The Role of Genomic Testing in Biliary Tract Cancers

James Harding, MD, the regional director of Early Drug Development and medical oncologist at Memorial Sloan Kettering Cancer Center, discusses the need for genomic testing in biliary tract cancers.

According to Harding, a good portion of biliary tract cancer have a targetable genomic alteration with an approved FDA therapy. For example, 40% to 50% of intrahepatic cholangiocarcinoma tumors are known to have an actionable target with FDA approved agents. Additionally, FGFR2-positive cholangiocarcinoma can be treated with pemigatinib (Pemazyre). Harding says that the field is ripe for expansion.

Genomic profiling can also be used to identify and properly treat HER2-positive biliary tract cancers. This cancer type can be split into 2 major classes. The larger of the 2 groups is HER2- amplified tumors, which serve to drive the malignancy. This mutation can be blocked with small molecule and antibody therapy. The less common mutation is HER2 missense mutations and are seen in a very low subset of biliary tract cancers and gall bladder cancers.