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Oneda E, Astore S, Gandolfi L, Melocchi L, Zaniboni A. Which therapy in biliary tract cancer? Review of main concerns in diagnosis and choice of therapy in advanced setting, current standard, and new options. Expert Opin Pharmacother 2024. [PMID: 39298328 DOI: 10.1080/14656566.2024.2406287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 09/16/2024] [Indexed: 09/21/2024]
Abstract
The incidence of biliary tract cancer is increasing in developed countries and is generating renewed interest in the scientific community due to the evidence of a high percentage (approximately 40%) of potentially targetable molecular alterations. However, to date, patient selection and the development of therapeutic approaches remain challenging due to the need for accurate diagnosis, adequate sampling, a specialized team for molecular analysis, centralization of patients in high-volume centers capable of supporting the high cost of these methods, and the feasibility of clinical studies on diseases with aggressive onset and poor prognosis. In this article, we would like to provide a detailed overview of the necessary tools for diagnostic framing and the various therapeutic scenarios being investigated concerning the most frequently detected molecular alterations.
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Affiliation(s)
- Ester Oneda
- Department of Clinical Oncology, Fondazione Poliambulanza, Italy
| | - Serena Astore
- Department of Clinical Oncology, Fondazione Poliambulanza, Italy
| | - Laura Gandolfi
- Department of Pathology, Fondazione Poliambulanza, Italy
| | - Laura Melocchi
- Department of Pathology, Fondazione Poliambulanza, Italy
| | - Alberto Zaniboni
- Department of Clinical Oncology, Fondazione Poliambulanza, Italy
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2
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Wagh H, Bhattacharya S. Targeted therapy with polymeric nanoparticles in PBRM1-mutant biliary tract cancers: Harnessing DNA damage repair mechanisms. Crit Rev Oncol Hematol 2024; 204:104505. [PMID: 39255911 DOI: 10.1016/j.critrevonc.2024.104505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/26/2024] [Accepted: 09/04/2024] [Indexed: 09/12/2024] Open
Abstract
Biliary tract cancers (BTCs) are aggressive malignancies with a dismal prognosis that require intensive targeted therapy. Approximately 10 % of BTCs have PBRM1 mutations, which impede DNA damage repair pathways and make cancer cells more susceptible to DNA-damaging chemicals. This review focus on development of poly(lactic-co-glycolic acid) (PLGA)-based nanoparticles targeting delivery system to selectively deliver chemotherapy into PBRM1-deficient BTC cells. These nanoparticles improve therapy efficacy by increasing medication targeting and retention at tumour locations. In preclinical studies, pharmacokinetic profile of this nanoparticle was encouraging and supported its ability to achieve extended circulation time with high drug accumulation in tumor. The review also highlights potential of Pou3F3:I54N to expedite bioassays for patient selection in BTC targeted therapies.
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Affiliation(s)
- Hrushikesh Wagh
- Department of Pharmaceutics, School of Pharmacy & Technology Management, SVKM'S NMIMS Deemed-to-be University, Shirpur, Maharashtra 425405, India.
| | - Sankha Bhattacharya
- Department of Pharmaceutics, School of Pharmacy & Technology Management, SVKM'S NMIMS Deemed-to-be University, Shirpur, Maharashtra 425405, India.
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3
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Rimini M, Fornaro L, Rizzato MD, Antonuzzo L, Rossari F, Satake T, Vandeputte H, Vivaldi C, Pressiani T, Lucchetti J, Kim JW, Abidoye O, Rapposelli IG, Tamberi S, Finkelmeier F, Giordano G, Nichetti F, Chon HJ, Braconi C, Pirrone C, Castet F, Tamburini E, Yoo C, Parisi A, Diana A, Scartozzi M, Prager GW, Avallone A, Schirripa M, Kim IH, Perkhofer L, Oneda E, Verrico M, Adeva J, Chan SL, Spinelli GP, Personeni N, Garajova I, Rodriquenz MG, Leo S, Salani F, De Rosa A, Lavacchi D, Foti S, Ikeda M, Dekervel J, Niger M, Balsano R, Tonini G, Kang M, Bekaii-Saab T, Esposito L, Boccaccino A, Himmelsbach V, Landriscina M, Djaballah SA, Zanuso V, Masi G, Lonardi S, Rimassa L, Casadei-Gardini A. Durvalumab plus gemcitabine and cisplatin in advanced biliary tract cancer: A large real-life worldwide population. Eur J Cancer 2024; 208:114199. [PMID: 39002348 DOI: 10.1016/j.ejca.2024.114199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND The TOPAZ-1 phase III trial showed a survival benefit with durvalumab plus gemcitabine and cisplatin in patients with advanced biliary tract cancer (BTC). To understand this combination's real-world efficacy and tolerability, we conducted a global multicenter retrospective analysis of its first-line treatment outcomes. METHODS We included patients with unresectable, locally advanced, or metastatic BTC treated with durvalumab, gemcitabine, and cisplatin at 39 sites in 11 countries (Europe, the United States, and Asia). The primary endpoint was overall survival (OS). RESULTS 666 patients were enrolled. Median OS was 15.1 months and median PFS was 8.2 months. The investigator-assessed overall response rate was 32.7 %, with stable disease in 45.2 % of patients. High baseline CEA levels, ECOG PS > 0, metastatic disease, and NLR > 3 were associated with poor survival. Any grade adverse events (AEs) occurred in 92.9 % of patients (grade >2: 46.6 %). Immune-related AEs (irAEs) occurred in 20.0 % (grade >2: 2.5 %). Three deaths (0.5 %) were deemed treatment-related, none linked to immunotherapy. Common irAEs were rash (8.2 % all grades; 0.3 % grade >2), itching (10.3 % all grades; 0.2 % grade >2), and hypothyroidism (5.1 % all grades; 0.3 % grade >2). Durvalumab discontinuation rate due to AEs was 1.5 %. ESMO-recommended genes were analyzed and no outcome differences were found. A comparative analysis with a historical cohort of patients treated with chemotherapy alone confirmed the positive survival impact of durvalumab in combination with cisplatin/gemcitabine. CONCLUSION This first global real-world analysis largely confirmed the TOPAZ-1 findings, supporting gemcitabine, cisplatin, and durvalumab as a first-line standard of care for patients with advanced BTC.
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Affiliation(s)
- Margherita Rimini
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Lorenzo Fornaro
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | | | - Lorenzo Antonuzzo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, Careggi University Hospital, Florence, Italy
| | - Federico Rossari
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Tomoyuki Satake
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hanne Vandeputte
- Digestive Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Caterina Vivaldi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Jessica Lucchetti
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma 200-00128, Italy
| | - Jin Won Kim
- Division of Hematology/Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Oluseyi Abidoye
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Stefano Tamberi
- Medical Oncology, Santa Maria delle Croci hospital, Ravenna AUSL Romagna Italy
| | - Fabian Finkelmeier
- Medical Clinic 1, University Hospital, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy; Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Hong Jae Chon
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Chiara Braconi
- University of Glasgow (School of Cancer Sciences), Beatson West of Scotland Cancer Centre, CRUK Scotland Centre, UK
| | - Chiara Pirrone
- IRCCS Ospedale Policlinico San Martino, Medical Oncology Unit 1, Genova, Italy
| | - Florian Castet
- Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Emiliano Tamburini
- Oncology Department and Palliative Care, Cardinale Panico Tricase City Hospital, Tricase 73039, Italy
| | - Changhoon Yoo
- ASAN Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Alessandro Parisi
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Via Conca 71, Ancona 60126, Italy
| | - Anna Diana
- Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Mario Scartozzi
- Department of Biomedical Sciences, Unit of Biology and Genetics, University of Cagliari, Cagliari, Italy
| | - Gerald W Prager
- Department of Medicine I, Clinical Division of Oncology, Medical University Vienna, Austria
| | - Antonio Avallone
- Clinical Experimental Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS Fondazione G. Pascale, Naples 80131, Italy
| | - Marta Schirripa
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
| | - Il Hwan Kim
- Division of Oncology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Lukas Perkhofer
- Internal Medicine 1, University Hospital Ulm, Ulm, Germany; Institute of Molecular Oncology and Stem Cell Biology, Ulm University Hospital, Ulm, Germany
| | - Ester Oneda
- Dipartimento di Oncologia medica, Fondazione Poliambulanza, Brescia, Italy
| | - Monica Verrico
- UOC Oncologia A, Department of Hematology, Oncology and Dermatology, Policlinico Umberto I University Hospital, Sapienza University of Rome, Viale Regina Elena, 324, Rome 00161, Italy
| | - Jorge Adeva
- 12 de Octubre University Hospital, Spanish Society of Medical Oncology (SEOM), Madrid, Spain
| | - Stephen L Chan
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Gian Paolo Spinelli
- UOC Oncologia Territoriale, Polo Pontino, La Sapienza Università Di Roma, Latina, Italy
| | - Nicola Personeni
- Medical Oncology Unit, P.O. Manerbio - ASST Garda, Manerbio, Brescia 25025, Italy
| | - Ingrid Garajova
- Medical Oncology Unit, University Hospital of Parma, Parma 43126, Italy
| | - Maria Grazia Rodriquenz
- Oncology Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Silvana Leo
- Division of Oncology, Vito Fazzi Hospital, Lecce, Italy
| | - Francesca Salani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma 200-00128, Italy
| | - Antonio De Rosa
- Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Daniele Lavacchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Clinical Oncology Unit, Careggi University Hospital, Florence, Italy, University of Florence, Florence, Italy
| | - Silvia Foti
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Jeroen Dekervel
- Digestive Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rita Balsano
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giuseppe Tonini
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome 21-00128, Italy
| | - Minsu Kang
- Division of Hematology/Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | | | - Luca Esposito
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | | | - Vera Himmelsbach
- Medical Clinic 1, University Hospital, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Matteo Landriscina
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy; Department of Medical and Surgical Sciences, University of Foggia, Italy
| | | | - Valentina Zanuso
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Sara Lonardi
- Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
| | - Andrea Casadei-Gardini
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy.
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4
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Fukuda S, Hijioka S, Nagashio Y, Yamashige D, Agarie D, Hagiwara Y, Okamoto K, Yagi S, Komori Y, Kuwada M, Maruki Y, Morizane C, Ueno H, Hiraoka N, Tsuchiya K, Okusaka T. Utility of Transpapillary Biopsy and Endoscopic Ultrasound-Guided Tissue Acquisition for Comprehensive Genome Profiling of Unresectable Biliary Tract Cancer. Cancers (Basel) 2024; 16:2819. [PMID: 39199592 PMCID: PMC11353131 DOI: 10.3390/cancers16162819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/04/2024] [Accepted: 08/09/2024] [Indexed: 09/01/2024] Open
Abstract
Tissue sampling in biliary tract cancer (BTC) is generally performed through transpapillary biopsy (TPB) or endoscopic ultrasound-guided tissue acquisition (EUS-TA). For the first time, we compared the suitability of specimens obtained using TPB and EUS-TA to determine the optimal tissue-sampling method for comprehensive genome profiling (CGP) analysis in patients with unresectable BTC (UR-BTC). Pathology precheck criteria for CGP analysis comprised the OncoGuide NCC Oncopanel System (NCCOP) and FoundationOne CDx (F1CDx). Seventy-eight patients with UR-BTC (35 TPB and 43 EUS-TA) were included. The NCCOP analysis suitability achievement rate was higher in EUS-TA specimens than in TPB specimens (34.9% vs. 8.6%, p = 0.007), whereas that of F1CDx was 0% in both groups. EUS-TA was identified as an independent factor that contributed to the suitability of the NCCOP analysis. The suitability of the NCCOP analysis of EUS-TA specimens showed a tendency to be higher for mass lesions (43.8% vs. 9.1%, p = 0.065), especially for target size ≥ 18.5 mm, and lower for perihilar cholangiocarcinoma (0% vs. 41.7%, p = 0.077). In TPB, papillary-type lesions (66.7% vs. 3.2%, p = 0.016) and peroral cholangioscopy-assisted biopsies (50.0% vs. 3.3%, p = 0.029) showed better potential for successful NCCOP analysis. EUS-TA is suitable for NCCOP analysis in UR-BTC and may be partially complemented by TPB.
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Affiliation(s)
- Soma Fukuda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
- Department of Gastroenterology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan;
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
| | - Yoshikuni Nagashio
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
| | - Daiki Yamashige
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
| | - Daiki Agarie
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
| | - Yuya Hagiwara
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
- Department of Gastroenterology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan;
| | - Kohei Okamoto
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
| | - Shin Yagi
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
| | - Yasuhiro Komori
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
| | - Masaru Kuwada
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
| | - Yuta Maruki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
| | - Chigusa Morizane
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
| | - Hideki Ueno
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
| | - Nobuyoshi Hiraoka
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
| | - Kiichiro Tsuchiya
- Department of Gastroenterology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan;
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (S.F.); (Y.N.); (D.Y.); (D.A.); (Y.H.); (K.O.); (S.Y.); (Y.K.); (M.K.); (Y.M.); (C.M.); (H.U.); (T.O.)
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5
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Macias RIR, Kanzaki H, Berasain C, Avila MA, Marin JJG, Hoshida Y. The Search for Risk, Diagnostic, and Prognostic Biomarkers of Cholangiocarcinoma and Their Biological and Clinicopathologic Significance. THE AMERICAN JOURNAL OF PATHOLOGY 2024:S0002-9440(24)00277-3. [PMID: 39103092 DOI: 10.1016/j.ajpath.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/01/2024] [Accepted: 06/20/2024] [Indexed: 08/07/2024]
Abstract
Cholangiocarcinomas (CCAs) are a heterogeneous group of malignant tumors that originate from the biliary tract. They are usually diagnosed in advanced stages, leading to a dismal prognosis for affected patients. As CCA often arises as a sporadic cancer in individuals lacking specific risk factors or with heterogeneous backgrounds, and there are no defined high-risk groups, the implementation of effective surveillance programs for CCA is problematic. The identification and validation of new biomarkers useful for risk stratification, diagnosis, prognosis, and prediction of treatment response remains an unmet need for patients with CCA, even though numerous studies have been conducted lately to try to discover and validate CCA biomarkers. In this review, we overview the available information about the different types of biomarkers that have been investigated in recent years using minimally invasive biospecimens (blood, serum/plasma, bile, and urine) and their potential usefulness in diagnosis, prognosis, and risk stratification. It is widely accepted that early detection of CCA will impact patients' outcomes, by improving survival rates, quality of life, and the possibility of less invasive and/or curative treatments; however, challenges to its translation and clinical application for patients with CCA need to be resolved.
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Affiliation(s)
- Rocio I R Macias
- Experimental Hepatology and Drug Targeting Group, University of Salamanca, IBSAL, Salamanca, Spain; Center for the Study of Liver and Gastrointestinal Diseases, Carlos III National Institute of Health, Madrid, Spain.
| | - Hiroaki Kanzaki
- Division of Digestive and Liver Diseases, Department of Internal Medicine, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carmen Berasain
- Center for the Study of Liver and Gastrointestinal Diseases, Carlos III National Institute of Health, Madrid, Spain; Hepatology Laboratory, Solid Tumors Program, Center for Applied Medical Research, Cancer Center University of Navarra, Pamplona, Spain
| | - Matias A Avila
- Center for the Study of Liver and Gastrointestinal Diseases, Carlos III National Institute of Health, Madrid, Spain; Hepatology Laboratory, Solid Tumors Program, Center for Applied Medical Research, Cancer Center University of Navarra, Pamplona, Spain
| | - Jose J G Marin
- Experimental Hepatology and Drug Targeting Group, University of Salamanca, IBSAL, Salamanca, Spain; Center for the Study of Liver and Gastrointestinal Diseases, Carlos III National Institute of Health, Madrid, Spain
| | - Yujin Hoshida
- Division of Digestive and Liver Diseases, Department of Internal Medicine, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.
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6
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Labiano I, Huerta AE, Alsina M, Arasanz H, Castro N, Mendaza S, Lecumberri A, Gonzalez-Borja I, Guerrero-Setas D, Patiño-Garcia A, Alkorta-Aranburu G, Hernández-Garcia I, Arrazubi V, Mata E, Gomez D, Viudez A, Vera R. Building on the clinical applicability of ctDNA analysis in non-metastatic pancreatic ductal adenocarcinoma. Sci Rep 2024; 14:16203. [PMID: 39003322 PMCID: PMC11246447 DOI: 10.1038/s41598-024-67235-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/09/2024] [Indexed: 07/15/2024] Open
Abstract
Pancreatic ductal adenocarcinoma represents one of the solid tumors showing the worst prognosis worldwide, with a high recurrence rate after adjuvant or neoadjuvant therapy. Circulating tumor DNA analysis raised as a promising non-invasive tool to characterize tumor genomics and to assess treatment response. In this study, surgical tumor tissue and sequential blood samples were analyzed by next-generation sequencing and were correlated with clinical and pathological characteristics. Thirty resectable/borderline pancreatic ductal adenocarcinoma patients treated at the Hospital Universitario de Navarra were included. Circulating tumoral DNA sequencing identified pathogenic variants in KRAS and TP53, and in other cancer-associated genes. Pathogenic variants at diagnosis were detected in patients with a poorer outcome, and were correlated with response to neoadjuvant therapy in borderline pancreatic ductal adneocarcinoma patients. Higher variant allele frequency at diagnosis was associated with worse prognosis, and thesum of variant allele frequency was greater in samples at progression. Our results build on the potential value of circulating tumor DNA for non-metastatic pancreatic ductal adenocarcinoma patients, by complementing tissue genetic information and as a non-invasive tool for treatment decision. Confirmatory studies are needed to corroborate these findings.
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Affiliation(s)
- Ibone Labiano
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
| | - Ana E Huerta
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
| | - Maria Alsina
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain.
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008, Pamplona, Spain.
| | - Hugo Arasanz
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008, Pamplona, Spain
| | - Natalia Castro
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
| | - Saioa Mendaza
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
| | - Arturo Lecumberri
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008, Pamplona, Spain
| | - Iranzu Gonzalez-Borja
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
| | - David Guerrero-Setas
- Molecular Pathology of Cancer Group, Navarrabiomed, Hospital Universitario de Navarra (HUN), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
| | - Ana Patiño-Garcia
- Department of Pediatrics and Clinical Genetics, Clínica Universidad de Navarra (CUN), Cancer Center Clínica Universidad de Navarra (CCUN), Program in Solid Tumors, Center for Applied Medical Research (CIMA) and Navarra Institute for Health Research (IdiSNA), University of Navarra, Pamplona, Spain
| | | | - Irene Hernández-Garcia
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008, Pamplona, Spain
| | - Virginia Arrazubi
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008, Pamplona, Spain
| | - Elena Mata
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008, Pamplona, Spain
| | - David Gomez
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008, Pamplona, Spain
| | - Antonio Viudez
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
| | - Ruth Vera
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008, Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008, Pamplona, Spain
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7
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Esmail A, Badheeb M, Alnahar BW, Almiqlash B, Sakr Y, Al-Najjar E, Awas A, Alsayed M, Khasawneh B, Alkhulaifawi M, Alsaleh A, Abudayyeh A, Rayyan Y, Abdelrahim M. The Recent Trends of Systemic Treatments and Locoregional Therapies for Cholangiocarcinoma. Pharmaceuticals (Basel) 2024; 17:910. [PMID: 39065760 PMCID: PMC11279608 DOI: 10.3390/ph17070910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Cholangiocarcinoma (CCA) is a hepatic malignancy that has a rapidly increasing incidence. CCA is anatomically classified into intrahepatic (iCCA) and extrahepatic (eCCA), which is further divided into perihilar (pCCA) and distal (dCCA) subtypes, with higher incidence rates in Asia. Despite its rarity, CCA has a low 5-year survival rate and remains the leading cause of primary liver tumor-related death over the past 10-20 years. The systemic therapy section discusses gemcitabine-based regimens as primary treatments, along with oxaliplatin-based options. Second-line therapy is limited but may include short-term infusional fluorouracil (FU) plus leucovorin (LV) and oxaliplatin. The adjuvant therapy section discusses approaches to improve overall survival (OS) post-surgery. However, only a minority of CCA patients qualify for surgical resection. In comparison to adjuvant therapies, neoadjuvant therapy for unresectable cases shows promise. Gemcitabine and cisplatin indicate potential benefits for patients awaiting liver transplantation. The addition of immunotherapies to chemotherapy in combination is discussed. Nivolumab and innovative approaches like CAR-T cells, TRBAs, and oncolytic viruses are explored. We aim in this review to provide a comprehensive report on the systemic and locoregional therapies for CCA.
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Affiliation(s)
- Abdullah Esmail
- Section of GI Oncology, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Mohamed Badheeb
- Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT 06610, USA
| | | | - Bushray Almiqlash
- Zuckerman College of Public Health, Arizona State University, Tempe, AZ 85287, USA;
| | - Yara Sakr
- Department of GI Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ebtesam Al-Najjar
- Section of GI Oncology, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Ali Awas
- Faculty of Medicine and Health Sciences, University of Science and Technology, Sanaa P.O. Box 15201-13064, Yemen
| | | | - Bayan Khasawneh
- Section of GI Oncology, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston, TX 77030, USA
| | | | - Amneh Alsaleh
- Department of Medicine, Desert Regional Medical Center, Palm Springs, CA 92262, USA
| | - Ala Abudayyeh
- Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yaser Rayyan
- Department of Gastroenterology & Hepatology, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Maen Abdelrahim
- Section of GI Oncology, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston, TX 77030, USA
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8
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Evans M, Kendall T. Practical considerations for pathological diagnosis and molecular profiling of cholangiocarcinoma: an expert review for best practices. Expert Rev Mol Diagn 2024; 24:393-408. [PMID: 38752560 DOI: 10.1080/14737159.2024.2353696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Advances in precision medicine have expanded access to targeted therapies and demand for molecular profiling of cholangiocarcinoma (CCA) patients in routine clinical practice. However, pathologists face challenges in establishing a definitive intrahepatic CCA (iCCA) diagnosis while preserving sufficient tissue for molecular profiling. Additionally, they frequently face challenges in optimal tissue handling to preserve nucleic acid integrity. AREAS COVERED This article first identifies the challenges in establishing a definitive diagnosis of iCCA in a lesional liver biopsy while preserving sufficient tissue for molecular profiling. Then, the authors explore the clinical value of molecular profiling, the basic principles of single gene and next-generation sequencing (NGS) techniques, and the challenges in tissue sampling for genomic testing. They also propose an algorithm for best practice in tissue management for molecular profiling of CCA. EXPERT OPINION Several practical challenges face pathologists during tissue sampling and processing for molecular profiling. Optimized tissue processing, careful tissue handling, and selection of appropriate approaches to molecular testing are essential to ensure that the highest possible quality of diagnostic information is provided in the greatest proportion of cases.
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Affiliation(s)
- Matt Evans
- Cellular Pathologist, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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9
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Rimini M, Masi G, Lonardi S, Nichetti F, Pressiani T, Lavacchi D, Jessica L, Giordano G, Scartozzi M, Tamburini E, Pastorino A, Rapposelli IG, Daniele B, Martinelli E, Garajova I, Aprile G, Schirripa M, Formica V, Salani F, Winchler C, Bergamo F, Balsano R, Gusmaroli E, Lorenzo A, Landriscina M, Pretta A, Toma I, Pirrone C, Diana A, Leone F, Brunetti O, Brandi G, Garattini SK, Satolli MA, Rossari F, Fornaro L, Niger M, Zanuso V, De Rosa A, Ratti F, Aldrighetti L, De Braud F, Foti S, Rizzato MD, Vivaldi C, Stefano C, Rimassa L, Antonuzzo L, Casadei-Gardini A. Durvalumab Plus Gemcitabine and Cisplatin Versus Gemcitabine and Cisplatin in Biliary Tract Cancer: a Real-World Retrospective, Multicenter Study. Target Oncol 2024; 19:359-370. [PMID: 38691295 DOI: 10.1007/s11523-024-01060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND The TOPAZ-1 phase III trial reported a survival benefit with the anti-programmed cell death ligand 1 (anti-PD-L1) durvalumab in combination with gemcitabine and cisplatin in patients with advanced biliary tract cancer (BTC). OBJECTIVE The present study investigated for the first time the impact on survival of adding durvalumab to cisplatin/gemcitabine compared with cisplatin/gemcitabine in a real-world setting. PATIENTS AND METHODS The analyzed population included patients with unresectable, locally advanced, or metastatic BTC treated with durvalumab in combination with cisplatin/gemcitabine or with cisplatin/gemcitabine alone. The impact of adding durvalumab to chemotherapy in terms of overall survival (OS) and progression free survival (PFS) was investigated with univariate and multivariate analysis. RESULTS Overall, 563 patients were included in the analysis: 213 received cisplatin/gemcitabine alone, 350 received cisplatin/gemcitabine plus durvalumab. At the univariate analysis, the addition of durvalumab was found to have an impact on survival, with a median OS of 14.8 months versus 11.2 months [hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.50-0.80, p = 0.0002] in patients who received cisplatin/gemcitabine plus durvalumab compared to those who received cisplatin/gemcitabine alone. At the univariate analysis for PFS, the addition of durvalumab to cisplatin/gemcitabine demonstrated a survival impact, with a median PFS of 8.3 months and 6.0 months (HR 0.57, 95% CI 0.47-0.70, p < 0.0001) in patients who received cisplatin/gemcitabine plus durvalumab and cisplatin/gemcitabine alone, respectively. The multivariate analysis confirmed that adding durvalumab to cisplatin/gemcitabine is an independent prognostic factor for OS and PFS, with patients > 70 years old and those affected by locally advanced disease experiencing the highest survival benefit. Finally, an exploratory analysis of prognostic factors was performed in the cohort of patients who received durvalumab: neutrophil-lymphocyte ratio (NLR) and disease stage were to be independent prognostic factors in terms of OS. The interaction test highlighted NLR ≤ 3, Eastern Cooperative Oncology Group Performance Status (ECOG PS) = 0, and locally advanced disease as positive predictive factors for OS on cisplatin/gemcitabine plus durvalumab. CONCLUSION In line with the results of the TOPAZ-1 trial, adding durvalumab to cisplatin/gemcitabine has been confirmed to confer a survival benefit in terms of OS and PFS in a real-world setting of patients with advanced BTC.
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Affiliation(s)
- Margherita Rimini
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianluca Masi
- Division of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, Pisa, Italy
| | - Sara Lonardi
- Dept of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
- Computational Oncology, Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
| | - Lucchetti Jessica
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Guido Giordano
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Mario Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Emiliano Tamburini
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | | | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Erika Martinelli
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Ingrid Garajova
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Marta Schirripa
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Francesca Salani
- Division of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, Pisa, Italy
| | - Costanza Winchler
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
| | - Francesca Bergamo
- Dept of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Rita Balsano
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Eleonora Gusmaroli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Angotti Lorenzo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Matteo Landriscina
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Andrea Pretta
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Ilaria Toma
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | - Chiara Pirrone
- Medical Oncology Unit 1, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Anna Diana
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Francesco Leone
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, BI, Italy
| | - Oronzo Brunetti
- Istituto Tumori "Giovanni Paolo II" of Bari, IRCCS, Bari, Italy
| | - Giovanni Brandi
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Silvio Ken Garattini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, 33100, Udine, UD, Italy
| | - Maria Antonietta Satolli
- Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federico Rossari
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Fornaro
- Division of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, Pisa, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Valentina Zanuso
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio De Rosa
- Dept of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
- Computational Oncology, Molecular Diagnostics Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Medical Oncology, University and University Hospital, Cagliari, Italy
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
- Medical Oncology Unit 1, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, BI, Italy
- Istituto Tumori "Giovanni Paolo II" of Bari, IRCCS, Bari, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, 33100, Udine, UD, Italy
- Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, oncology and gastroenterology of Padua, Padua, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Filippo De Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Medical Oncology, University and University Hospital, Cagliari, Italy
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
- Medical Oncology Unit 1, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
- Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, BI, Italy
- Istituto Tumori "Giovanni Paolo II" of Bari, IRCCS, Bari, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, 33100, Udine, UD, Italy
- Division of Medical Oncology 1, Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, oncology and gastroenterology of Padua, Padua, Italy
- Hepatobiliary Surgery Division, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Silvia Foti
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Caterina Vivaldi
- Division of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, Pisa, Italy
| | - Cascinu Stefano
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, 50134, Florence, Italy
| | - Andrea Casadei-Gardini
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy.
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Via Olgettina n. 60, Milan, Italy.
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10
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Dreikhausen L, Klupsch A, Wiest I, Xiao Q, Schulte N, Betge J, Boch T, Brochhausen C, Gaiser T, Hofheinz RD, Ebert M, Zhan T. Clinical impact of panel gene sequencing on therapy of advanced cancers of the digestive system: a retrospective, single center study. BMC Cancer 2024; 24:526. [PMID: 38664720 PMCID: PMC11046933 DOI: 10.1186/s12885-024-12261-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Panel gene sequencing is an established diagnostic tool for precision oncology of solid tumors, but its utility for the treatment of cancers of the digestive system in clinical routine is less well documented. METHODS We retrospectively identified patients with advanced or metastatic gastrointestinal, pancreaticobiliary or hepatic cancers who received panel gene sequencing at a tertiary university hospital from 2015 to 2022. For these cases, we determined the spectrum of genetic alterations, clinicopathological parameters and treatment courses. Assessment of actionability of genetic alterations was based on the OncoKB database, cancer-specific ESMO treatment guidelines, and recommendations of the local molecular tumor board. RESULTS In total, 155 patients received panel gene sequencing using either the Oncomine Focus (62 cases), Comprehensive (91 cases) or Childhood Cancer Research Assay (2 cases). The mean age of patients was 61 years (range 24-90) and 37% were female. Most patients suffered from either colorectal cancer (53%) or cholangiocellular carcinoma (19%). 327 genetic alterations were discovered in 123 tumor samples, with an average number of 2.1 alterations per tumor. The most frequently altered genes were TP53, KRAS and PIK3CA. Actionable gene alterations were detected in 13.5-56.8% of tumors, according to ESMO guidelines or the OncoKB database, respectively. Thirteen patients were treated with targeted therapies based on identified molecular alterations, with a median progression-free survival of 8.8 months. CONCLUSIONS Actionable genetic alterations are frequently detected by panel gene sequencing in patients with advanced cancers of the digestive tract, providing clinical benefit in selected cases. However, for the majority of identified actionable alterations, sufficient clinical evidence for targeted treatments is still lacking.
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Affiliation(s)
- Lena Dreikhausen
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anna Klupsch
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Isabella Wiest
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Qiyun Xiao
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nadine Schulte
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Betge
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Junior Clinical Cooperation Unit Translational Gastrointestinal Oncology and Preclinical Models, German Cancer Research Center, Heidelberg, Germany
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Medical Faculty Mannheim, DKFZ-Hector Cancer Institute, Heidelberg University, Mannheim, Germany
| | - Tobias Boch
- Department of Medicine III, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Medical Faculty Mannheim, DKFZ-Hector Cancer Institute, Heidelberg University, Mannheim, Germany
| | - Christoph Brochhausen
- Institute of Pathology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Timo Gaiser
- Institute of Pathology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralf-Dieter Hofheinz
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Medicine III, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias Ebert
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Medical Faculty Mannheim, DKFZ-Hector Cancer Institute, Heidelberg University, Mannheim, Germany
| | - Tianzuo Zhan
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Medical Faculty Mannheim, DKFZ-Hector Cancer Institute, Heidelberg University, Mannheim, Germany.
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11
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Lee CL, O'Kane GM, Mason WP, Zhang WJ, Spiliopoulou P, Hansen AR, Grant RC, Knox JJ, Stockley TL, Zadeh G, Chen EX. Circulating Oncometabolite 2-hydroxyglutarate as a Potential Biomarker for Isocitrate Dehydrogenase (IDH1/2) Mutant Cholangiocarcinoma. Mol Cancer Ther 2024; 23:394-399. [PMID: 38015561 PMCID: PMC10911702 DOI: 10.1158/1535-7163.mct-23-0460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/19/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
Isocitrate dehydrogenase (IDH) enzymes catalyze the decarboxylation of isocitrate to alpha-ketoglutarate (αKG). IDH1/2 mutations preferentially convert αKG to R-2-hydroxyglutarate (R2HG), resulting in R2HG accumulation in tumor tissues. We investigated circulating 2-hydroxyglutate (2HG) as potential biomarkers for patients with IDH-mutant (IDHmt) cholangiocarcinoma (CCA). R2HG and S-2-hydroxyglutarate (S2HG) levels in blood and tumor tissues were analyzed in a discovery cohort of patients with IDHmt glioma and CCA. Results were validated in cohorts of patients with CCA and clear-cell renal cell carcinoma. The R2HG/S2HG ratio (rRS) was significantly elevated in tumor tissues, but not in blood for patients with IDHmt glioma, while circulating rRS was elevated in patients with IDHmt CCA. There were overlap distributions of circulating R2HG and total 2HG in patients with both IDHmt and wild-type (IDHwt) CCA, while there was minimal overlap in rRS values between patients with IDHmt and IDHwt CCA. Using the rRS cut-off value of 1.5, the sensitivity of rRS was 90% and specificity was 96.8%. Circulating rRS is significantly increased in patients with IDHmt CCA compare with patients with IDHwt CCA. Circulating rRS is a sensitive and specific surrogate biomarker for IDH1/2 mutations in CCA. It can potentially be used as a tool for monitoring IDH-targeted therapy.
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Affiliation(s)
- Cha Len Lee
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Grainne M. O'Kane
- Department of Medical Oncology, Trinity St. James's Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Warren P. Mason
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
- MacFeeters Hamilton Center for Neuro-Oncology, University Health Network, Toronto, Canada
| | - Wen-Jiang Zhang
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Pavlina Spiliopoulou
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Aaron R. Hansen
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Robert C. Grant
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Jennifer J. Knox
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Tracy L. Stockley
- Advanced Molecular Diagnostic Laboratory, University Health Network, Toronto, Canada
| | - Gelareh Zadeh
- MacFeeters Hamilton Center for Neuro-Oncology, University Health Network, Toronto, Canada
| | - Eric X. Chen
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
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12
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Makawita S, Lee S, Kong E, Kwong LN, Abouelfetouh Z, Danner De Armas A, Xiao L, Murugesan K, Danziger N, Pavlick D, Korkut A, Ross JS, Javle M. Comprehensive Immunogenomic Profiling of IDH1-/ 2-Altered Cholangiocarcinoma. JCO Precis Oncol 2024; 8:e2300544. [PMID: 38547421 PMCID: PMC10994443 DOI: 10.1200/po.23.00544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/13/2023] [Accepted: 02/01/2024] [Indexed: 04/02/2024] Open
Abstract
PURPOSE Isocitrate dehydrogenase (IDH)1/2 genomic alterations (GA) occur in 20% of intrahepatic cholangiocarcinoma (iCCA); however, the immunogenomic landscape of IDH1-/2-mutated iCCA is largely unknown. METHODS Comprehensive genomic profiling (CGP) was performed on 3,067 cases of advanced iCCA. Tumor mutational burden (TMB), PD-L1 expression (Dako 22C3), microsatellite instability (MSI), and genomic loss of heterozygosity (gLOH) as a surrogate marker for homologous recombination deficiency were examined. RNA sequencing of 73 patient samples was analyzed for differences in stromal/immune cell infiltration, immune marker expression, and T-cell inflammation. Tissue microarray arrays were subjected to multiplex immunohistochemistry and colocalization analysis in 100 surgical samples. Retrospective clinical data were collected for 501 patients with cholangiocarcinoma to examine median overall survival (mOS) in IDH1/2+ versus IDHwt. RESULTS Of 3,067 iCCA cases subjected to CGP, 426 (14%) were IDH1+ and 125 (4%) were IDH2+. IDH1 GA included R132C (69%) and R132L/G/S/H/F (16%/7%/4%/3%/<1%). IDH2 GA occurred at R172 (94.4%) and R140 (6.6%). No significant difference was seen in median gLOH between IDH1+ versus IDHwt iCCA (P = .37), although patterns of comutations differed. MSI-High (P = .009), TMB ≥10 mut/Mb (P < .0001), and PD-L1 positivity were lower in IDH1/2+ versus IDHwt iCCA. Resting natural killer cell population, CD70, and programmed cell death 1 expression were significantly higher in non-IDH1-mutated cases, whereas V-set domain containing T-cell activation inhibitor 1 (B7-H4) expression was significantly higher in IDH1+. No significant difference in mOS was observed between IDH1/2+ versus IDHwt patients. CONCLUSION Significant differences in GA and immune biomarkers are noted between IDH1/2+ and IDHwt iCCA. IDH1-/2-mutated tumors appear immunologically cold without gLOH. These immunogenomic data provide insight for precision targeting of iCCA with IDH alterations.
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Affiliation(s)
- Shalini Makawita
- Department of Hematology & Oncology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX
| | - Sunyoung Lee
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elisabeth Kong
- Department of Bioinformatics and Computational Biology, The University of Texas MD, Houston, TX
| | - Lawrence N. Kwong
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Anaemy Danner De Armas
- Department of Pediatrics-Diabetes and Endocrinology, Baylor College of Medicine, Houston, TX
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Natalie Danziger
- Cancer Genomics Research and Pathology, Foundation Medicine Inc, Cambridge, MA
| | - Dean Pavlick
- Cancer Genomics Research and Pathology, Foundation Medicine Inc, Cambridge, MA
| | - Anil Korkut
- Department of Bioinformatics and Computational Biology, The University of Texas MD, Houston, TX
| | - Jeffrey S. Ross
- Cancer Genomics Research and Pathology, Foundation Medicine Inc, Cambridge, MA
- Departments of Pathology, Urology and Medicine (Oncology), Upstate Medical University, Syracuse, NY
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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13
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Ten Haaft BH, Pedregal M, Prato J, Klümpen HJ, Moreno V, Lamarca A. Revolutionizing anti-HER2 therapies for extrahepatic cholangiocarcinoma and gallbladder cancer: Current advancements and future perspectives. Eur J Cancer 2024; 199:113564. [PMID: 38266541 DOI: 10.1016/j.ejca.2024.113564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
Biliary tract cancers (BTCs) encompass a heterogeneous group of rare tumors, including intrahepatic cholangiocarcinoma (iCCA), extrahepatic cholangiocarcinoma (eCCA), gallbladder cancer (GBC) and ampullary cancer (AC). The present first-line palliative treatment regimen comprises gemcitabine and cisplatin in combination with immunotherapy based on two randomized controlled studies. Despite the thorough investigation of these palliative treatments, long-term survival remains low. Moving beyond conventional chemotherapies and immunotherapies, the realm of precision medicine has demonstrated remarkable efficacy in malignancies such as breast and gastric cancers, characterized by notable HER2 overexpression rates. In the context of biliary tract cancer, significant HER2 alterations are observed, particularly within eCCA and GBC, heightening the interest in precision medicine. Various anti-HER2 therapies, including trastuzumab, pertuzumab, trastuzumab-deruxtecan, zanidatamab and neratinib, have undergone investigation. The objective of this review is to summarize the current evidence and outline future directions of targeted HER2 treatment therapy in patients with biliary tract tumors, specially extrahepatic cholangiocarcinoma and gallbladder cancer.
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Affiliation(s)
- Britte Hea Ten Haaft
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands
| | - Manuel Pedregal
- START Madrid-FJD Phase I Unit, Department of Medical Oncology, Fundación Jiménez Díaz University Hospital, Madrid Spain
| | - Javier Prato
- START Madrid-FJD Phase I Unit, Department of Medical Oncology, Fundación Jiménez Díaz University Hospital, Madrid Spain
| | - Heinz-Josef Klümpen
- Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, location University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands
| | - Victor Moreno
- START Madrid-FJD Phase I Unit, Department of Medical Oncology, Fundación Jiménez Díaz University Hospital, Madrid Spain
| | - Angela Lamarca
- Department of Oncology, OncoHealth Institute, Fundación Jiménez Díaz University Hospital, Madrid Spain; Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom.
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14
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Rimini M, Loi E, Rizzato MD, Pressiani T, Vivaldi C, Gusmaroli E, Antonuzzo L, Martinelli E, Garajova I, Giordano G, Lucchetti J, Schirripa M, Cornara N, Rossari F, Vitiello F, Amadeo E, Persano M, Piva VM, Balsano R, Salani F, Pircher C, Cascinu S, Niger M, Fornaro L, Rimassa L, Lonardi S, Scartozzi M, Zavattari P, Casadei-Gardini A. Different Genomic Clusters Impact on Responses in Advanced Biliary Tract Cancer Treated with Cisplatin Plus Gemcitabine Plus Durvalumab. Target Oncol 2024; 19:223-235. [PMID: 38345693 DOI: 10.1007/s11523-024-01032-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The results reported in the TOPAZ-1 phase III trial led to the approval of the combination of cisplatin and gemcitabine with durvalumab as the new first-line standard of care for patients with locally advanced or metastatic cholangiocarcinoma. OBJECTIVE We performed a clustering analysis to classify patients into different groups based on their mutation profile, correlating the results of the analysis with clinical outcomes. METHODS We selected 51 patients with cholangiocarcinoma who were treated with the combination of chemotherapy and durvalumab and who were screened using the next-generation sequencing-based FoundationOne gene panel. We conducted mutation-based clustering of tumors and a survival analysis. RESULTS Three main clusters were identified. Cluster 1 is mostly characterized by mutations in genes belonging to the chromatin modification pathway, altered in 100% of patients. Cluster 2 is characterized by the alteration of several pathways, among which DNA damage control, chromatin modification, RTK/RAS, cell-cycle apoptosis, TP53, and PI3K were the most affected. Finally, most altered pathways in cluster 3 were RTK/RAS and cell-cycle apoptosis. Overall response rate was 4/13 (31%), 12/24 (50%), and 0/10 (0%) in cluster 1, cluster 2, and cluster 3, respectively, and the difference between the three clusters was statistically significant (p = 0.0188). CONCLUSIONS By grouping patients into three clusters with distinct molecular and genomic alterations, our analysis showed that patients included in cluster 2 had higher overall response rates, whereas patients included in cluster 3 had no objective response. Further investigations on larger and external cohorts are needed in order to validate our results.
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Affiliation(s)
- Margherita Rimini
- IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy.
- Department of Oncology, IRCCS San Raffaele Hospital, Via Olgettina n. 60, Milan, Italy.
| | - Eleonora Loi
- Department of Biomedical Sciences, Unit of Biology and Genetics, University of Cagliari, Cagliari, Italy
| | - Mario Domenico Rizzato
- Department of Oncology, Veneto Institute of Oncology IOV, IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Caterina Vivaldi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Eleonora Gusmaroli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Erika Martinelli
- Division of Medical Oncology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ingrid Garajova
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Jessica Lucchetti
- Division of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Marta Schirripa
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese Snc, Viterbo, Italy
| | - Noemi Cornara
- Department of Oncology, IRCCS San Raffaele Hospital, Via Olgettina n. 60, Milan, Italy
| | - Federico Rossari
- Department of Oncology, IRCCS San Raffaele Hospital, Via Olgettina n. 60, Milan, Italy
| | - Francesco Vitiello
- Department of Oncology, IRCCS San Raffaele Hospital, Via Olgettina n. 60, Milan, Italy
| | - Elisabeth Amadeo
- Department of Oncology, IRCCS San Raffaele Hospital, Via Olgettina n. 60, Milan, Italy
| | - Mara Persano
- Department of Biomedical Sciences, Unit of Biology and Genetics, University of Cagliari, Cagliari, Italy
| | - Vittoria Matilde Piva
- Department of Oncology, Veneto Institute of Oncology IOV, IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Rita Balsano
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesca Salani
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Institute of Interdisciplinary Research "Health Science", Scuola Superiore Sant'Anna, Pisa, Italy
| | - Chiara Pircher
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Stefano Cascinu
- IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
- Department of Oncology, IRCCS San Raffaele Hospital, Via Olgettina n. 60, Milan, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Lorenzo Fornaro
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Sara Lonardi
- Department of Oncology, Veneto Institute of Oncology IOV, IRCCS, Padua, Italy
| | - Mario Scartozzi
- Department of Biomedical Sciences, Unit of Biology and Genetics, University of Cagliari, Cagliari, Italy
| | - Patrizia Zavattari
- Department of Biomedical Sciences, Unit of Biology and Genetics, University of Cagliari, Cagliari, Italy
| | - Andrea Casadei-Gardini
- IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy
- Department of Oncology, IRCCS San Raffaele Hospital, Via Olgettina n. 60, Milan, Italy
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15
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O'Rourke CJ, Salati M, Rae C, Carpino G, Leslie H, Pea A, Prete MG, Bonetti LR, Amato F, Montal R, Upstill-Goddard R, Nixon C, Sanchon-Sanchez P, Kunderfranco P, Sia D, Gaudio E, Overi D, Cascinu S, Hogdall D, Pugh S, Domingo E, Primrose JN, Bridgewater J, Spallanzani A, Gelsomino F, Llovet JM, Calvisi DF, Boulter L, Caputo F, Lleo A, Jamieson NB, Luppi G, Dominici M, Andersen JB, Braconi C. Molecular portraits of patients with intrahepatic cholangiocarcinoma who diverge as rapid progressors or long survivors on chemotherapy. Gut 2024; 73:496-508. [PMID: 37758326 PMCID: PMC10894814 DOI: 10.1136/gutjnl-2023-330748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Cytotoxic agents are the cornerstone of treatment for patients with advanced intrahepatic cholangiocarcinoma (iCCA), despite heterogeneous benefit. We hypothesised that the pretreatment molecular profiles of diagnostic biopsies can predict patient benefit from chemotherapy and define molecular bases of innate chemoresistance. DESIGN We identified a cohort of advanced iCCA patients with comparable baseline characteristics who diverged as extreme outliers on chemotherapy (survival <6 m in rapid progressors, RP; survival >23 m in long survivors, LS). Diagnostic biopsies were characterised by digital pathology, then subjected to whole-transcriptome profiling of bulk and geospatially macrodissected tissue regions. Spatial transcriptomics of tumour-infiltrating myeloid cells was performed using targeted digital spatial profiling (GeoMx). Transcriptome signatures were evaluated in multiple cohorts of resected cancers. Signatures were also characterised using in vitro cell lines, in vivo mouse models and single cell RNA-sequencing data. RESULTS Pretreatment transcriptome profiles differentiated patients who would become RPs or LSs on chemotherapy. Biologically, this signature originated from altered tumour-myeloid dynamics, implicating tumour-induced immune tolerogenicity with poor response to chemotherapy. The central role of the liver microenviroment was confrmed by the association of the RPLS transcriptome signature with clinical outcome in iCCA but not extrahepatic CCA, and in liver metastasis from colorectal cancer, but not in the matched primary bowel tumours. CONCLUSIONS The RPLS signature could be a novel metric of chemotherapy outcome in iCCA. Further development and validation of this transcriptomic signature is warranted to develop precision chemotherapy strategies in these settings.
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Affiliation(s)
- Colm J O'Rourke
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Department of Health and Medical Sciences, Copenhagen, Denmark
| | - Massimiliano Salati
- Division of Oncology, Department of Oncology and Hematology, University Hospital Modena, Modena, Italy
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Colin Rae
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Guido Carpino
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Sciences, Sapienza University of Rome, Roma, Italy
| | - Holly Leslie
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Antonio Pea
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Maria G Prete
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Luca R Bonetti
- Division of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Amato
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Robert Montal
- Cancer Biomarkers Research Group, Department of Medical Oncology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Colin Nixon
- Cancer Research UK Beatson Cancer Research Institute, Glasgow, UK
| | | | | | - Daniela Sia
- Liver Cancer Translational Research Laboratory, BCLC Group, Liver Unit and Pathology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eugenio Gaudio
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Sciences, Sapienza University of Rome, Roma, Italy
| | - Diletta Overi
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Sciences, Sapienza University of Rome, Roma, Italy
| | - Stefano Cascinu
- Medical Oncology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Dan Hogdall
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Department of Health and Medical Sciences, Copenhagen, Denmark
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | - Sian Pugh
- Addenbrooke's Hospital, Cambridge, UK
| | - Enric Domingo
- Department of Oncology, University of Oxford, Oxford, UK
| | | | | | - Andrea Spallanzani
- Division of Oncology, Department of Oncology and Hematology, University Hospital Modena, Modena, Italy
| | - Fabio Gelsomino
- Division of Oncology, Department of Oncology and Hematology, University Hospital Modena, Modena, Italy
| | - Josep M Llovet
- Translational Research in Hepatic Oncology, Liver Unit, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Diego F Calvisi
- Institute of Pathology, University of Regensburg Faculty of Medicine, Regensburg, Germany
- Medical, Surgical, and Clinical Sciences, University of Sassari, Sassari, Italy
| | - Luke Boulter
- MRC HGU, The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, Edinburgh, UK
- CRUK Scotland Cancer Centre, Glasgow-Edinburgh, UK
| | - Francesco Caputo
- Division of Oncology, Department of Oncology and Hematology, University Hospital Modena, Modena, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Internal Medicine and Hepatology Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Nigel B Jamieson
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- CRUK Scotland Cancer Centre, Glasgow-Edinburgh, UK
| | - Gabriele Luppi
- Division of Oncology, Department of Oncology and Hematology, University Hospital Modena, Modena, Italy
| | - Massimo Dominici
- Division of Oncology, Department of Oncology and Hematology, University Hospital Modena, Modena, Italy
| | - Jesper B Andersen
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Department of Health and Medical Sciences, Copenhagen, Denmark
| | - Chiara Braconi
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- CRUK Scotland Cancer Centre, Glasgow-Edinburgh, UK
- Beatson West of Scotland Cancer Centre, Glasgow, UK
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16
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Fassan M, Angerilli V, Normanno N, Pruneri G, Marchetti A, Grillo F, Tonini G, Scarpa A, Rimassa L. Practical guidelines for molecular testing of cholangiocarcinoma in clinical practice: Italian experts' position paper. Crit Rev Oncol Hematol 2024; 194:104224. [PMID: 38211900 DOI: 10.1016/j.critrevonc.2023.104224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 01/13/2024] Open
Abstract
Biliary tract cancers (BTCs) represent a spectrum of malignancies associated with a dismal prognosis. Recent genomic profiling studies have provided a deeper understanding of the complex and heterogenous molecular landscape of BTCs, identifying several actionable genetic alterations, and expanding treatment options. Due to the high number and complexity of genetic alterations which require testing, next-generation sequencing (NGS) is currently the preferred approach over conventional methods (i.e., immunohistochemistry, fluorescence in-situ hybridization and PCR) for molecular profiling of BTCs and should be performed upfront in all BTC patients. However, BTC sampling often yields low tumor cellularity tissue, hampering NGS analysis. Future perspectives to overcome this obstacle include liquid biopsy and optimization of biopsy protocols. In this position paper, the authors discuss the current histopathologic, molecular, and therapeutic landscape of BTCs, provide a critical overview of the available testing methods for molecular diagnostics, and propose a practical diagnostic algorithm for molecular testing of BTC samples.
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Affiliation(s)
- Matteo Fassan
- Department of Medicine (DIMED), University of Padua, Padua, Italy; Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | | | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Giancarlo Pruneri
- Pathology Unit 2, Department of Innovation Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; University of Milan, School of Medicine, Milan, Italy
| | - Antonio Marchetti
- Department of Medical, Oral and Biotechnological Sciences, Centre for Advanced Studies and Technology (CAST), University of Chieti, Chieti, Italy
| | - Federica Grillo
- Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy; IRCCS-Ospedale Policlinico San Martino, Genoa, Italy.
| | - Giuseppe Tonini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Aldo Scarpa
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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17
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Stenzinger A, Vogel A, Lehmann U, Lamarca A, Hofman P, Terracciano L, Normanno N. Molecular profiling in cholangiocarcinoma: A practical guide to next-generation sequencing. Cancer Treat Rev 2024; 122:102649. [PMID: 37984132 DOI: 10.1016/j.ctrv.2023.102649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
Cholangiocarcinomas (CCA) are a heterogeneous group of tumors that are classified as intrahepatic, perihilar, or distal according to the anatomic location within the biliary tract. Each CCA subtype is associated with distinct genomic alterations, including single nucleotide variants, copy number variants, and chromosomal rearrangements or gene fusions, each of which can influence disease prognosis and/or treatment outcomes. Molecular profiling using next-generation sequencing (NGS) is a powerful technique for identifying unique gene variants carried by an individual tumor, which can facilitate their accurate diagnosis as well as promote the optimal selection of gene variant-matched targeted treatments. NGS is particularly useful in patients with CCA because between one-third and one-half of these patients have genomic alterations that can be targeted by drugs that are either approved or in clinical development. NGS can also provide information about disease evolution and secondary resistance alterations that can develop during targeted therapy, and thus facilitate assessment of prognosis and choice of alternative targeted treatments. Pathologists play a critical role in assessing the viability of biopsy samples for NGS, and advising treating clinicians whether NGS can be performed and which of the available platforms should be used to optimize testing outcomes. This review aims to provide clinical pathologists and other healthcare professionals with practical step-by-step guidance on the use of NGS for molecular profiling of patients with CCA, with respect to tumor biopsy techniques, pre-analytic sample preparation, selecting the appropriate NGS panel, and understanding and interpreting results of the NGS test.
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Affiliation(s)
- Albrecht Stenzinger
- Institute of Pathology Heidelberg (IPH), Center for Molecular Pathology, University Hospital Heidelberg, In Neuenheimer Feld 224, 69120 Heidelberg, Building 6224, Germany.
| | - Arndt Vogel
- Division of Gastroenterology and Hepatology, Toronto General Hospital Medical Oncology, Princess Margaret Cancer Centre, Schwartz Reisman Liver Research Centre, 200 Elizabeth Street, Office: 9 EB 236 Toronto, ON, M5G 2C4, Canada.
| | - Ulrich Lehmann
- Institute for Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - Angela Lamarca
- Department of Medical Oncology, Oncohealth Institute, Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Fundación Jiménez Díaz University Hospital, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain; Department of Medical Oncology, The Christie NHS Foundation Trust, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, IHU RespirERA, Siège de l'Université: Grand Château, 28 Avenue de Valrose, 06103 Nice CEDEX 2, France.
| | - Luigi Terracciano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy.
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy.
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Rimassa L, Brandi G, Niger M, Normanno N, Melisi D. Diagnosis and treatment of cholangiocarcinoma in Italy: A Delphi consensus statement. Crit Rev Oncol Hematol 2023; 192:104146. [PMID: 37777074 DOI: 10.1016/j.critrevonc.2023.104146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Clinical practice guidelines for the management of cholangiocarcinoma (CCA)/biliary tract cancer recommend genomic profiling to guide treatment decisions. Variable access to such profiling across Italy means many oncologists are unfamiliar with when and how to conduct genetic testing and prescribe targeted treatments. METHODS A Scientific Board of Italian oncologists who treat CCA (the authors) developed recommendations, based on recent clinical evidence, for using molecular testing in diagnosing, assessing, and treating CCA in Italy. The Delphi process was used to reach consensus on these recommendations among 38 Italian oncologists. Consensus was considered to be met if ≥ 66.7 % of the panel agreed or strongly agreed with each statement. FINDINGS Consensus was reached on 28 statements across four themes: (1) epidemiology and risk factors; (2) diagnosis, including molecular diagnosis; (3) treatment selection; and (4) treatment safety. INTERPRETATION These recommendations should aid Italian clinicians in selecting appropriate treatment options for their patients.
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Affiliation(s)
- Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Giovanni Brandi
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, DIMEC, University of Bologna, Via Massarenti 9, 40138, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 53, 80131 Naples, Italy
| | - Davide Melisi
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, P.le L. A. Scuro 10, 37134 Verona, Italy; Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, P.le L. A. Scuro 10, 37134 Verona, Italy
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Kurfurstova D, Slobodova Z, Zoundjiekpon V, Urban O. The contribution of new methods in cytology for increasing sensitivity in the diagnosis of extrahepatic bile duct lesions. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:309-318. [PMID: 37964583 DOI: 10.5507/bp.2023.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
The aim of this review is to provide a comprehensive analysis of the existing literature pertaining to cytology of extrahepatic bile ducts. A search using the keywords "biliary brush cytology" was conducted in the PubMed database, with a focus on recent articles. The inclusion criteria primarily encompassed publications addressing problematic biliary stenosis. Emphasis was placed on identifying articles that explored innovative or less-utilized examination techniques aimed at enhancing the sensitivity of cytological examination. This review presents a comprehensive overview of the various types of materials used in sampling and the corresponding sampling methods. Additionally, it explores cytological and cytogenetic techniques, such as fluorescence in situ hybridization (FISH) and genetic methods (miRNA, NGS, cfDNA). These techniques possess the potential to improve the accuracy of diagnosing bile duct tumors, although their sensitivity varies. Furthermore, their utilization can facilitate early therapy, which plays a crucial role in patient prognosis. Each examination is always dependent on the quality and quantity of material delivered. A higher sensitivity of these examinations can be achieved by combining biliary cytology and other complementary methods.
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Affiliation(s)
- Daniela Kurfurstova
- Department of Clinical and Molecular Pathology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
| | - Zuzana Slobodova
- Department of Clinical and Molecular Pathology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
| | - Vincent Zoundjiekpon
- 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
| | - Ondrej Urban
- 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
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20
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Valery M, Vasseur D, Fachinetti F, Boilève A, Smolenschi C, Tarabay A, Antoun L, Perret A, Fuerea A, Pudlarz T, Boige V, Hollebecque A, Ducreux M. Targetable Molecular Alterations in the Treatment of Biliary Tract Cancers: An Overview of the Available Treatments. Cancers (Basel) 2023; 15:4446. [PMID: 37760415 PMCID: PMC10526255 DOI: 10.3390/cancers15184446] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Biliary tract cancers (BTCs) are rare tumours, most often diagnosed at an unresectable stage, associated with poor prognosis, with a 5-year survival rate not exceeding 10%. Only first- and second-line treatments are well codified with the combination of cisplatin-gemcitabine chemotherapy and immunotherapy followed by 5-FU and oxaliplatin chemotherapy, respectively. Many studies have shown that BTC, and more particularly intrahepatic cholangiocarcinoma (iCCA), have a high rate of targetable somatic alteration. To date, the FDA has approved several drugs. Ivosidenib targeting IDH1 mutations, as well as futibatinib and pemigatinib targeting FGFR2 fusions, are approved for pre-treated advanced CCA. The combination of dabrafenib and trametinib are approved for BRAFV600E mutated advanced tumours, NTRK inhibitors entrectinib and larotrectinib for tumours bearing NTRK fusion and prembrolizumab for MSI-H advanced tumours, involving a small percentage of BTC in these three settings. Several other potentially targetable alterations are found in BTC, such as HER2 mutations or amplifications or KRASG12C mutations and mutations in genes involved in DNA repair mechanisms. This review aims to clarify the specific diagnostic modalities for gene alterations and to summarize the results of the main trials and developments underway for the management of advanced BTC with targetable alterations.
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Affiliation(s)
- Marine Valery
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Damien Vasseur
- Medical Biology and Pathology Department, Gustave Roussy, F-94805 Villejuif, France;
| | - Francesco Fachinetti
- Dana-Farber Institute, Lowe Center for Thoracic Oncology, Boston, MA 02215, USA;
| | - Alice Boilève
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
- Université Paris-Saclay, Gustave Roussy, Inserm Unité Dynamique des Cellules Tumorales, F-94805 Villejuif, France
| | - Cristina Smolenschi
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
- Département d’Innovation Thérapeutique, Gustave Roussy, F-94805 Villejuif, France
| | - Anthony Tarabay
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Leony Antoun
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Audrey Perret
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Alina Fuerea
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Thomas Pudlarz
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Valérie Boige
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Antoine Hollebecque
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
- Département d’Innovation Thérapeutique, Gustave Roussy, F-94805 Villejuif, France
| | - Michel Ducreux
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
- Université Paris-Saclay, Gustave Roussy, Inserm Unité Dynamique des Cellules Tumorales, F-94805 Villejuif, France
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21
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Rimini M, Fornaro L, Lonardi S, Niger M, Lavacchi D, Pressiani T, Lucchetti J, Giordano G, Pretta A, Tamburini E, Pirrone C, Rapposelli IG, Diana A, Martinelli E, Garajová I, Simionato F, Schirripa M, Formica V, Vivaldi C, Caliman E, Rizzato MD, Zanuso V, Nichetti F, Angotti L, Landriscina M, Scartozzi M, Ramundo M, Pastorino A, Daniele B, Cornara N, Persano M, Gusmaroli E, Cerantola R, Salani F, Ratti F, Aldrighetti L, Cascinu S, Rimassa L, Antonuzzo L, Casadei-Gardini A. Durvalumab plus gemcitabine and cisplatin in advanced biliary tract cancer: An early exploratory analysis of real-world data. Liver Int 2023; 43:1803-1812. [PMID: 37452505 DOI: 10.1111/liv.15641] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/15/2023] [Accepted: 05/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The TOPAZ-1 phase III trial reported a survival benefit with the anti-programmed death cell ligand 1 (anti-PD-L1) durvalumab in combination with gemcitabine and cisplatin in patients with advanced biliary tract cancer. The present study investigated the efficacy and safety of this new standard treatment in a real-world setting. METHODS The analysed population included patients with unresectable, locally advanced or metastatic adenocarcinoma of the biliary tract treated with durvalumab in combination with gemcitabine and cisplatin at 17 Italian centres. The primary endpoint of the study was progression-free survival (PFS), whereas secondary endpoints included overall survival (OS), overall response rate (ORR) and safety. Unadjusted and adjusted hazard ratios (HRs) by baseline characteristics were calculated using the Cox proportional hazards model. RESULTS From February 2022 to November 2022, 145 patients were enrolled. After a median follow-up of 8.5 months (95% CI: 7.9-13.6), the median PFS was 8.9 months (95% CI: 7.4-11.7). Median OS was 12.9 months (95% CI: 10.9-12.9). The investigator-assessed confirmed ORR was 34.5%, and the disease control rate was 87.6%. Any grade adverse events (AEs) occurred in 137 patients (94.5%). Grades 3-4 AEs occurred in 51 patients (35.2%). The rate of immune-mediated AEs (imAEs) was 22.7%. Grades 3-4 imAEs occurred in 2.1% of the patients. In univariate analysis, non-viral aetiology, ECOG PS >0 and NLR ≥3 correlated with shorter PFS. CONCLUSION The results reported in this first real-world analysis mostly confirmed the results achieved in the TOPAZ-1 trial in terms of PFS, ORR and safety.
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Affiliation(s)
- Margherita Rimini
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Sara Lonardi
- Medical Oncology 3, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Jessica Lucchetti
- Division of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Andrea Pretta
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Emiliano Tamburini
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | - Chiara Pirrone
- Medical Oncology Unit 1, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Anna Diana
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Erika Martinelli
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Ingrid Garajová
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Francesca Simionato
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Marta Schirripa
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Caterina Vivaldi
- Medical Oncology, University Hospital of Pisa, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Enrico Caliman
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Mario Domenico Rizzato
- Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Valentina Zanuso
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Computational Oncology, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lorenzo Angotti
- Division of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Matteo Landriscina
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Mario Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Matteo Ramundo
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | | | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Noemi Cornara
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Mara Persano
- Oncology Unit, San Martino Hospital, Oristano, Italy
| | - Eleonora Gusmaroli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Cerantola
- Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Francesca Salani
- Medical Oncology, University Hospital of Pisa, Pisa, Italy
- Institute of Interdisciplinary Research "Health Science", Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Cascinu
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Casadei-Gardini
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
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Ilyas SI, Affo S, Goyal L, Lamarca A, Sapisochin G, Yang JD, Gores GJ. Cholangiocarcinoma - novel biological insights and therapeutic strategies. Nat Rev Clin Oncol 2023; 20:470-486. [PMID: 37188899 PMCID: PMC10601496 DOI: 10.1038/s41571-023-00770-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/17/2023]
Abstract
In the past 5 years, important advances have been made in the scientific understanding and clinical management of cholangiocarcinoma (CCA). The cellular immune landscape of CCA has been characterized and tumour subsets with distinct immune microenvironments have been defined using molecular approaches. Among these subsets, the identification of 'immune-desert' tumours that are relatively devoid of immune cells emphasizes the need to consider the tumour immune microenvironment in the development of immunotherapy approaches. Progress has also made in identifying the complex heterogeneity and diverse functions of cancer-associated fibroblasts in this desmoplastic cancer. Assays measuring circulating cell-free DNA and cell-free tumour DNA are emerging as clinical tools for detection and monitoring of the disease. Molecularly targeted therapy for CCA has now become a reality, with three drugs targeting oncogenic fibroblast growth factor receptor 2 (FGFR2) fusions and one targeting neomorphic, gain-of-function variants of isocitrate dehydrogenase 1 (IDH1) obtaining regulatory approval. By contrast, immunotherapy using immune-checkpoint inhibitors has produced disappointing results in patients with CCA, underscoring the requirement for novel immune-based treatment strategies. Finally, liver transplantation for early stage intrahepatic CCA under research protocols is emerging as a viable therapeutic option in selected patients. This Review highlights and provides in-depth information on these advances.
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Affiliation(s)
- Sumera I Ilyas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Silvia Affo
- Liver, Digestive System and Metabolism Research, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Lipika Goyal
- Department of Medicine, Mass General Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Angela Lamarca
- Department of Oncology, OncoHealth Institute, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Department of Medical Oncology, The Christie NHS Foundation, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Gonzalo Sapisochin
- Ajmera Transplant Program and HPB Surgical Oncology, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
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23
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Taghizadeh H, Schmalfuss T, Maj-Hes A, Singer J, Prager GW. Austrian tricentric real-life analysis of molecular profiles of metastatic biliary tract cancer patients. Front Oncol 2023; 13:1143825. [PMID: 37234989 PMCID: PMC10206115 DOI: 10.3389/fonc.2023.1143825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction Metastatic biliary tract cancer (BTC) is a rare and aggressive entity associated with poor prognosis. It represents a major challenge for adequate treatment strategies. In recent years, BTC has become a model for precision medicine in gastrointestinal oncology. Therefore, the analysis of the individual molecular profile in BTC patients may lead to targeted therapies for the benefit of patients. Methods In this Austrian, tricentric, real-world, retrospective analysis, we investigated patients diagnosed with metastatic BTC who underwent molecular profiling between 2013 and 2022. Results In total, 92 patients were identified in this tricentric analysis and 205 molecular aberrations, including 198 mutations affecting 89 different genes in 61 patients were found. The predominant mutations were in KRAS (n=17; 22.4%), TP53 (n=17; 22.4%), PIK3CA (n=7; 9.2%), FGFR2 (n=7; 9.2%), DNMT3A (n=7; 9.2%), IDH1 (n=7; 9.2%), IDH2 (n=6; 7.9%), CDKN2A (n=6; 7.9%), BAP1 (n=4; 5.3%), NF1 (n=4; 5.3%), and NF2 (n=4; 5.3%). Three patients had HER2 amplification. MSI-H status and FGFR2 fusion genes were each observed in two different patients. One patient had a BRAF V600E mutation. Eventually, 10 patients received targeted therapy, of whom one-half derived clinical benefit. Conclusions Molecular profiling of BTC patients is implementable in routine clinical practice and should be regularly employed to detect and exploit molecular vulnerabilities.
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Affiliation(s)
- Hossein Taghizadeh
- Division of Oncology, Department of Internal Medicine I, University Hospital St. Pölten, St. Pölten, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Karl Landsteiner Institute for Oncology and Nephrology, St. Pölten, Austria
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Theresa Schmalfuss
- Division of Oncology, Department of Internal Medicine I, University Hospital St. Pölten, St. Pölten, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Agnieszka Maj-Hes
- Medical University Vienna, Department of Medicine I, Division of Oncology, Vienna, Austria
- Department of Pulmonology, Klinik Penzing, Vienna, Austria
| | - Josef Singer
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Oncology, Department of Internal Medicine II, University Hospital Krems, Krems, Austria
| | - Gerald W. Prager
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Medical University Vienna, Department of Medicine I, Division of Oncology, Vienna, Austria
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24
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Kim KH, Yi HS, Lee H, Bae GE, Yeo MK. Targeting the Sequences of Circulating Tumor DNA of Cholangiocarcinomas and Its Applications and Limitations in Clinical Practice. Int J Mol Sci 2023; 24:ijms24087512. [PMID: 37108676 PMCID: PMC10144736 DOI: 10.3390/ijms24087512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Cholangiocarcinoma is a malignant epithelial tumor arising from bile ducts that is frequently fatal. Diagnosis is difficult due to tumor location in the biliary tract. Earlier diagnosis requires less invasive methods of identifying effective biomarkers for cholangiocarcinoma. The present study investigated the genomic profiles of cell-free DNA (cfDNA) and DNA from corresponding primary cholangiocarcinomas using a targeted sequencing panel. Somatic mutations in primary tumor DNA and circulating tumor DNA (ctDNA) were compared and clinical applications of ctDNA validated in patients with cholangiocarcinoma. A comparison of primary tumor DNA and ctDNA identified somatic mutations in patients with early cholangiocarcinomas that showed clinical feasibility for early screening. The predictive value of single-nucleotide variants (SNVs) of preoperative plasma cfDNA positive for somatic mutations of the primary tumor was 42%. The sensitivity and specificity of postoperative plasma SNVs in detecting clinical recurrence were 44% and 45%, respectively. Targetable fibroblast growth factor receptor 2 (FGFR2) and Kirsten rat sarcoma virus (KRAS) mutations were detected in 5% of ctDNA samples from patients with cholangiocarcinoma. These findings showed that genomic profiling of cfDNA was useful in clinical evaluation, although ctDNA had limited ability to detect mutations in cholangiocarcinoma patients. Serial monitoring of ctDNA is important clinically and in assessing real-time molecular aberrations in cholangiocarcinoma patients.
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Affiliation(s)
- Kyung-Hee Kim
- Department of Pathology, Chungnam National University School of Medicine, Munwha-ro 282, Daejeon 35015, Republic of Korea
| | - Hyon-Seung Yi
- Laboratory of Endocrinology and Immune System, Chungnam National University School of Medicine, Daejeon 35015, Republic of Korea
| | - Hyunjung Lee
- Department of Pathology, Chungnam National University School of Medicine, Munwha-ro 282, Daejeon 35015, Republic of Korea
| | - Go-Eun Bae
- Department of Pathology, Chungnam National University School of Medicine, Munwha-ro 282, Daejeon 35015, Republic of Korea
| | - Min-Kyung Yeo
- Department of Pathology, Chungnam National University School of Medicine, Munwha-ro 282, Daejeon 35015, Republic of Korea
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25
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Angerilli V, Fornaro L, Pepe F, Rossi SM, Perrone G, Malapelle U, Fassan M. FGFR2 testing in cholangiocarcinoma: translating molecular studies into clinical practice. Pathologica 2023; 115:71-82. [PMID: 37017301 PMCID: PMC10462997 DOI: 10.32074/1591-951x-859] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 04/06/2023] Open
Abstract
Cholangiocarcinoma (CCA) is a heterogeneous group of neoplasms burdened by a dismal prognosis. Several studies have investigated the genomic profile of CCA and identified numerous druggable genetic alterations, including FGFR2 fusions/rearrangements. Approximately 5-7% of CCAs and 10-20% of intrahepatic iCCAs harbor FGFR2 fusions. With the recent advent of FGFR-targeting therapies into clinical practice, a standardization of molecular testing for FGFR2 alterations in CCA will be necessary. In this review, we describe the technical aspects and challenges related to FGFR2 testing in routine practice, focusing on the comparison between Next-Generation Sequencing (NGS) and FISH assays, the best timing to perform the test, and on the role of liquid biopsy.
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Affiliation(s)
- Valentina Angerilli
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua (PD), Italy
| | - Lorenzo Fornaro
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa (PI), Italy
| | - Francesco Pepe
- Department of Public Health, University of Naples Federico II, Naples (NA), Italy
| | - Silvia Maria Rossi
- Department of Medicine and Surgery, Research Unit of Anatomical Pathology, Università Campus Bio-Medico di Roma, Roma, Italy
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Giuseppe Perrone
- Department of Medicine and Surgery, Research Unit of Anatomical Pathology, Università Campus Bio-Medico di Roma, Roma, Italy
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples (NA), Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua (PD), Italy
- Veneto Institute of Oncology, IOV - IRCCS, Padua (PD), Italy
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26
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Li Z, Zhou H, Xia Z, Xia T, Du G, Franziska SD, Li X, Zhai X, Jin B. HMGA1 augments palbociclib efficacy via PI3K/mTOR signaling in intrahepatic cholangiocarcinoma. Biomark Res 2023; 11:33. [PMID: 36978140 PMCID: PMC10053751 DOI: 10.1186/s40364-023-00473-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (iCCA) is a highly aggressive cancer that is challenging to diagnose at an early stage. Despite recent advances in combination chemotherapy, drug resistance limits the therapeutic value of this regimen. iCCA reportedly harbors high HMGA1 expression and pathway alterations, especially hyperactivation of the CCND1/CDK4/CDK6 and PI3K signaling pathway. In this study, we explored the potential of targeting CDK4/6 and PI3K inhibition to treat iCCA. METHODS The significance of HMGA1 in iCCA was investigated with in vitro/vivo experiments. Western blot, qPCR, dual-luciferase reporter and immunofluorescence assays were performed to examine the mechanism of HMGA1 induced CCND1 expression. CCK-8, western blot, transwell, 3D sphere formation and colony formation assays were conducted to predict the potential role of CDK4/6 inhibitors PI3K/mTOR inhibitors in iCCA treatment. Xenograft mouse models were also used to determine the efficacy of combination treatment strategies related to HMGA1 in iCCA. RESULTS HMGA1 promoted the proliferation, epithelial-mesenchymaltransition (EMT), metastasis and stemness of iCCA. In vitro studies showed that HMGA1 induced CCND1 expression via promoting CCND1 transcription and activating the PI3K signaling pathway. Palbociclib(CDK4/6 inhibitor) could suppress iCCA proliferation, migration and invasion, especially during the first 3 days. Although there was more stable attenuation of growth in the HIBEpic model, we observed substantial outgrowth in each hepatobiliary cancer cell model. PF-04691502(PI3K/mTOR inhibitor) exhibited similar effects to palbociclib. Compared with monotherapy, the combination retained effective inhibition for iCCA through the more potent and steady inhibition of CCND1, CDK4/6 and PI3K pathway. Furthermore, more significant inhibition of the common downstream signaling pathways is observed with the combination compared to monotherapy. CONCLUSIONS Our study reveals the potential therapeutic role of dual inhibition of CDK4/6 and PI3K/mTOR pathways in iCCA, and proposes a new paradigm for the clinical treatment of iCCA.
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Affiliation(s)
- Zhipeng Li
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Huaxin Zhou
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, China
- The Second Clinical College of Shandong University, Jinan, China
| | - Zhijia Xia
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tong Xia
- Organ Transplant Department, Qilu Hospital of Shandong University, Jinan, China
| | - Gang Du
- Organ Transplant Department, Qilu Hospital of Shandong University, Jinan, China
| | - Strohmer Dorothee Franziska
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Xiaoming Li
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, China.
| | - Xiangyu Zhai
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, China.
| | - Bin Jin
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, China.
- Organ Transplant Department, Qilu Hospital of Shandong University, Jinan, China.
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27
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Wang L, Tang K, Li X, Lu W. Anti-PD-1-based immunotherapy plus lenvatinib to treat advanced gallbladder cancer in the elderly: a case series and review of current literature. J Cancer Res Clin Oncol 2023; 149:941-950. [PMID: 35759010 DOI: 10.1007/s00432-022-04126-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is a rare malignant tumour of the bile duct. Due to the lack of typical clinical manifestations in the early stage, it is basically at an advanced stage when discovered. Radical resection remains the only curative therapy for patients with GBC. The resection rate is relatively low due to tumour invasion and metastasis, and the overall prognosis is poor. For most patients with unresectable lesions, chemotherapy has been the only recommended treatment for decades. Immunotherapy combined with TKIs (tyrosine kinase inhibitors) was proven to be effective in patients with hepatocellular carcinoma and cholangiocarcinoma. Some physicians have attempted to apply immunotherapy and TKIs combined with traditional chemotherapy in patients with advanced GBC. However, the outcomes were not clear because limited cases were reported. CASE PRESENTATION We present a case series of four elderly patients with advanced GBC who received tislelizumab and lenvatinib combined with chemotherapy. All four patients responded to this treatment approach. Tumour responses were better in Patient 1 (TMB-H, MSS), Patient 2 (low TMB, MSS), and Patient 3 (low TMB, MSI-H) than in Patient 4 (low TMB, MSS), in whom metastasis occurred during the later stage of treatment. CONCLUSION The combination of tislelizumab and lenvatinib may be a promising treatment for patients with advanced GBC. The efficacy and safety need further confirmation.
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Affiliation(s)
- Lantian Wang
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Kezhong Tang
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xiawei Li
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Wenjie Lu
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
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28
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Labiano I, Huerta AE, Arrazubi V, Hernandez-Garcia I, Mata E, Gomez D, Arasanz H, Vera R, Alsina M. State of the Art: ctDNA in Upper Gastrointestinal Malignancies. Cancers (Basel) 2023; 15:1379. [PMID: 36900172 PMCID: PMC10000247 DOI: 10.3390/cancers15051379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Circulating tumor DNA (ctDNA) has emerged as a promising non-invasive source to characterize genetic alterations related to the tumor. Upper gastrointestinal cancers, including gastroesophageal adenocarcinoma (GEC), biliary tract cancer (BTC) and pancreatic ductal adenocarcinoma (PADC) are poor prognostic malignancies, usually diagnosed at advanced stages when no longer amenable to surgical resection and show a poor prognosis even for resected patients. In this sense, ctDNA has emerged as a promising non-invasive tool with different applications, from early diagnosis to molecular characterization and follow-up of tumor genomic evolution. In this manuscript, novel advances in the field of ctDNA analysis in upper gastrointestinal tumors are presented and discussed. Overall, ctDNA analyses can help in early diagnosis, outperforming current diagnostic approaches. Detection of ctDNA prior to surgery or active treatment is also a prognostic marker that associates with worse survival, while ctDNA detection after surgery is indicative of minimal residual disease, anticipating in some cases the imaging-based detection of progression. In the advanced setting, ctDNA analyses characterize the genetic landscape of the tumor and identify patients for targeted-therapy approaches, and studies show variable concordance levels with tissue-based genetic testing. In this line, several studies also show that ctDNA serves to follow responses to active therapy, especially in targeted approaches, where it can detect multiple resistance mechanisms. Unfortunately, current studies are still limited and observational. Future prospective multi-center and interventional studies, carefully designed to assess the value of ctDNA to help clinical decision-making, will shed light on the real applicability of ctDNA in upper gastrointestinal tumor management. This manuscript presents a review of the evidence available in this field up to date.
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Affiliation(s)
- Ibone Labiano
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008 Pamplona, Spain
| | - Ana Elsa Huerta
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008 Pamplona, Spain
| | - Virginia Arrazubi
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008 Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008 Pamplona, Spain
| | - Irene Hernandez-Garcia
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008 Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008 Pamplona, Spain
| | - Elena Mata
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008 Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008 Pamplona, Spain
| | - David Gomez
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008 Pamplona, Spain
| | - Hugo Arasanz
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008 Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008 Pamplona, Spain
| | - Ruth Vera
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008 Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008 Pamplona, Spain
| | - Maria Alsina
- Oncobiona Group, Navarrabiomed-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea 3, 31008 Pamplona, Spain
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Irunlarrea 3, 31008 Pamplona, Spain
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29
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Choi WJ, Ivanics T, Gravely A, Gallinger S, Sapisochin G, O'Kane GM. Optimizing Circulating Tumour DNA Use in the Perioperative Setting for Intrahepatic Cholangiocarcinoma: Diagnosis, Screening, Minimal Residual Disease Detection and Treatment Response Monitoring. Ann Surg Oncol 2023; 30:3849-3863. [PMID: 36808320 DOI: 10.1245/s10434-023-13126-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 02/23/2023]
Abstract
In this review, we present the current evidence and future perspectives on the use of circulating tumour DNA (ctDNA) in the diagnosis, management and understanding the prognosis of patients with intrahepatic cholangiocarcinoma (iCCA) undergoing surgery. Liquid biopsies or ctDNA maybe utilized to: (1) determine the molecular profile of the tumour and therefore guide the selection of molecular targeted therapy in the neoadjuvant setting, (2) form a surveillance tool for the detection of minimal residual disease or cancer recurrence after surgery, and (3) diagnose and screen for early iCCA detection in high-risk populations. The potential for ctDNA can be tumour-informed or -uninformed depending on the goals of its use. Future studies will require ctDNA extraction technique validations, with standardizations of both the platforms and the timing of ctDNA collections.
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Affiliation(s)
- Woo Jin Choi
- HBP and Multi Organ Transplant Program, Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,HPB Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Tommy Ivanics
- Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Annabel Gravely
- HPB Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Steven Gallinger
- HBP and Multi Organ Transplant Program, Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.,HPB Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Gonzalo Sapisochin
- HBP and Multi Organ Transplant Program, Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. .,HPB Surgical Oncology, University Health Network, Toronto, Ontario, Canada.
| | - Grainne M O'Kane
- Department of Medical Oncology, Trinity St. James's Cancer Institute, Trinity College Dublin, Dublin, Ireland.
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30
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Goyal L, Meric-Bernstam F, Hollebecque A, Valle JW, Morizane C, Karasic TB, Abrams TA, Furuse J, Kelley RK, Cassier PA, Klümpen HJ, Chang HM, Chen LT, Tabernero J, Oh DY, Mahipal A, Moehler M, Mitchell EP, Komatsu Y, Masuda K, Ahn D, Epstein RS, Halim AB, Fu Y, Salimi T, Wacheck V, He Y, Liu M, Benhadji KA, Bridgewater JA. Futibatinib for FGFR2-Rearranged Intrahepatic Cholangiocarcinoma. N Engl J Med 2023; 388:228-239. [PMID: 36652354 DOI: 10.1056/nejmoa2206834] [Citation(s) in RCA: 165] [Impact Index Per Article: 165.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Alterations in fibroblast growth factor receptor 2 (FGFR2) have emerged as promising drug targets for intrahepatic cholangiocarcinoma, a rare cancer with a poor prognosis. Futibatinib, a next-generation, covalently binding FGFR1-4 inhibitor, has been shown to have both antitumor activity in patients with FGFR-altered tumors and strong preclinical activity against acquired resistance mutations associated with ATP-competitive FGFR inhibitors. METHODS In this multinational, open-label, single-group, phase 2 study, we enrolled patients with unresectable or metastatic FGFR2 fusion-positive or FGFR2 rearrangement-positive intrahepatic cholangiocarcinoma and disease progression after one or more previous lines of systemic therapy (excluding FGFR inhibitors). The patients received oral futibatinib at a dose of 20 mg once daily in a continuous regimen. The primary end point was objective response (partial or complete response), as assessed by independent central review. Secondary end points included the response duration, progression-free and overall survival, safety, and patient-reported outcomes. RESULTS Between April 16, 2018, and November 29, 2019, a total of 103 patients were enrolled and received futibatinib. A total of 43 of 103 patients (42%; 95% confidence interval, 32 to 52) had a response, and the median duration of response was 9.7 months. Responses were consistent across patient subgroups, including patients with heavily pretreated disease, older adults, and patients who had co-occurring TP53 mutations. At a median follow-up of 17.1 months, the median progression-free survival was 9.0 months and overall survival was 21.7 months. Common treatment-related grade 3 adverse events were hyperphosphatemia (in 30% of the patients), an increased aspartate aminotransferase level (in 7%), stomatitis (in 6%), and fatigue (in 6%). Treatment-related adverse events led to permanent discontinuation of futibatinib in 2% of the patients. No treatment-related deaths occurred. Quality of life was maintained throughout treatment. CONCLUSIONS In previously treated patients with FGFR2 fusion or rearrangement-positive intrahepatic cholangiocarcinoma, the use of futibatinib, a covalent FGFR inhibitor, led to measurable clinical benefit. (Funded by Taiho Oncology and Taiho Pharmaceutical; FOENIX-CCA2 ClinicalTrials.gov number, NCT02052778.).
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Affiliation(s)
- Lipika Goyal
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Funda Meric-Bernstam
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Antoine Hollebecque
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Juan W Valle
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Chigusa Morizane
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Thomas B Karasic
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Thomas A Abrams
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Junji Furuse
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Robin K Kelley
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Philippe A Cassier
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Heinz-Josef Klümpen
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Heung-Moon Chang
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Li-Tzong Chen
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Josep Tabernero
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Do-Youn Oh
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Amit Mahipal
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Markus Moehler
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Edith P Mitchell
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Yoshito Komatsu
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Kunihiro Masuda
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Daniel Ahn
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Robert S Epstein
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Abdel-Baset Halim
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Yao Fu
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Tehseen Salimi
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Volker Wacheck
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Yaohua He
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Mei Liu
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Karim A Benhadji
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - John A Bridgewater
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
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Roth GS, Neuzillet C, Sarabi M, Edeline J, Malka D, Lièvre A. Cholangiocarcinoma: what are the options in all comers and how has the advent of molecular profiling opened the way to personalised medicine ? Eur J Cancer 2023; 179:1-14. [PMID: 36463640 DOI: 10.1016/j.ejca.2022.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022]
Abstract
Cholangiocarcinoma is a deadly cancer comprising very heterogenous subtypes with a limited therapeutic arsenal in all comers. However, recent significant advances were made with immunotherapy in the first-line treatment of advanced cholangiocarcinoma, with the addition of durvalumab to cisplatin-gemcitabine chemotherapy showing a survival benefit. In the second line setting, only FOLFOX (5FU/folinic acid-oxaliplatin) is validated by a phase 3 trial, yet with a very modest benefit on survival; new options using 5FU with nanoliposomal-irinotecan may emerge in the next few years. The advent of molecular profiling in advanced cholangiocarcinoma in the last decade revealed frequent targetable alterations such as IDH1 mutations, FGFR2 fusions or rearrangements, HER2 amplification, BRAF V600E mutation and others. This strategy opened the way to personalised medicine for patients which are still fit after first-line treatment and the use of targeted inhibitors in first line constitutes a huge challenge with many ongoing trials to improve patients' care. This review exposes the recent clinical trial findings in non-molecularly selected advanced cholangiocarcinoma, offers a focus on how systematic molecular screening should be structured to allow patients to access to personalised medicine, and details which are the therapeutic options accessible in case of actionable alteration.
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Affiliation(s)
- Gael S Roth
- Univ. Grenoble Alpes / Hepato-Gastroenterology and Digestive Oncology Department, CHU Grenoble Alpes / Institute for Advanced Biosciences, CNRS UMR 5309-INSERM U1209, Grenoble, France.
| | - Cindy Neuzillet
- Institut Curie, Versailles Saint-Quentin University - Paris Saclay University, Saint-Cloud, France
| | - Matthieu Sarabi
- Medical Oncology Department, Centre Léon Bérard, 28 Rue Laennec, Lyon 69008, France; Tumor Escape, Resistance and Immunity Department, Centre de Recherche en Cancérologie de Lyon, INSERM 1052, CNRS 5286, Lyon, France
| | | | - David Malka
- Medical Oncology, Institut Mutualiste Montsouris, Paris, France
| | - Astrid Lièvre
- Department of Gastroenterology, Rennes University Hospital, University of Rennes 1, INSERM Unité 1242, Rennes, France
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Storandt MH, Jin Z, Mahipal A. Pemigatinib in cholangiocarcinoma with a FGFR2 rearrangement or fusion. Expert Rev Anticancer Ther 2022; 22:1265-1274. [PMID: 36408971 DOI: 10.1080/14737140.2022.2150168] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Cholangiocarcinoma (CCA) accounts for approximately 3% of gastrointestinal malignancies and is associated with a high mortality rate. Recent progress in the understanding of cholangiocarcinoma tumorigenesis and molecular markers has led to the development of several targeted therapies applicable to this disease. Fibroblast growth factor receptor 2 (FGFR2) gene fusion or translocation, resulting in constitutive activation of the FGFR tyrosine kinase, has been identified as a driver of oncogenesis in 10-15% of intrahepatic CCA. Pemigatinib is an FGFR inhibitor that has demonstrated survival benefit in the second line setting for treatment of CCA with FGFR2 fusion or rearrangement refractory to chemotherapy. Pemigatinib was the first targeted therapy to be approved by the FDA for treatment of cholangiocarcinoma. AREAS COVERED This article reviews FGFR and its dysregulation in oncogenesis, FGFR inhibitors, especially pemigatinib, utilized in treatment of CCA, common adverse events associated with FGFR inhibitors, and future directions in the field of targeted drug development for CCA. EXPERT OPINION FGFR inhibitors, including pemigatinib, have shown promise in the management of CCA with FGFR2 fusion or rearrangement; however, acquired resistance remains a major barrier in the field of FGFR inhibitors and requires further study.
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Affiliation(s)
| | - Zhaohui Jin
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Amit Mahipal
- Department of Oncology, Mayo Clinic, Rochester, MN, USA.,Department of Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
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Ho J, Fiocco C, Spencer K. Treating Biliary Tract Cancers: New Targets and Therapies. Drugs 2022; 82:1629-1647. [DOI: 10.1007/s40265-022-01808-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/29/2022]
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Mutations de l'ADN dans les cholangiocarcinomes : cibler IDH1 et autres mutations. Bull Cancer 2022; 109:11S21-11S27. [DOI: 10.1016/s0007-4551(22)00465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Madoff DC, Abi-Jaoudeh N, Braxton D, Goyal L, Jain D, Odisio BC, Salem R, Schattner M, Sheth R, Li D. An Expert, Multidisciplinary Perspective on Best Practices in Biomarker Testing in Intrahepatic Cholangiocarcinoma. Oncologist 2022; 27:884-891. [PMID: 35925597 PMCID: PMC9526481 DOI: 10.1093/oncolo/oyac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/01/2022] [Indexed: 11/20/2022] Open
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is a rare and aggressive malignancy that arises from the intrahepatic biliary tree and is associated with a poor prognosis. Until recently, the treatment landscape of advanced/metastatic iCCA has been limited primarily to chemotherapy. In recent years, the advent of biomarker testing has identified actionable genetic alterations in 40%-50% of patients with iCCA, heralding an era of precision medicine for these patients. Biomarker testing using next-generation sequencing (NGS) has since become increasingly relevant in iCCA; however, several challenges and gaps in standard image-guided liver biopsy and processing have been identified. These include variability in tissue acquisition relating to the imaging modality used for biopsy guidance, the biopsy method used, number of passes, needle choice, specimen preparation methods, the desmoplastic nature of the tumor, as well as the lack of communication among the multidisciplinary team. Recognizing these challenges and the lack of evidence-based guidelines for biomarker testing in iCCA, a multidisciplinary team of experts including interventional oncologists, a gastroenterologist, medical oncologists, and pathologists suggest best practices for optimizing tissue collection and biomarker testing in iCCA.
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Affiliation(s)
- David C Madoff
- Corresponding author: David C. Madoff, MD, FSIR, FACR, FCIRSE, Yale School of Medicine, 330 Cedar Street, TE-2, New Haven, CT 06520, USA. Tel: +1 203 785 5102; Fax: +1 203 737 1241;
| | | | - David Braxton
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | | | - Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Bruno C Odisio
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Riad Salem
- Northwestern University, Chicago, IL, USA
| | - Mark Schattner
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rahul Sheth
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Berchuck JE, Facchinetti F, DiToro DF, Baiev I, Majeed U, Reyes S, Chen C, Zhang K, Sharman R, Junior PLSU, Maurer J, Shroff RT, Pritchard CC, Wu MJ, Catenacci DVT, Javle M, Friboulet L, Hollebecque A, Bardeesy N, Zhu AX, Lennerz JK, Tan B, Borad M, Parikh AR, Kiedrowski LA, Kelley RK, Mody K, Juric D, Goyal L. The Clinical Landscape of Cell-Free DNA Alterations in 1,671 Patients with Advanced Biliary Tract Cancer. Ann Oncol 2022; 33:1269-1283. [PMID: 36089135 DOI: 10.1016/j.annonc.2022.09.150] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/18/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Targeted therapies have transformed clinical management of advanced biliary tract cancer (BTC). Cell-free DNA (cfDNA) analysis is an attractive approach for cancer genomic profiling that overcomes many limitations of traditional tissue-based analysis. We examined cfDNA as a tool to inform clinical management of patients with advanced BTC and generate novel insights into BTC tumor biology. PATIENTS AND METHODS We analyzed next-generation sequencing data of 2,068 cfDNA samples from 1,671 patients with advanced BTC generated with Guardant360. We performed clinical annotation on a multi-institutional subset (n=225) to assess intra-patient cfDNA-tumor concordance and the association of cfDNA variant allele fraction (VAF) with clinical outcomes. RESULTS Genetic alterations were detected in cfDNA in 84% of patients, with targetable alterations detected in 44% of patients. FGFR2 fusions, IDH1 mutations, and BRAF V600E were clonal in majority of cases, affirming these targetable alterations as early driver events in BTC. Concordance between cfDNA and tissue for mutation detection was high for IDH1 mutations (87%) and BRAF V600E (100%), and low for FGFR2 fusions (18%). cfDNA analysis uncovered novel putative mechanisms of resistance to targeted therapies, including mutation of the cysteine residue (FGFR2 C492F) to which covalent FGFR inhibitors bind. High pre-treatment cfDNA VAF associated with poor prognosis and shorter response to chemotherapy and targeted therapy. Finally, we report the frequency of promising targets in advanced BTC currently under investigation in other advanced solid tumors, including KRAS G12C (1.0%), KRAS G12D (5.1%), PIK3CA mutations (6.8%), and ERBB2 amplifications (4.9%). CONCLUSIONS These findings from the largest and most comprehensive study to date of cfDNA from patients with advanced BTC highlight the utility of cfDNA analysis in current management of this disease. Characterization of oncogenic drivers and mechanisms of therapeutic resistance in this study will inform drug development efforts to reduce mortality for patients with BTC.
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Affiliation(s)
- Jacob E Berchuck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Francesco Facchinetti
- Université Paris-Saclay, Institut Gustave Roussy, Inserm U981, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Daniel F DiToro
- Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Islam Baiev
- Department of Medicine, Mass General Cancer Center, Harvard Medical School, Boston, MA
| | - Umair Majeed
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | | | - Christopher Chen
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Karen Zhang
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Reya Sharman
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ
| | | | - Jordan Maurer
- Department of Medicine, Mass General Cancer Center, Harvard Medical School, Boston, MA
| | - Rachna T Shroff
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ
| | - Colin C Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Meng-Ju Wu
- Department of Medicine, Mass General Cancer Center, Harvard Medical School, Boston, MA
| | | | - Milind Javle
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Luc Friboulet
- Université Paris-Saclay, Institut Gustave Roussy, Inserm U981, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Antoine Hollebecque
- Université Paris-Saclay, Institut Gustave Roussy, Inserm U981, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Nabeel Bardeesy
- Department of Medicine, Mass General Cancer Center, Harvard Medical School, Boston, MA
| | - Andrew X Zhu
- Jiahui International Cancer Center, Jihaui Health, Shanghai, China; I-Mab Biopharma, Shanghai, China
| | - Jochen K Lennerz
- Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Benjamin Tan
- Department of Medicine, Washington University, St. Louis, MO
| | - Mitesh Borad
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ
| | - Aparna R Parikh
- Department of Medicine, Mass General Cancer Center, Harvard Medical School, Boston, MA
| | | | - Robin Kate Kelley
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Kabir Mody
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | - Dejan Juric
- Department of Medicine, Mass General Cancer Center, Harvard Medical School, Boston, MA
| | - Lipika Goyal
- Department of Medicine, Mass General Cancer Center, Harvard Medical School, Boston, MA.
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Precision Oncology for Biliary Tract Tumors: It’s Written in Blood! Ann Oncol 2022; 33:1209-1211. [DOI: 10.1016/j.annonc.2022.09.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 11/18/2022] Open
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Høgdall D, O'Rourke CJ, Andersen JB. Molecular therapeutic targets for cholangiocarcinoma: Present challenges and future possibilities. Adv Cancer Res 2022; 156:343-366. [PMID: 35961705 DOI: 10.1016/bs.acr.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A diagnosis of cholangiocarcinoma (CCA) is implicit with poor prognosis and limited treatment options, underscoring the near equivalence of incidence and mortality rates in this disease. In less than 9years from genomic identification to FDA-approval of the corresponding inhibitors, fibroblast growth factor receptor 2 (FGFR2) rearrangements and isocitrate dehydrogenase 1 (IDH1) mutations became exemplary successes of precision oncology in subsets of patients with CCA. However, clinical trial results from multikinase inhibitors in unselected populations have been less successful, while the impact of immunotherapies are only beginning to impact this setting. Development of future therapeutics is incumbent with new challenges. Many driver alterations occur in tumor suppressor-like genes which are not directly druggable. Therapeutically, this will require identification of ensuant "non-oncogene addiction" involving genes which are not themselves oncogenes but become tumor survival dependencies when a specific driver alteration occurs. The low recurrence frequency of genomic alterations between CCA patients will require careful evaluation of targeted agents in biomarker-enrolled trials, including basket trial settings. Systematic expansion of candidate drug targets must integrate genes affected by non-genetic alterations which incorporates the fundamental contribution of the microenvironment and immune system to treatment response, disease facets which have been traditionally overlooked by DNA-centric analyses. As treatment resistance is an inevitability in advanced disease, resistance mechanisms require characterization to guide the development of combination therapies to increase the duration of clinical benefit. Patient-focused clinical, technological and analytical synergy is needed to deliver future solutions to these present therapeutic challenges.
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Affiliation(s)
- Dan Høgdall
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Oncology, Herlev and Gentofte Hospital, Herlev, Copenhagen University Hospital, Copenhagen, Denmark
| | - Colm J O'Rourke
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper B Andersen
- Biotech Research and Innovation Centre (BRIC), Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Macias RIR, Cardinale V, Kendall TJ, Avila MA, Guido M, Coulouarn C, Braconi C, Frampton AE, Bridgewater J, Overi D, Pereira SP, Rengo M, Kather JN, Lamarca A, Pedica F, Forner A, Valle JW, Gaudio E, Alvaro D, Banales JM, Carpino G. Clinical relevance of biomarkers in cholangiocarcinoma: critical revision and future directions. Gut 2022; 71:1669-1683. [PMID: 35580963 DOI: 10.1136/gutjnl-2022-327099] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023]
Abstract
Cholangiocarcinoma (CCA) is a malignant tumour arising from the biliary system. In Europe, this tumour frequently presents as a sporadic cancer in patients without defined risk factors and is usually diagnosed at advanced stages with a consequent poor prognosis. Therefore, the identification of biomarkers represents an utmost need for patients with CCA. Numerous studies proposed a wide spectrum of biomarkers at tissue and molecular levels. With the present paper, a multidisciplinary group of experts within the European Network for the Study of Cholangiocarcinoma discusses the clinical role of tissue biomarkers and provides a selection based on their current relevance and potential applications in the framework of CCA. Recent advances are proposed by dividing biomarkers based on their potential role in diagnosis, prognosis and therapy response. Limitations of current biomarkers are also identified, together with specific promising areas (ie, artificial intelligence, patient-derived organoids, targeted therapy) where research should be focused to develop future biomarkers.
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Affiliation(s)
- Rocio I R Macias
- Experimental Hepatology and Drug Targeting (HEVEPHARM) group, University of Salamanca, IBSAL, Salamanca, Spain.,Center for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Carlos III National Institute of Health, Madrid, Spain
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Timothy J Kendall
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Matias A Avila
- Center for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Carlos III National Institute of Health, Madrid, Spain.,Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Maria Guido
- Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Cedric Coulouarn
- UMR_S 1242, COSS, Centre de Lutte contre le Cancer Eugène Marquis, INSERM University of Rennes 1, Rennes, France
| | - Chiara Braconi
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Adam E Frampton
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - John Bridgewater
- Department of Medical Oncology, UCL Cancer Institute, London, UK
| | - Diletta Overi
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Stephen P Pereira
- Institute for Liver & Digestive Health, University College London, London, UK
| | - Marco Rengo
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Jakob N Kather
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Angela Lamarca
- Medical Oncology/Institute of Cancer Sciences, The Christie NHS Foundation Trust/University of Manchester, Manchester, UK
| | - Federica Pedica
- Department of Pathology, San Raffaele Scientific Institute, Milan, Italy
| | - Alejandro Forner
- Center for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Carlos III National Institute of Health, Madrid, Spain.,BCLC group, Liver Unit, Hospital Clínic Barcelona. IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan W Valle
- Medical Oncology/Institute of Cancer Sciences, The Christie NHS Foundation Trust/University of Manchester, Manchester, UK
| | - Eugenio Gaudio
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Domenico Alvaro
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Jesus M Banales
- Center for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Carlos III National Institute of Health, Madrid, Spain.,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), Ikerbasque, San Sebastian, Spain.,Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Guido Carpino
- Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Rome, Italy
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40
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Kirchweger P, Wundsam HV, Rumpold H. Circulating tumor DNA for diagnosis, prognosis and treatment of gastrointestinal malignancies. World J Clin Oncol 2022; 13:473-484. [PMID: 35949436 PMCID: PMC9244970 DOI: 10.5306/wjco.v13.i6.473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/06/2021] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive detection of circulating tumor DNA (ctDNA) in peripheral blood or other body fluids of patients with gastrointestinal malignancies via liquid biopsy has emerged as a promising biomarker. This is urgently needed, as conventional imaging and plasma protein-derived biomarkers lack sensitivity and specificity in prognosis, early detection of relapse or treatment monitoring. This review summarizes the potential role of liquid biopsy in diagnosis, prognosis and treatment monitoring of gastrointestinal malignancies, including upper gastrointestinal, liver, bile duct, pancreatic and colorectal cancer. CtDNA can now be part of the clinical routine as a promising, highly sensitive and specific biomarker with a broad range of applicability. Liquid-biopsy based postoperative relapse prediction could lead to improved survival by intensification of adjuvant treatment in patients identified to be at risk of early recurrence. Moreover, ctDNA allows monitoring of antineoplastic treatment success, with identification of potentially developed resistance or therapeutic targets during the course of treatment. It may also assist in early change of chemotherapy in metastatic gastrointestinal malignancies prior to imaging findings of relapse. Nevertheless, clinical utility is dependent on the tumor’s entity and burden.
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Affiliation(s)
- Patrick Kirchweger
- Department of Surgery, Ordensklinikum Linz, Linz 4010, Austria
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz 4010, Austria
- Medical Faculty, JKU University Linz, Linz 4040, Austria
| | | | - Holger Rumpold
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz 4010, Austria
- Medical Faculty, JKU University Linz, Linz 4040, Austria
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41
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Durães C, Pereira Gomes C, Costa JL, Quagliata L. Demystifying the Discussion of Sequencing Panel Size in Oncology Genetic Testing. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/22c9259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Clinical laboratories worldwide are implementing next-generation sequencing (NGS) to identify cancer genomic variants and ultimately improve patient outcomes. The ability to massively sequence the entire genome or exome of tumour cells has been critical to elucidating many complex biological questions. However, the depth of information obtained by these methods is strenuous to process in the clinical setting, making them currently unfeasible for broader adoption. Instead, targeted sequencing, usually on a selection of clinically relevant genes, represents the predominant approach that best balances accurate identification of genomic variants with high sensitivity and a good cost-effectiveness ratio. The information obtained from targeted sequencing can support diagnostic classification, guide therapeutic decisions, and provide prognostic insights. The use of targeted gene panels expedites sample processing, including data analysis, results interpretation, and medical reports generation, directly affecting patient management. The key decision factors for selecting sequencing methods and panel size in routine testing should include diagnostic yield and clinical utility, sample availability, and processing turnaround time.
Profiling by default all patients with late-stage cancer with large panels is not affordable for most healthcare systems and does not provide substantial clinical benefit at present. Balancing between understanding cancer biology, including patients in clinical trials, maximising testing, and ensuring a sustainable financial burden for society requires thorough consideration. This review provides an overview of the advantages and drawbacks of different sizes NGS panels for tumour molecular profiling and their clinical applicability.
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Affiliation(s)
- Cecília Durães
- Clinical Next-Generation Sequencing Division, Genetic Sciences Group, Thermo Fisher Scientific, Carlsbad, California, USA
| | | | - Jose Luis Costa
- Clinical Next-Generation Sequencing Division, Genetic Sciences Group, Thermo Fisher Scientific, Carlsbad, California, USA
| | - Luca Quagliata
- Clinical Next-Generation Sequencing Division, Genetic Sciences Group, Thermo Fisher Scientific, Carlsbad, California, USA
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Arechederra M, Rullán M, Amat I, Oyon D, Zabalza L, Elizalde M, Latasa MU, Mercado MR, Ruiz-Clavijo D, Saldaña C, Fernández-Urién I, Carrascosa J, Jusué V, Guerrero-Setas D, Zazpe C, González-Borja I, Sangro B, Herranz JM, Purroy A, Gil I, Nelson LJ, Vila JJ, Krawczyk M, Zieniewicz K, Patkowski W, Milkiewicz P, Cubero FJ, Alkorta-Aranburu G, G Fernandez-Barrena M, Urman JM, Berasain C, Avila MA. Next-generation sequencing of bile cell-free DNA for the early detection of patients with malignant biliary strictures. Gut 2022; 71:1141-1151. [PMID: 34285068 PMCID: PMC9120390 DOI: 10.1136/gutjnl-2021-325178] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/08/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Despite significant progresses in imaging and pathological evaluation, early differentiation between benign and malignant biliary strictures remains challenging. Endoscopic retrograde cholangiopancreatography (ERCP) is used to investigate biliary strictures, enabling the collection of bile. We tested the diagnostic potential of next-generation sequencing (NGS) mutational analysis of bile cell-free DNA (cfDNA). DESIGN A prospective cohort of patients with suspicious biliary strictures (n=68) was studied. The performance of initial pathological diagnosis was compared with that of the mutational analysis of bile cfDNA collected at the time of first ERCP using an NGS panel open to clinical laboratory implementation, the Oncomine Pan-Cancer Cell-Free assay. RESULTS An initial pathological diagnosis classified these strictures as of benign (n=26), indeterminate (n=9) or malignant (n=33) origin. Sensitivity and specificity of this diagnosis were 60% and 100%, respectively, as on follow-up 14 of the 26 and eight of the nine initially benign or indeterminate strictures resulted malignant. Sensitivity and specificity for malignancy of our NGS assay, herein named Bilemut, were 96.4% and 69.2%, respectively. Importantly, one of the four Bilemut false positives developed pancreatic cancer after extended follow-up. Remarkably, the sensitivity for malignancy of Bilemut was 100% in patients with an initial diagnosis of benign or indeterminate strictures. Analysis of 30 paired bile and tissue samples also demonstrated the superior performance of Bilemut. CONCLUSION Implementation of Bilemut at the initial diagnostic stage for biliary strictures can significantly improve detection of malignancy, reduce delays in the clinical management of patients and assist in selecting patients for targeted therapies.
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Affiliation(s)
- Maria Arechederra
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - María Rullán
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Irene Amat
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Department of Pathology, Navarra University Hospital Complex, Pamplona, Spain
| | - Daniel Oyon
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Lucia Zabalza
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Maria Elizalde
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain
| | - M Ujue Latasa
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Maria R Mercado
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Department of Pathology, Navarra University Hospital Complex, Pamplona, Spain
| | - David Ruiz-Clavijo
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Cristina Saldaña
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Ignacio Fernández-Urién
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Juan Carrascosa
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Vanesa Jusué
- Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - David Guerrero-Setas
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Molecular Pathology of Cancer Group, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Cruz Zazpe
- Department of General Surgery, Navarra University Hospital Complex, Pamplona, Spain
| | | | - Bruno Sangro
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Liver Unit, Dept. of Internal Medicine, Clinica Universitaria de Navarra, Pamplona, Spain,CIBEREHD, Madrid, Spain
| | - Jose M Herranz
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain,CIBEREHD, Madrid, Spain
| | - Ana Purroy
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Biobank Unit, Navarrabiomed, Pamplona, Spain
| | - Isabel Gil
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Biobank Unit, Navarrabiomed, Pamplona, Spain
| | - Leonard J Nelson
- Institute for Bioengineering, University of Edinburgh, Edinburgh, UK
| | - Juan J Vila
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany,Liver and Internal Medicine Unit, Medical University of Warsaw, Warszawa, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Waldemar Patkowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Milkiewicz
- Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland,Translational Medicine Group, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Francisco Javier Cubero
- CIBEREHD, Madrid, Spain,Department of Immunology, Ophtalmology and ENT, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | | | - Maite G Fernandez-Barrena
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,CIBEREHD, Madrid, Spain
| | - Jesus M Urman
- Navarra Institute for Health Research, IdiSNA, Pamplona, Spain,Department of Gastroenterology and Hepatology, Navarra University Hospital Complex, Pamplona, Spain
| | - Carmen Berasain
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain .,Navarra Institute for Health Research, IdiSNA, Pamplona, Spain.,CIBEREHD, Madrid, Spain
| | - Matias A Avila
- Hepatology Program, CIMA, University of Navarra, Pamplona, Spain .,Navarra Institute for Health Research, IdiSNA, Pamplona, Spain.,CIBEREHD, Madrid, Spain
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43
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Carotenuto M, Sacco A, Forgione L, Normanno N. Genomic alterations in cholangiocarcinoma: clinical significance and relevance to therapy. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2022; 3:200-223. [PMID: 36046845 PMCID: PMC9400790 DOI: 10.37349/etat.2022.00079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/22/2022] [Indexed: 11/22/2022] Open
Abstract
Improving the survival of patients with cholangiocarcinoma (CCA) has long proved challenging, although the treatment of this disease nowadays is on advancement. The historical invariability of survival outcomes and the limited number of agents known to be effective in the treatment of this disease has increased the number of studies designed to identify genetic targetable hits that can be efficacious for novel therapies. In this respect, the increasing feasibility of molecular profiling starting either from tumor tissue or circulating cell-free DNA (cfDNA) has led to an increased understanding of CCA biology. Intrahepatic CCA (iCCA) and extrahepatic CCA (eCCA) display different and typical patterns of actionable genomic alterations, which offer opportunity for therapeutic intervention. This review article will summarize the current knowledge on the genomic alterations of iCCA and eCCA, provide information on the main technologies for genomic profiling using either tumor tissue or cfDNA, and briefly discuss the main clinical trials with targeted agents in this disease.
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Affiliation(s)
- Marianeve Carotenuto
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
| | - Alessandra Sacco
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
| | - Laura Forgione
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
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44
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DNA Damage Response Inhibitors in Cholangiocarcinoma: Current Progress and Perspectives. Cells 2022; 11:cells11091463. [PMID: 35563769 PMCID: PMC9101358 DOI: 10.3390/cells11091463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/16/2022] [Accepted: 04/24/2022] [Indexed: 12/27/2022] Open
Abstract
Cholangiocarcinoma (CCA) is a poorly treatable type of cancer and its incidence is dramatically increasing. The lack of understanding of the biology of this tumor has slowed down the identification of novel targets and the development of effective treatments. Based on next generation sequencing profiling, alterations in DNA damage response (DDR)-related genes are paving the way for DDR-targeting strategies in CCA. Based on the notion of synthetic lethality, several DDR-inhibitors (DDRi) have been developed with the aim of accumulating enough DNA damage to induce cell death in tumor cells. Observing that DDRi alone could be insufficient for clinical use in CCA patients, the combination of DNA-damaging regimens with targeted approaches has started to be considered, as evidenced by many emerging clinical trials. Hence, novel therapeutic strategies combining DDRi with patient-specific targeted drugs could be the next level for treating cholangiocarcinoma.
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45
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Silverman IM, Li M, Murugesan K, Krook MA, Javle MM, Kelley RK, Borad MJ, Roychowdhury S, Meng W, Yilmazel B, Milbury C, Shewale S, Feliz L, Burn TC, Albacker LA. Validation and Characterization of FGFR2 Rearrangements in Cholangiocarcinoma with Comprehensive Genomic Profiling. J Mol Diagn 2022; 24:351-364. [PMID: 35176488 DOI: 10.1016/j.jmoldx.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/26/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022] Open
Abstract
Cholangiocarcinoma (CCA) is a heterogeneous biliary tract cancer with a poor prognosis. Approximately 30% to 50% of patients harbor actionable alterations, including FGFR2 rearrangements. Pemigatinib, a potent, selective fibroblast growth factor receptor (FGFR) FGFR1-3 inhibitor, is approved for previously treated, unresectable, locally advanced or metastatic CCA harboring FGFR2 fusions/rearrangements, as detected by a US Food and Drug Administration-approved test. The next-generation sequencing (NGS)-based FoundationOneCDx (F1CDx) was US Food and Drug Administration approved for detecting FGFR2 fusions or rearrangements. The precision and reproducibility of F1CDx in detecting FGFR2 rearrangements in CCA were examined. Analytical concordance between F1CDx and an externally validated RNA-based NGS (evNGS) test was performed. Identification of FGFR2 rearrangements in the screening population from the pivotal FIGHT-202 study (NCT02924376) was compared with F1CDx. The reproducibility and repeatability of F1CDx were 90% to 100%. Adjusted positive, negative, and overall percentage agreements were 87.1%, 99.6%, and 98.3%, respectively, between F1CDx and evNGS. Compared with evNGS, F1CDx had a positive predictive value of 96.2% and a negative predictive value of 98.5%. The positive percentage agreement, negative percentage agreement, overall percentage agreement, positive predictive value, and negative predictive value were 100% for F1CDx versus the FIbroblast Growth factor receptor inhibitor in oncology and Hematology Trial-202 (FIGHT-202) clinical trial assay. Of 6802 CCA samples interrogated, 9.2% had FGFR2 rearrangements. Cell lines expressing diverse FGFR2 fusions were sensitive to pemigatinib. F1CDx demonstrated sensitivity, reproducibility, and high concordance with clinical utility in identifying patients with FGFR2 rearrangements who may benefit from pemigatinib treatment.
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Affiliation(s)
- Ian M Silverman
- Translational Sciences, Incyte Research Institute, Wilmington, Delaware
| | - Meijuan Li
- Research and Development, Foundation Medicine, Cambridge, Massachusetts
| | | | - Melanie A Krook
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Milind M Javle
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robin K Kelley
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | | | | | - Wei Meng
- Research and Development, Foundation Medicine, Cambridge, Massachusetts
| | - Bahar Yilmazel
- Research and Development, Foundation Medicine, Cambridge, Massachusetts
| | - Coren Milbury
- Research and Development, Foundation Medicine, Cambridge, Massachusetts
| | - Shantanu Shewale
- Research and Development, Foundation Medicine, Cambridge, Massachusetts
| | - Luis Feliz
- Clinical Development, Incyte Biosciences International Sàrl, Morges, Switzerland
| | - Timothy C Burn
- Translational Sciences, Incyte Research Institute, Wilmington, Delaware.
| | - Lee A Albacker
- Research and Development, Foundation Medicine, Cambridge, Massachusetts.
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46
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Rizzo A, Cusmai A, Palmiotti G. Second-line fluoropyrimidine-based doublet chemotherapy for advanced biliary tract cancer: a new standard of care? Expert Rev Gastroenterol Hepatol 2022; 16:201-203. [PMID: 35220859 DOI: 10.1080/17474124.2022.2047652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alessandro Rizzo
- Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico "Don Tonino Bello," I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Antonio Cusmai
- Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico "Don Tonino Bello," I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Gennaro Palmiotti
- Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico "Don Tonino Bello," I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Bari, Italy
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47
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Cho MT, Gholami S, Gui D, Tejaswi SL, Fananapazir G, Abi-Jaoudeh N, Jutric Z, Samarasena JB, Li X, Valerin JB, Mercer J, Dayyani F. Optimizing the Diagnosis and Biomarker Testing for Patients with Intrahepatic Cholangiocarcinoma: A Multidisciplinary Approach. Cancers (Basel) 2022; 14:392. [PMID: 35053557 PMCID: PMC8773504 DOI: 10.3390/cancers14020392] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 01/06/2023] Open
Abstract
Cholangiocarcinoma (CCA) is a heterogenous group of malignancies originating in the biliary tree, and associated with poor prognosis. Until recently, treatment options have been limited to surgical resection, liver-directed therapies, and chemotherapy. Identification of actionable genomic alterations with biomarker testing has revolutionized the treatment paradigm for these patients. However, several challenges exist to the seamless adoption of precision medicine in patients with CCA, relating to a lack of awareness of the importance of biomarker testing, hurdles in tissue acquisition, and ineffective collaboration among the multidisciplinary team (MDT). To identify gaps in standard practices and define best practices, multidisciplinary hepatobiliary teams from the University of California (UC) Davis and UC Irvine were convened; discussions of the meeting, including optimal approaches to tissue acquisition for diagnosis and biomarker testing, communication among academic and community healthcare teams, and physician education regarding biomarker testing, are summarized in this review.
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Affiliation(s)
- May T. Cho
- University of California Irvine Health, Orange, CA 92868, USA; (N.A.-J.); (Z.J.); (J.B.S.); (X.L.); (J.B.V.); (F.D.)
| | - Sepideh Gholami
- University of California Davis Health, Sacramento, CA 95817, USA; (S.G.); (D.G.)
| | - Dorina Gui
- University of California Davis Health, Sacramento, CA 95817, USA; (S.G.); (D.G.)
| | | | | | - Nadine Abi-Jaoudeh
- University of California Irvine Health, Orange, CA 92868, USA; (N.A.-J.); (Z.J.); (J.B.S.); (X.L.); (J.B.V.); (F.D.)
| | - Zeljka Jutric
- University of California Irvine Health, Orange, CA 92868, USA; (N.A.-J.); (Z.J.); (J.B.S.); (X.L.); (J.B.V.); (F.D.)
| | - Jason B. Samarasena
- University of California Irvine Health, Orange, CA 92868, USA; (N.A.-J.); (Z.J.); (J.B.S.); (X.L.); (J.B.V.); (F.D.)
| | - Xiaodong Li
- University of California Irvine Health, Orange, CA 92868, USA; (N.A.-J.); (Z.J.); (J.B.S.); (X.L.); (J.B.V.); (F.D.)
| | - Jennifer B. Valerin
- University of California Irvine Health, Orange, CA 92868, USA; (N.A.-J.); (Z.J.); (J.B.S.); (X.L.); (J.B.V.); (F.D.)
| | - Jacob Mercer
- Helsinn Therapeutics (U.S.), Inc., Iselin, NJ 08830, USA;
| | - Farshid Dayyani
- University of California Irvine Health, Orange, CA 92868, USA; (N.A.-J.); (Z.J.); (J.B.S.); (X.L.); (J.B.V.); (F.D.)
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48
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Manne A, Woods E, Tsung A, Mittra A. Biliary Tract Cancers: Treatment Updates and Future Directions in the Era of Precision Medicine and Immuno-Oncology. Front Oncol 2021; 11:768009. [PMID: 34868996 PMCID: PMC8634105 DOI: 10.3389/fonc.2021.768009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022] Open
Abstract
The effective management of biliary tract cancers (BTCs) has been hampered by limited options for systemic therapy. In recent years, the focus on precision medicine has made technologies such as next-generation sequencing (NGS) accessible to clinicians to identify targetable mutations in BTCs in tumor tissue (primarily) as well as blood, and to treat them with targeted therapies when possible. It has also expanded our understanding of functional pathways associated with genetic alterations and opened doors for identifying novel targets for treatment. Recent advances in the precision medicine approach allowed us to identify new molecular markers in BTCs, such as epigenetic changes (methylation and histone modification) and non-DNA markers such as messenger RNA, microRNA, and long non-coding RNA. It also made detecting these markers from non-traditional sources such as blood, urine, bile, and cytology (from fine-needle aspiration and biliary brushings) possible. As these tests become more accessible, we can see the integration of different molecular markers from all available sources to aid physicians in diagnosing, assessing prognosis, predicting tumor response, and screening BTCs. Currently, there are a handful of approved targeted therapies and only one class of immunotherapy agents (immune checkpoint inhibitors or ICIs) to treat BTCs. Early success with new targets, vascular endothelial growth factor receptor (VEGFR), HER2, protein kinase receptor, and Dickkopf-1 (DKK1); new drugs for known targets, fibroblast growth factor receptors (FGFRs) such as futabatinib, derazantinib, and erdafitinib; and ICIs such as durvalumab and tremelimumab is encouraging. Novel immunotherapy agents such as bispecific antibodies (bintrafusp alfa), arginase inhibitors, vaccines, and cellular therapy (chimeric antigen receptor-T cell or CAR-T, natural killer cells, tumor-infiltrating lymphocytes) have the potential to improve outcomes of BTCs in the coming years.
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Affiliation(s)
- Ashish Manne
- Department of Internal Medicine, Division of Medical Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Edward Woods
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Allan Tsung
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, United States
| | - Arjun Mittra
- Department of Internal Medicine, Division of Medical Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
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49
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Ioffe D, Phull P, Dotan E. Optimal Management of Patients with Advanced or Metastatic Cholangiocarcinoma: An Evidence-Based Review. Cancer Manag Res 2021; 13:8085-8098. [PMID: 34737637 PMCID: PMC8558827 DOI: 10.2147/cmar.s276104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/18/2021] [Indexed: 12/13/2022] Open
Abstract
Cholangiocarcinomas are rare tumors originating at any point along the biliary tree. These tumors often pose significant challenges for diagnosis and treatment, and often carry a poor prognosis. However, in recent years, studies have identified significant molecular heterogeneity with up to 50% of tumors having detectable mutations, leading to the guideline recommendations for molecular testing as part of the diagnostic workup for these tumors. In addition, better classification of these tumors and understanding of their biology has led to new drugs being approved for treatment of this resistant tumor. This manuscript will provide a comprehensive review of the epidemiology, risk factors, diagnostic approach, molecular classification, and treatment options for patients with advanced cholangiocarcinomas.
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Affiliation(s)
- Dina Ioffe
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Pooja Phull
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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50
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Braun S, McSheehy P, Litherland K, McKernan P, Forster-Gross N, Bachmann F, El-Shemerly M, Dimova-Dobreva M, Polyakova I, Häckl M, Zhou P, Lane H, Kellenberger L, Engelhardt M. Derazantinib: an investigational drug for the treatment of cholangiocarcinoma. Expert Opin Investig Drugs 2021; 30:1071-1080. [PMID: 34698609 DOI: 10.1080/13543784.2021.1995355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION This review evaluates the clinical role of fibroblast growth factor receptor 2 (FGFR2) inhibition with derazantinib in patients with intrahepatic cholangiocarcinoma (iCCA) harboring actionable oncogenic FGFR2 fusions/rearrangements, mutations and amplifications. FGFR inhibitors such as derazantinib are currently being evaluated to address the unmet medical need of patients with previously treated, locally advanced or metastatic iCCA harboring such genetic aberrations. AREAS COVERED We summarize the pharmacokinetics, and the emerging safety and efficacy data of the investigational FGFR inhibitor derazantinib. We discuss the future directions of this novel therapeutic agent for iCCA. EXPERT OPINION Derazantinib is a potent FGFR1‒3 kinase inhibitor which also has activity against colony stimulating factor-1‒receptor (CSF1R) and vascular endothelial growfth factor receptor‒2 (VEGFR2), suggesting a potentially differentiated role in the treatment of patients with iCCA. Derazantinib has shown clinically meaningful efficacy with durable objective responses, supporting the therapeutic potential of derazantinib in previously treated patients with iCCA harboring FGFR2 fusions/rearrangements, mutations and amplifications. The clinical safety profile of derazantinib was well manageable and compared favorably to the FGFR inhibitor class, particularly with a low incidence of drug-related hand-foot syndrome, stomatitis, retinal and nail toxicity. These findings support the need for increased molecular profiling of cholangiocarcinoma patients.
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Affiliation(s)
- Stephan Braun
- Development, Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Paul McSheehy
- Development, Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Karine Litherland
- Development, Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Phil McKernan
- Development, Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | - Felix Bachmann
- Development, Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | | | - Inessa Polyakova
- Development, Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Manuel Häckl
- Development, Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Ping Zhou
- Development, Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Heidi Lane
- Development, Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | - Marc Engelhardt
- Development, Basilea Pharmaceutica International Ltd, Basel, Switzerland
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