“In recent years we have recorded an increase in cases of cholangiocarcinoma, partly due to both an increase in diagnostic capabilities and an increase in hepatic steatosis.” This was said by Andrea Casadei Gardini, oncologist of the Medical Oncology Operational Unit of the Irccs San Raffaele Hospital in Milan and associate professor of Oncology at the Vita-Salute San Raffaele University of Milan, on the occasion of the media tutorial created with Servier on the most advance in precision oncology, which was held this morning in Rome.
“Cholangiocarcinoma is a type of primary tumor of the liver, which records around 5,400 new diagnoses in Italy every year – explains the expert – It is distinguished based on the site of onset as intrahepatic, if it develops within the liver, and extrahepatic and of the gallbladder, if it arises from the extrahepatic bile ducts. To date – he continues – there are no methods for early diagnosis or routine screening tests capable of identifying the disease in its initial phase, when surgery is still possible. For this reason, 70% of patients are diagnosed with an already advanced disease.” 5-year survival is still low, at 17% in men and 15% in women.
“However, recent progress in the field of molecular profiling and gene sequencing – underlines Casadei Gardini – have highlighted, even in this neoplasm, genetic alterations, which may represent new therapeutic targets. 45% of patients with cholangiocarcinoma present a genetic alteration potentially ‘actionable’, i.e. the target of targeted therapies, the most frequent in intrahepatic forms are Idh1 mutations, present in approximately 20% of cases, and Fgfr2 translocations, detectable in 10%”. Detecting the presence of Idh1 mutations can make a difference in the outcome of therapy.
“Tests should be performed in all patients from the beginning of the treatment process, therefore also in patients who are candidates for surgery, due to the high percentage of relapses following surgery and because the time factor plays a crucial role in the management of pathology”, underlines Casadei Gardini. Clinical studies have demonstrated the effectiveness of targeted therapies in the presence of genetic alterations. In particular, ivosidenib is the first targeted inhibitor of Idh1 approved in Europe for patients with locally advanced or metastatic cholangiocarcinoma with a mutation ( Idh1), previously treated with at least one line of systemic therapy.
“In the Claridhy study published in ‘Jama Oncology’ – concludes Casadei Gardini – the new molecule highlighted a reduction in the risk of disease progression by 63%. The benefits were also confirmed in a ‘real world’ study, which reproduces daily clinical practice.”
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