1. Cholangiocellular Carcinoma Interactive Case Discussion
Dr. Hilmi Ege
ACIBADEM BODRUM ONCOLOGY CENTER

2. CHOLANGIOCARCINOMA (CCA)

3. Epidemiology of Cholangiocarcinoma

4. CCA Treatment Options

5. Cholangiocellular Carcinoma Case I
46 yer old male patient
1/2016 Elevated LFTS - Chronic hepatitis B Diagnosis
5/2017 Laparoscopic cystectomy at another hospital
5/2017 Lymphadenopathy and multiple liver masses being discovered and biopsy showing cholangiocarcinoma
6/2017 Immunohistochemistry reviewed by a second pathologist reconfirming cholangiocarcinoma
6/2017 PET CT revealing multiple metastatic lymph nodes in the mediastinum and abdomen

6. CT Scan 5/2017

7. MRI Scan 6/2017

8. Cholangiocellular Carcinoma Case I
Portal Vein Thrombosis
Ascites
Albumin Level 2,3 gm/dl
Elevated LFTS AST 250 – ALT 250 , Bilirubin

9. Which systemic chemotherapy regimen would you choose ?
1. GemOX – Gemcitabine + Oxaliplatin
2. Cisplatin + Gemcitabine
3. FOLFIRINOX
4. TKI
5. Immunotherapy
6. Other – Clinical trial ( Antiangiogenic , Anti FGF )

10. ANC and Thrombocyte
Levels

11. Options of therapy
Single agent chemotherapy Cisplatin- gemcitabine combination Oxaliplatin-gemcitabine combinations Oxaliplain – fluorouracil combinations Cisplatin-fluorouracil combinatons Gemcitabine- fluorouracil combinations Triplet combinations (ECF, ECX, GEP, others)
G: gemcitabine, E: epirubicine, P: platinum, F: fluorouracil, X; Capecitabine,
C: cisplatin

12. Chemotherapy Cisplatin + Gemcitabine x 2 cycles
GemOX vs FOLFIRINOX reviewed and considered
FOLFIRINOX x 4 Cycles
Immunotherapy (Pembrolizumab) application prepared for off label use but patient's clinical status deteriorated very quickly

13. MRI Scan 9/2017

14. Cholangiocellular Carcinoma Case II
66 year old female patient
7/2015 Laparoscopic cholecystectomy
Pathology: Gallbladder papilary adenocarcinoma
7/2015 Local lymph node inolvement

15. Cholangiocellular Carcinoma Case II
Adjuvant chemotherapy with Gemcitabine + Cisplatin x 3 cycles
Renal dysfunction and mild hearing loss
Adjuvant RT + oral capecitabine
Adjuvant chemotherapy with Gemcitabine x 3 cycles

18. CT Scan revealing relapse site

20. Co-Primary endpoints: RFS and QOL
194 Pts

24. NCCN Gallbladder Cancer

25. NCCN Intrahepatic Cholangiocarcinoma

26. Prognosis of CCA Patients

27. Background iCCA

28. FGFR Signaling Pathway

29. FGFR2 Fusions Trigger Constitutive FGFR Signaling

30. Metastatic CCA Treatment

31. FGFR2 Fusions Trigger Constitutive FGFR Signaling

32. FGFR2 Fusions Trigger Constitutive FGFR Signaling

33. FGFR Signaling Pathway Inhibition

34. Fight-101 Study Design

37. Thank You For Your Attention