Cholangiocarcinomas are bile duct cancers. The bile ducts are thin ducts or tubes that go from liver and gall bladder to the small intestine. The main function of bile ducts is to allow the flow of bile fluid from liver to small intestine where it helps to digest the fats in food. The bile is digestive fluid, secreted by liver and it is stored in gall bladder. The treatment for this cancer (cholangicarcinoma) is evolving and includes chemotherapy and/or other targeted therapies based on the genetic testing. A New treatment Futibatinib has been approved for intrahepatic cholangiocarcimona.
The tumor may or may not be well seen on the imaging, if it is small in size. The small mass-forming intrahepatic cholangiocarcinomas can present as arterially hyperenhancing where it could mimic like another type of liver cancer called Hepatocellular Carcinoma or HCC. The HCC tumors usually hyperenhances during the arterial phase and demonstrates washout during the delayed venous phase of the imaging study.
The intrahepatic tumors sometimes can contain both types of cancer cells of cholangiocarcinoma and HCC within the same nodule, making diagnosis challenging (termed as mixed hepatocellular-cholangiocellular carcinomas). If there is absence of the classic imaging features and supportive information for HCC or cholangiocarcinoma, your physician or radiologist may suggest getting a biopsy.
The genetic testing could help to find the best suitable treatment options, for example, FGFR2 can respond to treatment with drug Futibatinib.
In September 2022, the U.S. Food and Drug Administration (FDA) granted accelerated approval to futibatinib (Lytgobi) for adults with previously treated, unresectable, locally advanced or metastatic intrahepatic cholangiocarcinoma harboring fibroblast growth factor receptor 2 (FGFR2) gene fusions or other rearrangements.
The drug was evaluated and studied in TAS-120-101 trial, which was a multicenter, open-label, single-arm trial. The Overall response rate was 42% (95% confidence Interval [CI] = 32%–52%) and it was reported that all 43 responders achieved partial responses. The median duration of response was 9.7 months (95% CI = 7.6–17.1 months).
