#GI21 time for another #Tweetorial🧵 on


in a very 🎯 “Target-rich” disease

~3️⃣0️⃣% actionable findings

Interestingly we found more #FGFR🧬 fusions on liquid🩸than tissue 🔬. #OncoAlert
🧵2️⃣ #GI21
#Cholangiocarcinoma is the poster child of actionable aberrations & truly a 🎯“Target-rich” disease.

We focused on %numbers for aberrations for which there’s either an ✅approved drug, guideline endorsement, #clinicaltrials or even off-label reports/cases.👇🏾
🧵3️⃣ #GI21
We often don’t think of #ctDNA based platforms to be as sensitive for detecting fusions; when present it is real & an actionable finding.

Interestingly we found #FGFR🧬fusions
💭 maybe because of selection bias. #ctDNA filling the void. #OncoAlert
🧵4️⃣ #GI21
Focusing #FGFR 🧬 fusions & fusions in general, you have to know your testing platform. Whether it’s tissue🔬or🩸liquid, fusions can be detected.

🩸is not meant to replace🔬but for some pts may be the only option. Tissue often not sufficient in #cholangiocarcinoma.
🧵5️⃣ #GI21
All of us who treat #cholangiocarcinoma & doing #clinicaltrials using #FGFR🧬⛔️ know challenging it is to find these patients who would derive immense benefit from these new drugs. 🔐

#ctDNA can help aid & find the additional cohort of pts where 🔬wasn’t feasible.
🧵6️⃣ #GI21
With increasing number of 🎯targeted⛔️therapies now being approved or available through trials or off-label, acquired mechanisms of resistance can be non-invasively be captured on #ctDNA based platforms.

👇🏾pt ē ERRFI1 on Erlotinib.
Exquisite response📉.
Later MET📈.
🧵7️⃣ #GI21
We have a real opportunity to make an impact on the lives of our pts ē #cholangiocarcinoma. We may not have drugs or options/trials for all the aberrations👇🏾.
However, in about ~ 3️⃣0️⃣% of these➡️ #PrecisionMedicine.
#ctDNA can fill the void. #HPBCSM #OncoAlert @ASCO
#GI21 #HappeningNow @ASCO
Glad that
Is now @NCCN guidelines.
>1️⃣5️⃣% of intrahepatic #cholangiocarcinoma #HPBCSM.

Again cannot overemphasize the “Target-rich” nature of disease. #ctDNA NGS platforms upfront & potentially at progression. New trials open too. PARP⛔️.
#GI21 #HappeningNow
Moving from one targeted therapy for again intrahepatic #cholangiocarcinoma to another.

We already have pemigatinib approved. This is Infigratinib BGJ398 QED.

~1️⃣5️⃣% IHCC.

Note 👆🏾liquid can fill the void for some pts ➡️ ⬇️tissue. #OncoAlert
One under recognized utility of 🧬 testing results here is for pts ē #CUP #CancerofUNKNOWNprimary presenting as a liver mass. While advances in pathology help guess which 🪣 to classify, it’s not always diagnostic.
If you find 🧬FGFR or IDH; likely #cholangiocarcinoma. #GI21
#GI21 interesting discussion on value of NGS 🔬as well as #liquidbiopsies #ctDNA which is theme of 👆🏾#Tweetorial.

Post IDH1⛔️➡️ISOTYPE SWITCHING 1️⃣➡️2️⃣❗️; maybe role for other therapies; needs to be studied.
Post FGFR⛔️➡️FGFR mutations; ❌fusions. Role for ?sequencing.
#GI21 on post-FGFR⛔️resistance.

Please do 👀/🖍 💭 on my📝on #FGFR-fusion➕ #cholangiocarcinoma.
🆓 Available now👉🏾 karger.com/Article/Fullte…
Acquired 📈🔴🟠⚪️ #FGFR mutations ➡️ FGFR⛔️ #ctDNA 🩸🧬;📉chemo💡♻️.
2️⃣Temporal ⏳


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More from @pashtoonkasi

1 Jul 20
Bird’s-eye view 👁 on what to look out for @WCGIC #WorldGI2020.
Opening remarks on important data 📺 @myESMO - by Dr. Eric Van Cutsem @UZLeuven.
🟩Good to see more #PrecisionMedicine🧬
🟥#Immunotherapy #Immuno-#oncology
🟦TNT & other chemo strategies
@Annals_Oncology #OncoAlert
🆕#ctDNA #liquidbiopsies 🩸🧬
👀 👇🏾at the number of #clinicaltrials cropping up in this space‼️
We have 2🇺🇸studies open. #CRCSM #WorldGI2020
#WORLDGI2020 This is 🆒 ☢️ 32-P EUS-guided implantation in #pancreascancer #PANCSM @myESMO @WCGIC @Annals_Oncology.

Still miles to go. OS median of 16 months pointing again to the systemic nature of disease. Need to piggyback these local approaches to better systemic. #OncoAlert
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