Mitesh J. Borad, MD, on Hepatobiliary Cancers: Management Updates

Mitesh Borad: It's been an exciting few years in the management of patients with hepatobiliary cancers. From this perspective, I had the opportunity to present on a number of themes that are relevant to day-to-day practice for these patients. Starting off, we would have the management of patients with advanced hepatocellular cancer who have advanced disease, recurrent disease, or metastatic disease. From this perspective, we have a number of different treatment options now with serafenib and lenvatinib as the tyrosine kinase inhibitor options, atezolizumab and bevacizumab as a doublet that has an antiangiogenic and a checkpoint inhibitor, and from the Himalaya study now, durvalumab and tremelimumab, which constitutes a dual checkpoint-based approach. In terms of management of advanced biliary tract cancers in the first line setting, again, we have a very exciting development in the form of TOPAZ-1, where now we see that the addition of durvalumab to gemcitabine and cisplatin, standard therapy leads to survival improvements. Biliary tract cancers, as we know through the application of next generation sequencing, have exhibited a large array of targets in terms of things that we could pursue with available drugs and those in development. From this perspective, we have a number of agents that are already FDA-approved. These include the fibroblast growth factor receptor inhibitors, pemigatinib, futibatinib, and infigratinib, which was unfortunately recently withdrawn, but was FDA-approved as the first agent in this space, along with itacitinib, which targets IDH-1 mutations. So, there's an array of drugs specifically approved for advanced biliary tract cancers with these alterations, and there's a very robust pipeline of agents being developed to other targets. This also highlights a very important facet for these cancers, that genomic profiling should be very much a standard approach, whether it's through tissue-based assessments or liquid biopsy assessments, or both preferably, and opens up a new arena in how we think about these cancers beyond cytotoxic agents. All in all, the last few years have been a tour de force with advances, which will hopefully translate to more and more improvements that we can see in the clinic in terms of survival benefits, quality of life improvements, and hope for patients.