Sequencing therapy in the current therapeutic landscape of cholangiocarcinoma


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


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

Transcription edited for clarity.


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