Gastrointestinal Oncology CME ACCREDITED Watch Time: 29 mins

touchEXPERT OPINIONS Aiming for new targets in biliary tract cancer

Watch leading experts in biliary tract cancer discuss the current unmet needs and how targeted treatments can improve patient outcomes.

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Prof. Do-Youn Oh
Seoul National University Hospital, Seoul, South Korea
The current clinical landscape for BTC

Prof. Do-Youn Oh discusses the unmet needs for patients with BTCs and what the current treatment algorithm looks like. She also considers possible future treatments that may improve outcomes for these patients.

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Interview Questions

In this interview, Prof. Do-Youn Oh answers the following questions:

  • What is the global burden of BTC?
  • What is the heterogeneity of BTC and how does it impact on treatment decisions?
  • What is the current treatment algorithm for BTC?
  • What is the landscape for new drug development in BTC?
About Prof. Do-Youn Oh

Do-Youn Oh is currently Professor in Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine. She graduated from Seoul National University College of Medicine in 1997, and had residency training in Internal Medicine, and fellowship of Hematology/Medical Oncology training in Seoul National University Hospital. She got her Ph.D Degree in the Department of Internal Medicine, Seoul National University College of Medicine in 2005. Since 2006, she has been working as a professor in Seoul National University Hospital.

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Her main research interest is gastric cancer, pancreatic cancer and biliary tract cancer with particular interest in the translational research and early drug development. She has published over 250 peer-reviewed journal articles. She has lots of committee memberships in the medical society, including Korean Cancer Association, Korean Association of Clinical Oncology, Korean Cancer Study Group, American Society of Clinical Oncology and American Association for Cancer Research.

 

Prof. Do-Youn Oh has no financial interests/relationships or affiliations to disclose in relation to this activity.

 
Prof. Juan Valle
The Christie NHS Foundation Trust, Manchester, UK
How genetic alterations and the tumour microenvironment are driving the development of new therapies

Prof. Juan Valle discusses the current genetic landscape and actionable signatures of BTC. He also considers how this knowledge is influencing drug development.

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Interview Questions

In this interview, Prof. Juan Valle answers the following questions:

  • BTCs are a group of cancers with different clinical and molecular characteristics. How does this heterogeneity impact on the classification of these tumours?
  • What are the most prevalent genetic subgroups of BTC that have been identified?
  • What is the role of targeting IDH1 in BTC?
  • What is the role of targeting FGFR in BTC?
  • What other targets could be exploited by tumour-agnostic agents?
About Prof. Juan Valle

Juan Valle is a Professor of Medical Oncology in the University of Manchester (Division of Cancer Sciences, Faculty of Biology, Medicine and Health). He is based at The Christie NHS Foundation Trust within the Gastrointestinal Disease Group and treats cancers of the pancreas, liver and biliary tract, and neuroendocrine tumours (NETs).

Prof. Valle has been awarded a number of grants for research leading to a number of high-impact, practice-changing publications and presentations at national and international meetings; he is a peer-reviewer for a number of international medical journals and grant-awarding bodies.

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Prof. Valle established The Christie Neuroendocrine European Neuroendocrine Tumour Society (ENETS) Centre of Excellence in Manchester in 2011 and currently sits on the ENETS Advisory Board; he previously Chaired the UK National Cancer Research Institute (NCRI) neuroendocrine subgroup (2013 – 2017). Prof. Valle is an active member of the NCRI hepatobiliary and pancreatic subgroups; co-Chair of the EORTC Hepatobiliary Task Force; and sits on the Scientific and Medical Advisory Board of the Cholangiocarcinoma Foundation [USA]. He previously was a member of the National Cancer Institute Hepatobiliary Task Force [USA].

Society memberships include ASCO (American Society of Clinical Oncology), ESMO (European Society of Medical Oncology), UKI NETS (UK and Ireland Neuroendocrine Tumour Society) and ENETS (European Neuroendocrine Tumour Society).

Prof. Juan Valle discloses: Consultant/Advisory Boards fees Agios, AstraZeneca, Incyte, Merck, NuCana, QED Therapeutic and Taiho Pharmaceuticals. Speaker’s bureau fees from Incyte and NuCana.

 
Dr Rachna Shroff
University of Arizona Cancer Center, Tucson, AZ, USA
New hope from emerging therapies

Dr Rachna Shroff discusses new and emerging targeted therapies and immunotherapies for the treatment of BTCs. She also considers what are the implications for practice of these new agents.

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Interview Questions

In this interview, Dr Rachna Shroff answers the following questions:

  • Why should we molecularly profile the tumours of patients with BTC?
  • How should we treat patients with FGFR-mutated BTC?
  • How should we treat patients with IDH-mutated BTC?
  • How should we manage patients with acquired resistance to their treatment?
  • What immunotherapy agents are in development for the treatment of BTCs?
About Dr Rachna Shroff

Rachna T. Shroff, MD, MS, joined the faculty of the University of Arizona College of Medicine – Tucson in April 2018, as an Associate Professor in the Department of Medicine, Division of Hematology and Oncology, and Chief of the Section of GI Medical Oncology at the UA Cancer Center. She also is the Director of the Clinical Trials Office for the entire Cancer Center and she serves as the leader of the Gastrointestinal (GI) Oncology Disease Oriented Team, which oversees the GI research program at the university. Dr Shroff has focused her career on clinical and translational research in gastrointestinal malignancies.

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Nationally, Dr Shroff has been a member of the ASCO Scientific Committee (American Society of Clinical Oncology), the ASCO Education Committee, Noncolorectal Track, as well as the ASCO Gastrointestinal Guidelines Advisory Group. She also serves as the ASCO liaison on the GI ASCO Program Committee. She participates in the Southwest Oncology Group (SWOG) GI Committee, and the NCI Hepatobiliary Taskforce (National Cancer Institute), being the national Principal Investigator on pivotal, randomized phase 3 study, SWOG 1815. She is involved in the International Cholangiocarcinoma Research Network (ICRN) where she participates in the Immuno-Oncology Working Group.

 

Dr Rachna Shroff discloses: Grants/research support from Exelixis Pharmaceuticals, Halozyme Therapeutics, Merck, Pieris Pharmaceuticals, Rafael Pharmaceuticals and Taiho Pharmaceutical. Consultant/Advisory Boards fees from Agios Pharmaceuticals, AstraZeneca, Clovis Oncology, Debiopharm, Exelixis Pharmaceuticals, Incyte, Merck, QED Therapeutics and Seattle Genetics.

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Overview & Learning Objectives
Overview

In this activity, gastrointestinal oncology experts discuss the current unmet needs in BTC and how the development of new treatments is driven by our understanding of the genetics and tumour microenvironment of BTCs. 

This activity has been jointly provided by Oakstone and touchIME ONCOLOGY. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians.

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Target audience

This activity has been designed to meet the educational needs of oncologists, hepatologists and other allied healthcare professionals involved in the management of BTCs.

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Faculty

Prof. Do-Youn Oh has no financial interests/relationships or affiliations to disclose in relation to this activity.

Prof. Juan Valle discloses: Consultant/Advisory Boards fees Agios, AstraZeneca, Incyte, Merck, NuCana, QED Therapeutic and Taiho Pharmaceuticals. Speaker’s bureau fees from Incyte and NuCana.

Dr Rachna Shroff discloses: Grants/research support from Exelixis Pharmaceuticals, Halozyme Therapeutics, Merck, Pieris Pharmaceuticals, Rafael Pharmaceuticals and Taiho Pharmaceutical. Consultant/Advisory Boards fees from Agios Pharmaceuticals, AstraZeneca, Clovis Oncology, Debiopharm, Exelixis Pharmaceuticals, Incyte, Merck, QED Therapeutics, Seattle Genetics,

Content Reviewer

Walter Murray Yarbrough, MD, FACP, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Hannah Fisher has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Oakstone Publishing and touchIME. Oakstone Publishing is accredited by the ACCME to provide contining medical education for physicians.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA) European physicians interested in converting AMA PRA Categoty 1 Credit into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Oakstone Publishing designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In order to receive credit for this activity, participants must review and complete the post-test and evaluation form. A score of 70% or higher is needed to obtain CME credit. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

Date of original release: 15 September 2020. Date credits expire: 15 September 2021.

Learning Objectives

After watching this activity, participants should be better able to:

  • Describe the unmet therapeutic needs for patients with biliary tract cancer
  • Describe the genetic characteristics and tumour microenvironment of biliary tract cancers
  • Explain the supporting data for new and emerging treatments for biliary tract cancers

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/5
Which of the following statements is true regarding patients diagnosed with biliary tract cancer?
Correct

An estimated >65% of patients diagnosed with biliary tract cancer have non-resectable disease.

Reference

Valle JW, et al. Cancer Discov. 2017;7:943–62.

Question 2/5
The phase III ClarIDHy study of ivosidenib versus placebo in IDH1-mutant chemotherapy-refractory cholangiocarcinoma reported what as an outcome?

EORTC QLQ-C30, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30; OS, overall survival; PFS, progression-free survival.
Correct

PFS was significantly improved with ivosidenib compared with placebo (median 2.7 months [95% CI 1.6–4.2] vs 1.4 months [1.4–1.6]; hazard ratio 0·37; 95% CI 0.25–0.54; one-sided p<0·0001).

CI, confidence interval; PFS, progression-free survival.

Reference

Abou-Alfa GK, et al. Lancet Oncol. 2020;21:796–807.

Question 3/5
On the basis of the phase II INCB054828 trial, which of the following adverse events should you monitor patients receiving pemigatinib for?
Correct

In this trial, the most common any-grade treatment emergent adverse events were hyperphosphataemia (73.2%), fatigue (49.3%) and stomatitis (45.1%).

Reference

Javle M, et al. Hepatobiliary Surg Nutr. 2019;8(Suppl. 1):AB051.

Question 4/5
For a patient with unresectable intrahepatic cholangiocarcinoma that was found to harbour MSI-H/dMMR, which of the following would you consider for primary treatment?

dMMR - deficient mismatch repair, MSI - microsatellite instability
Correct

The current NCCN guidelines recommend pembrolizumab for the treatment of MSI-H/dMMR tumours in the first-line setting.

dMMR, deficient mismatch repair; MSI, microsatellite instability; NCCN, National Comprehensive Cancer Network.

Reference

NCCN Clinical Practice Guidelines in Oncology. Hepatobiliary Cancers. Version 5.2020. 2020. Available at: www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf (accessed August 2020)

Question 5/5
Which of the following mutations is found in patients with biliary tract cancer of all origins at a prevalence of over 5%?
Correct

HER2 mutations have been reported in 10–15% of patients with biliary tract cancer.

Reference

Lamarca A, et al. J Hepatol. 2020;73:170–85.

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