Systemic treatment of patients with locally advanced or metastatic cholangiocarcinoma - an Austrian expert consensus statement

Hossein Taghizadeh; Angela Djanani; Wolfgang Eisterer; Armin Gerger; Birgit Gruenberger; Thomas Gruenberger; Holger Rumpold; Lukas Weiss; Thomas Winder; Ewald Wöll; Gerald W Prager

doi:10.3389/fonc.2023.1225154

Systemic treatment of patients with locally advanced or metastatic cholangiocarcinoma - an Austrian expert consensus statement

Front Oncol. 2023 Aug 30:13:1225154. doi: 10.3389/fonc.2023.1225154. eCollection 2023.

Authors

Hossein Taghizadeh^{1

2}, Angela Djanani³, Wolfgang Eisterer⁴, Armin Gerger⁵, Birgit Gruenberger⁶, Thomas Gruenberger⁷, Holger Rumpold⁸, Lukas Weiss⁹, Thomas Winder¹⁰, Ewald Wöll¹¹, Gerald W Prager¹²

Affiliations

¹ Department of Internal Medicine I, University Hospital St. Pölten, St. Pölten, Austria.
² Karl Landsteiner University of Health Sciences, Krems, Austria.
³ Clinical Division of Gastroenterology, Hepatology and Metabolism, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria.
⁴ Department of Internal Medicine, Klagenfurt Hospital, Klagenfurt am Wörthersee, Austria.
⁵ Department of Internal Medicine, Clinical Division of Oncology, Medical University of Graz, Graz, Austria.
⁶ Department of Internal Medicine and Hematology and Internal Oncology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria.
⁷ Department of Surgery, Clinic Favoriten, Hepatopancreatobiliary Center (HPB) Center, Health Network Vienna, and Sigmund Freud Private University, Vienna, Austria.
⁸ Visceral Oncology Center, Ordensklinikum Linz, Linz, Austria.
⁹ Department of Internal Medicine III, Paracelsus Medical University, Salzburg, Austria.
¹⁰ Department of Internal Medicine II, Hospital Feldkirch, Feldkirch, Austria.
¹¹ Department of Internal Medicine, Saint Vincent Hospital Zams, Zams, Austria.
¹² Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria.

Abstract

Locally advanced or metastatic cholangiocarcinoma is an aggressive carcinoma with a dismal prognosis. For the first-line treatment of locally advanced or metastatic cholangiocarcinoma, cisplatin/gemcitabine has been the standard of care for more than 10 years. Its combination with the immune checkpoint inhibitor durvalumab resulted in an efficiency improvement in the phase III setting. Regarding the use of chemotherapy in the second line, positive phase III data could only be generated for FOLFOX. The evidence base for nanoliposomal irinotecan (Nal-IRI) plus 5-fluorouracil (5-FU) and leucovorin (LV) is contradictory. After the failure of first-line treatment, targeted therapies can be offered if the molecular targets microsatellite instability-high (MSI-H), IDH1, FGFR2, BRAF V600E, and NTRK are detected. These targeted agents are generally preferable to second-line chemotherapy. Broad molecular testing should be performed, preferably from tumor tissue, at the initiation of first-line therapy to timely identify potential molecular targets.

Keywords: biliary tract cancer (BTC); chemotherapy; cholangiocarcinoma; molecular profiling; targeted therapy.