S16 Ep33: Real-World Data Support ctDNA-Guided Treatment Strategies in FGFR2-Altered Cholangiocarcinoma: With Marina Baretti, MD

Welcome to OncLive On Air®! I’m your host today, Ashling Wahner.

OncLive On Air is a podcast from OncLive®, which provides oncology professionals with the resources and information they need to provide the best patient care. In both digital and print formats, OncLive covers every angle of oncology practice, from new technology to treatment advances to important regulatory decisions.

In today’s episode, Marina Baretti, MD, discussed the real-world utilization of tissue-free circulating tumor DNA (ctDNA) monitoring in cholangiocarcinoma (CCA). Baretti is an assistant professor and the Jiasheng Chair in Hepato-Biliary Cancer Research at Johns Hopkins University School of Medicine, as well as co-director of the Liver and Biliary Cancer Multidisciplinary Clinic at the Sidney Kimmel Comprehensive Cancer Center in Baltimore, Maryland. 

In the exclusive interview, Dr Baretti discussed multiple potential roles for ctDNA testing in CCA management, including the detection of minimal residual disease following curative-intent surgery, longitudinal monitoring of treatment response in advanced disease, and identification of emergent resistance mechanisms with targeted therapy.

Baretti also reviewed findings from a small real-world observational analysis of 44 patients, in which a tissue-free ctDNA assay demonstrated high sensitivity, detecting variant allele frequencies as low as 0.2% and identifying actionable alterations in most patients; ctDNA dynamics also correlated with response and enabled early detection of resistance alterations, including secondary FGFR2 mutations, prior to radiographic progression in select cases.

Lastly, Baretti contextualized these findings within the broader treatment landscape by reviewing data from the phase 2 FIGHT-202 trial (NCT02924376), which supported the FDA approval of pemigatinib (Pemazyre) in patients with previously treated CCA harboring FGFR2 fusions or rearrangements. Real-world data have confirmed the efficacy and safety of this agent observed in clinical trials, reinforcing the importance of comprehensive molecular profiling.

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