with gemcitabine and cisplatin, no immunotherapy was on the protocol.

3 Answers available

Does ctDNA play a “surveillance” role in advanced biliary tract cancers during active therapy assessing response and/or defining relapsing disease?

Was this monitored in TOPAZ-1?

1 Answer available

In patients with perihilar cholangiocarcinoma eligible for liver transplant, what is the protocol for neoadjuvant chemo-RT, particularly when brachytherapy is not available?

The Mayo Clinic protocol recommends initial fields -1.5 Gy BID initially to 45 Gy followed by a Brachytherapy boost. If HDR /LDR is not available, wha...

3 Answers available

How do you sequence hypofractionated radiation and systemic therapy for patients with unresectable cholangiocarcinoma?

When using hypofractionated RT (i.e., 67.5 Gy in 15 fractions), can chemotherapy be delivered concurrently? Options for systemic therapy in NCC...

3 Answers available

Do you give adjuvant chemotherapy for an incidental cholangiocarcinoma found at time of liver transplant (done for HCC or other reason) in the explanted liver?

If so, what regimen? At what point is it safe to start chemo in a freshly transplanted liver?

1 Answer available

Are durva/cis/gem or pembro/cis/gem less efficacious in cholangiocarcinomas with FGFR2 fusions?

And is there any role in utilizing FGFR2 inhibitors in first line setting? The PROOF trial utilizing Infigratinib in first line was stopped after the...

1 Answer available

How would you treat an MSI-H metastatic cholangiocarcinoma found on liquid biopsy?

Would you offer single agent immunotherapy or chemo-immunotherapy with gem/cis durva/pembro?

1 Answer available

How do you manage patients with suspected cholangiocarcinoma that presents with biliary obstruction but has repeated negative brushings/biopsies?

Is liquid biopsy helpful? Would you treat if this shows somatic mutation?

2 Answers available

What is your preferred first line therapy for metastatic cholangiocarcinoma, if the patient is cisplatin ineligible or cisplatin is unavailable?

2 Answers available

Would you offer adjuvant capecitabine to a patient with resected intrahepatic cholangiocarcinoma after being treated with neoadjuvant GAP chemotherapy?

4 months of Neoadjuvant GAP resulted in conversion from unresectable to resectable.

1 Answer available

For inoperable cholangiocarcinoma, do you recommend up-front chemotherapy prior to offering SBRT or combination chemoradiation?

1 Answer available

In the Nebraska/Mayo transplant protocol for perihilar cholangiocarcinoma, do you ever offer prophylactic biliary drainage/stenting to prevent obstruction post-chemoradiation?

If the patient had PSC and baseline atrophy preventing brachytherapy boost (received SBRT boost instead), would this change your threshold for stentin...

1 Answer available

In stage 4 hilar cholangiocarcinoma, after stenting the biliary tree is there value in radiating the hilar area in addition to systemic therapy so as to maintain patency of the biliary system for a longer period of time or do you depend on the systemic therapy and the stenting alone?

1 Answer available

Would you consider PD-L1 score when deciding whether to incorporate durvalumab in first-line metastatic biliary cancer?

If so, what assay would you use in this population? Do we have data on TMB/PDL1 status of long-term survivors?

2 Answers available

Can durvalumab incorporation to gem+cis for advanced BTCs allow for earlier discontinuation of cytotoxic chemotherapy in patients exhibiting response?

TOPAZ-1 trial allowed for up to 8 cycles of gem/cis. Were there differences in chemotherapy duration/# cycles between treatment groups? Does use of du...

4 Answers available

Would you add durvalumab to gem+cis in a patient with recurrent cholangiocarcinoma after liver transplant?

How would you balance the OS benefit from TOPAZ-1 with the risks of immunotherapy in this or other high-risk populations?

2 Answers available

Do you offer durvalumab in combination with gemcitabine and cisplatin in patients with metastatic ampullary adenocarcinoma, given the fact that ABC-02 trial included patients with ampullary adenocarcinoma while TOPAZ trial excluded those patients?

2 Answers available

What adjuvant therapy would you offer to a young patient with resected margin-negative stage III extrahepatic cholangiocarcinoma?

Multiple positive nodes

1 Answer available

How would you approach a patient with imaging and labs suggestive of potentially resectable cholangiocarcinoma when several core biopsies reveal bridging fibrosis with no malignant cells?

1 Answer available

Is there a role for pre-operative RT (+/-chemo) for a borderline resectable Klatskin tumor as an attempt to try to get them to surgery?