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Targeted Therapies in CCA: Assessment of US Oncologist Practice Patterns

2021 Year in Review: Cholangiocarcinoma — December 17, 2021

Findings from a clinical practice assessment identified gaps in knowledge, competence, and confidence regarding testing and the use of targeted therapies in patients with unresectable CCA, underscoring the important role of education in overcoming these gaps.

A continuing medical education (CME)-certified clinical practice assessment was conducted to evaluate educational gaps in knowledge, competence, confidence, and attitudes of oncologists regarding clinical evidence, role of molecular testing, and place in the treatment paradigm for the use of targeted therapies in patients with unresectable cholangiocarcinoma (CCA). Results of the survey-based self-assessment were presented at the 2021 American Society of Clinical Oncology Gastrointestinal Cancers Symposium.

From June 24, 2020, through August 31, 2020, a 25–multiple-choice question learning tool was made available online to physicians to gain foundational knowledge and receive feedback about their performance compared with that of other test-takers. A total of 1009 learners participated in the activity, including 758 physicians. Of the 758 physician participants, 104 were oncologists—the majority (61%) practiced in the community. Oncologists indicated that they treated several types of cancer and expressed a lack of confidence about using targeted therapies or recognizing targets for biomarker testing.

Several practice gaps were identified related to next-generation sequencing (NGS), biomarkers, FIGHT-202 trial and ClarIDHy trial data, and emerging therapies or targets for CCA. With regard to NGS, 21% of participants do not use NGS testing, 32% use it upon disease progression, and 35% did not realize that not all panels detect FGFR2 fusions. In terms of biomarkers, 20% do not test for any biomarker, whereas 56% of oncologists test for FGFR and 29% test for IDH mutations. Overall, 62% test for microsatellite instability-high/PD-L1 status, 31% recognized that FGFR2 gene fusions and rearrangements were found exclusively in patients with intrahepatic CCA, and 60% recognized the incidence of IDH1 mutations.

Regarding the FIGHT-202 trial data, 45% of oncologists were able to recognize biomarker eligibility for pemigatinib, 9% could identify pemigatinib overall survival outcomes, and 30% were able to determine the most common grade 3 adverse events associated with the use of pemigatinib. With respect to the ClarIDHy trial data, 51% of those surveyed recognized the progression-free survival end point with ivosidenib, 34% were able to identify ivosidenib treatment eligibility, and 55% recognized the most common adverse events related to ivosidenib use. With respect to emerging therapies or targets, 55% of oncologists recognized that HER2 gene alterations occur at a rate of 5% to 8%, 22% recognized TAS-120 (futibatinib) as a pan-FGFR irreversible inhibitor, 30% were able to identify that 3 therapies are under evaluation for FGFR2 gene fusions or translocations in the first-line setting against chemotherapy, and 62% incorrectly identified antivascular endothelial growth factor therapies as promising novel agents with antitumor activity when administered as monotherapy.

Findings from this CME-certified clinical practice assessment identified gaps in knowledge, competence, and confidence regarding testing, and the use of targeted therapies and emerging data in patients with unresectable CCA, underscoring the important role played by education in overcoming these gaps.

Source: Parikh K, Cameron DR, Abair T, et al. Targeted therapies in cholangiocarcinoma: assessment of US oncologist practice patterns. J Clin Oncol. 2021;39(suppl_3):347-347.

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