Thread by @W_Park_MD

1/12 #TumorBoardTuesday #CCA
56y 🚭M w/ abd pain, 🚫🍻, 🚫Hx hepatitis

FHx - uncle (80) CRC, aunt (40) breast Ca
📷CT: 9cm liver mass with portal vein clot
🔦EGD/Colonoscopy unrevealing
🔬Bx: poorly diff adenoCa. pMMR, PD-L1 CPS 0%

Unresectable IHCC, PS 0, how would U Tx?

2/12 #TumorBoardTuesday

💊Tx with G/C for 4mo➡️SDz
✂️Still unresectable
But…G2✋🏽🦶🏽neuropathy

🩺Outside tumor board discussion suggested switching Tx.
Tumor NGS
👉ARID1A S745fs

🤔What would you choose for next Tx?

3/12 #TumorBoardTuesday Mini-Tweetorial 1 👨‍🏫
#BiliaryTractCancer @curecc @CCA_Alliance
➡️ Other 1L Tx's

✅Ph2 high ORR for GCN @rachnatshroff
pubmed.ncbi.nlm.nih.gov/30998813/
✅Ph3 SWOG 1815⌛️data
clinicaltrials.gov/ct2/show/NCT03…
✅TOPAZ-1: G/C+durva⬆️mOS, mPFS, RRvs. G/C
meetings.asco.org/abstracts-pres…

5/12 #TumorBoardTuesday Mini-Tweetorial 3 👨‍🏫

Post-gem 2L Tx ✅NIFTY trial pubmed.ncbi.nlm.nih.gov/34656226/

ARID1A: ≈ 18% in #CCA. Therapeutic 🎯 thru “X?”
DDR, EZH2, PI3K/AKT, immune TME
• pubmed.ncbi.nlm.nih.gov/34671561/
• pubmed.ncbi.nlm.nih.gov/26125128/
• clinicaltrials.gov/ct2/show/NCT04…
@the_danielahn

6/12 #TumorBoardTuesday Back to case🔎
💊FOLFIRI x 2mos
➡️Consult🥼seeking a clinical trial

#ctDNA (MSK-ACCESS) @MskccCMO🔎 FGFR2-BICC1 fusion that wasn’t present in the outside somatic NGS

Do we have a Tx for FGFR2 fusion?

🤔 What method is best for detecting fusion 🧬?

7/12 #TumorBoardTuesday

➡️2mo after pemigatinib, 🎉radiographic response! 💚

➡️In-house (MSK-IMPACT & RNA fusion capture) report:
germline testing: (-)
somatic testing: MSS, TMB 2.5, ARID1A p.S745Lfs*87,

FGFR2 - BICC1 fusion🧬

8/12 #TumorBoardTuesday Mini-Tweetorial 4 👨‍🏫

🗝️#Cholangiocarcinoma #BiliaryTractCancer have many therapeutic🎯so⚡️ALWAYS⚡️seek NGS with RNA capture fusion panel & seek clinical trials‼️

🗝️FGFR2 genetic alterations (~15%) & rearrangements like fusion are ≈10% in #CCA

9/12 #TumorBoardTuesday Mini-Tweetorial 5 👨‍🏫
Many FGFR inhibitors
💊Pemigatinib pubmed.ncbi.nlm.nih.gov/32203698/
clinicaltrials.gov/ct2/show/NCT03…
💊Infigratinib pubmed.ncbi.nlm.nih.gov/34358484/
clinicaltrials.gov/ct2/show/NCT03…
💊Derazantinib
pubmed.ncbi.nlm.nih.gov/30420614/
💊Futibatinib
pubmed.ncbi.nlm.nih.gov/34551969/

10/12 #TumorBoardTuesday #OncTwitter

#🧬RNA capture method ⬆️ the chance of detecting fusions.

# Amplicon-based 🧬can miss fusions.

#ctDNA can be a timely tool to detect actionable mutations

11/12 #TumorBoardTuesday
Polyclonal acquired resistance to FGFRi was demonstrated from #ctDNA
@AnnaVarghese4 @EileenMOReilly @MFBerger1
ascopubs.org/doi/full/10.12…

New data of immunotherapy and more targeted therapy are emerging in #BiliaryTractCancer.

12/12 #TumorBoardTuesday #BiliaryTractCancer

🙌🏽Patient’s QoL is great 🎉
😴Experiencing mild fatigue with mild anemia.
👀Routine ocular exams were normal x 2
🧂Normal phosphorus on low phosphurus diet..
💅Has change in color of nails.
👄Has mild dry mouth and skin.

Just FYI, the emoticons are to emphasize images of potential symptoms experienced with FGFR inhibitors. Manicures are not recommended for dry nails~ moisturizers are recommended or urea based cream