Targeting FGFR in intrahepatic cholangiocarcinoma [iCCA]: leading the way for precision medicine in biliary tract cancer [BTC]?

Gabriella Aitcheson, Amit Mahipal, Binu V. John

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: The increasing availability of next-generation DNA sequencing (NGS) opens the opportunity to tailor therapies to potential targets. Intrahepatic cholangiocarcinoma (iCCA) has the most actionable genomic targets of the hepatobiliary malignancies, including mutations in Isocitrate Dehydrogenase (IDH) and Fibroblast Growth Factor Receptor (FGFR), particularly FGFR2. With the recent accelerated approval of pemigatinib and several trials currently underway, FGFR2 inhibition will set the mold for tailored therapies in hepatobiliary cancer. Areas covered: We review the current standard of therapy for iCCA, the genomic targets, and the role of FGFR inhibitors in developing the treatment landscape. The FGFR mechanism of actionand use of IDH1/2 inhibition and immunotherapy in iCCA are also discussed. We queried the PubMed and ClinicalTrials.gov databases, along with conference proceedings for relevant data. Expert opinion: While more mature data are needed from the trials in progress, currently published analyses show survival benefit with FGFR2 inhibitors in patients positive for FGFR2 fusion who have failed the standard of care. Infigratinib, futibatinib, pemigatinib and derazantinib have all demonstrated promising activity iCCA patients harboring FGFR2 fusion. Eventually, head-to-head trials will be needed to fully understand the benefits of each agent and the role of reversible versus irreversible FGFR2 inhibitors.

Original languageEnglish (US)
Pages (from-to)463-477
Number of pages15
JournalExpert Opinion on Investigational Drugs
Volume30
Issue number4
DOIs
StatePublished - 2021

Keywords

  • cholangiocarcinoma
  • FGFR
  • genomic sequencing
  • intrahepatic cholangiocarcinoma
  • liver cancer
  • next-generation sequencing
  • pemigatinib
  • Targeted therapy

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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