How would you approach the treatment of metastatic cholangiocarcinoma after progression on gemcitabine/cisplatin, FOLFOX, and pemigatinib?

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...

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 varying ...

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.