How would you treat an MSI-H metastatic cholangiocarcinoma found on liquid biopsy?
How would you treat a patient with metastatic cholangiocarcinoma found to be MSI-H on liquid NGS?
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This question has come up several times over the years at the Cholangiocarcinoma Foundation Conference. Several case outcomes were presented by numerous colleagues.
We are, in fact in the process of finishing up a series on this exact scenario.
At present, I have 2 active patients where from the insurance I got approval for Gem/Cis/Durva, and continuing only with Durva. Both patients approaching a year now and NED. I know of 5+ from Ohio State and others who’ve done the same.
This also is a question for Upper GI cancers where you can consider doing the same.
While the data is only for colorectal cancer with KEYNOTE-177, MSI-High/dMMR is a different beast altogether and the first marker to get agnostic approval.
A nice review of 3 studies by Dr. @Dr. First Last again looked at the chemo-IO versus IO question. And my opinion is that IO is what’s driving the benefit.
Unless there’s a visceral crisis where you can’t risk progression, I’d do IO, send a baseline ctDNA/NGS, and repeat in 3 weeks. You’ll know both through plasma MSI disappearance and ctDNA decrement that it’s working. You can always add gem/cis chemo later.
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