How would you approach the treatment of metastatic cholangiocarcinoma after progression on gemcitabine/cisplatin, FOLFOX, and pemigatinib?
Would you consider using infigratinib after progression on pemigatinib?
Answer from: Medical Oncologist at Academic Institution
This is a tough situation. Depending on the patient's performance status and organ function, a clinical trial is strongly recommended. If the patient has FGFR2 fusion or chromosome rearrangement with prior exposure to pemigatinib, resistance mutation (gatekeeper mutation) is likely present and may b...
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Answer from: Medical Oncologist at Academic Institution
In reference to the question about switching from one FGFR inhibitor to another, that is a great thought that we have been navigating for a while, with the presumption of potential resistance to one of the anti-FGFR2 and alternating to another (see Goyal et al., PMID 28034880 for a model of var...
Answer from: Medical Oncologist at Community Practice
Agree with the excellent comments above. If no access for a trial of a more potent FGFRi and preserved PS, would also consider FOLFIRI/ NALIRI chemotherapy based on NIFTY trial in addition to the options mentioned above, especially if neuropathies are an issue.