Abstract
Simple SummaryCholangiocarcinoma (CCA) is a group of rare cancers that are associated with poor prognosis. Biomarker testing may provide CCA patients access to effective, personalized treatment options. However, several barriers exist to the seamless adoption of precision medicine in patients with CCA. Experts from the University of California (UC) Davis and UC Irvine identified gaps in standard practices for biomarker testing and recommended best practices, which are summarized in this review.Cholangiocarcinoma (CCA) is a heterogenous group of malignancies originating in the biliary tree, and associated with poor prognosis. Until recently, treatment options have been limited to surgical resection, liver-directed therapies, and chemotherapy. Identification of actionable genomic alterations with biomarker testing has revolutionized the treatment paradigm for these patients. However, several challenges exist to the seamless adoption of precision medicine in patients with CCA, relating to a lack of awareness of the importance of biomarker testing, hurdles in tissue acquisition, and ineffective collaboration among the multidisciplinary team (MDT). To identify gaps in standard practices and define best practices, multidisciplinary hepatobiliary teams from the University of California (UC) Davis and UC Irvine were convened; discussions of the meeting, including optimal approaches to tissue acquisition for diagnosis and biomarker testing, communication among academic and community healthcare teams, and physician education regarding biomarker testing, are summarized in this review.
Highlights
Recognizing these challenges, the University of California (UC) Davis and UC Irvine multidisciplinary hepatobiliary teams convened to identify gaps in standard practices and to define best practices and recommendations for intrahepatic cholangiocarcinoma (iCCA) patient care; this review summarizes their discussions on iCCA diagnosis, optimal approaches to tissue acquisition for diagnosis and biomarker testing, communication among academic healthcare teams and their community colleagues, and the need to improve education regarding biomarker testing among academic and community physicians
While the assays can differentiate iCCA from liver metastases, it should be noted that it may not be useful in differentiating iCCA from HCC or pancreatic acinar cell carcinoma lesions; HCC and pancreatic acinar-specific markers should be used to rule out these tumors
Despite unprecedented advancements in precision medicine and improvements in overall patient outcomes, several hurdles associated with iCCA patient care remain and include: (1) difficulty in iCCA diagnosis; (2) lack of standardization for imaging and biopsy techniques; (3) difficulty in acquiring and processing biopsy tissue for Next-Generation Sequencing (NGS); (4) the need to optimize multidisciplinary patient management; (5) lack of awareness of the importance of biomarker testing; (6) knowledge of the differences in biomarker testing platforms; (7) familiarity with biomarker-driven clinical trials; and (8) knowledge of available, Food and Drug Administration (FDA)-approved targeted therapy options for iCCA
Summary
Tejaswi 3 , Ghaneh Fananapazir 4 , Nadine Abi-Jaoudeh 1 , Zeljka Jutric 1 , Jason B. Samarasena 1 , Xiaodong Li 1 , Jennifer B. Valerin 1 , Jacob Mercer 5 and Farshid Dayyani 1. Simple Summary: Cholangiocarcinoma (CCA) is a group of rare cancers that are associated with poor prognosis. Biomarker testing may provide CCA patients access to effective, personalized treatment options. Several barriers exist to the seamless adoption of precision medicine in patients with CCA. Experts from the University of California (UC) Davis and UC Irvine identified gaps in standard practices for biomarker testing and recommended best practices, which are summarized in this review. D.; Tejaswi, S.L.; Fananapazir, G.; Abi-Jaoudeh, N.; Jutric, Z.; Samarasena, J.B.; Li, X.; Valerin, J.B.; et al Optimizing the Diagnosis and Biomarker Testing for Patients with. Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil-
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