Biliary Tract Cancer and CUP Flashcards
Most common risk factors for biliary tract cancer (5)
PSC
Lynch syndrome
HCV
Diabetes
Obesity
Best adjuvant treatment for biliary tract cancer?
Capecitabine
1L for metastatic biliary tract cancers?
Gem Cis +/- Durva or Pembro
Difference in local therapy options for hilar vs intrahepatic cholangiocarcinoma?
Hilar cholangio cannot get TACE, RFA, Y90, etc. because of increased risk of abscess or complications
Patient undergoes routine cholecystectomy and finds a T1a gallbladder cancer. Management?
Observation
Patient undergoes a routine cholecystectomy and finds a T2 gallbladder cancer. Management?
Surgical resection of gallbladder fossa and lymphadenectomy
Which patients can be cured with orthotopic liver transplant?
Hilar cholangio
Intrahepatic cholangio with PSC or cirrhosis
strict transplant criteria
Best adjuvant therapy for cholangiocarcinoma?
Capecitabine
Only use radiation for R1 resection
Benefit of adjuvant radiation in biliary tract cancers?
Improves PFS, but no OS
Which BTC has the highest likelihood of having targetable mutation?
Intrahepatic cholangiocarcinoma
4 most common targetable mutations in biliary tract cancer
IDH1/2
FGFR1-3
BRAF
HER2
Treatment options for advanced BTC with FGFR2 fusions? (3)
Pemigatinib
INfigratinib
Futibatinib
all in second line*
Treatment option for advanced BTC with IDH1 mutation?
Ivosidenib
2L
Treatment option for advanced BTC with BRAF V600E mutation
Dabrafenib + Trametinib
second line*
Treatment option for advanced BTC with HER2 amplification?
None are FDA approved.
Trastuzumab + Pertuzumab is in NCCN guidelines
