Welcome Note: Dr. Ravinder Yadav from Medical Learning Hub welcomed the esteemed speakers, Dr. Shyam Aggarwal, Dr. Aparna Dhar, Dr. Ankur Nandan Varshney along with all the participants.
Session 1 : Cholangiocarcinoma in India by Dr. Shyam Aggarwal, Chairman, Department of Medical Oncology at Sir Ganga Ram Hospital in New Delhi, Key points discussed were
Epidemiology and Subtypes:
CCA incidence is high in Asia (China, South Korea, Thailand) due to geographical and genetic factors. In India, it constitutes 6.4% of liver malignancies and 2.4% of gallbladder cancers, with subtypes including intrahepatic (8.8%), perihilar (79.6%), and distal (11.7%) CCA.
Advanced Disease at Diagnosis:
72% of cases are unresectable at presentation, with 44.1% metastatic, 33.4% localized, and 17.9% locally advanced, underscoring the need for systemic therapies.
Treatment Approaches:
First-line metastatic CCA: Gemcitabine-Cisplatin (63.5%) or Gemcitabine-Oxaliplatin (25.5%).
Second-line: Cape-IRI (45%) or FOLFOX/Cape-OX (53.3% for locally advanced).
Diagnostic challenges include differentiation from HCC, pancreatic cancer, and CUP, with misdiagnosis impacting outcomes.
Precision Medicine & Multidisciplinary Care:
Molecular Tumor Boards (MTBs) improve outcomes by integrating genomic testing and expert input (oncologists, pathologists, geneticists).
ESMO/NCCN 2025 guidelines emphasize personalized therapy and multidisciplinary management for BTC.
Session 2 : Genomic testing landscape by Dr. Aparna Dhar, Director: Hereditary, Precision Oncology and Genetic Counseling. Molecular Oncology and Cancer Genetics, Max Institute of Cancer Care, Delhi NCR , Key points discussed were
Molecular Diversity Drives Treatment :
CCA's distinct genomic profiles (FGFR2 fusions, IDH1 mutations, HER2 amplifications) enable targeted therapies
These alterations vary by subtype, necessitating comprehensive molecular testing
Immunotherapy Revolution :
TOPAZ-1/KEYNOTE-966 established GemCis + immunotherapy as new 1L standard
Biomarkers (MSI-H/dMMR) help identify immunotherapy candidates, though rare
Diagnostic Complexities :
Frequent misdiagnosis (vs HCC/pancreatic cancer) delays treatment
Liquid biopsy offers alternative when tissue is limited, but has detection gaps
Precision Medicine in Practice :
Ongoing Challenges & Future :
Session 3 : Role of IDH1 and Ivosidenib - ClarIDHY Trial by Dr. Ankur Nandan Varshney, Consultant, Medical Oncology at Medanta Hospital Gurugram.
IDH1 Mutation Drives CCA Pathogenesis :
Mutant IDH1 produces 2-HG, disrupting cellular differentiation and promoting tumor growth
Found in ~14% of intrahepatic CCA cases (mutually exclusive with IDH2)
ClarIDHy Trial Established Ivosidenib Efficacy:
First FDA-approved targeted therapy for IDH1+ CCA
Improved median OS (10.8 vs 5.1 months post-crossover adjustment) and PFS (2.7 vs 1.4 months)
Well-tolerated: Most common AEs were low-grade diarrhea/fatigue
Early Use Enhances Outcomes :
Real-World & Combination Data :
Real-world mOS reached 15 months, surpassing trial results
Early-phase trials show promise for ivosidenib + GemCis (ORR 46%) in 1L
Future Directions :
Q&A Session: The session concluded with an interactive Q&A segment, moderated by Dr Shyam Aggarwal, Dr Aparna and Dr Ankur as panelist, shared their expert insights.
Closing Remarks: Dr. Shubhi concluded the session with a vote of thanks, appreciating the speaker and participants for their valuable contributions.
We wish you a great learning experience!
Theme topic: Unlocking the Promise of Precision Therapy in Cholangiocarcinoma | Servier
- Context setting: Cholangiocarcinoma in India - 10 mins (Dr. Shyam Aggarwal, Chairman, Department of Medical Oncology at Sir Ganga Ram Hospital in New Delhi)
Genomic testing landscape - 15 mins (10 min talk + 5 mins discussion) (Dr. Aparna Dhar, Director: Hereditary, Precision Oncology and Genetic Counseling. Molecular Oncology and Cancer Genetics, Max Institute of Cancer Care, Delhi NCR)
- Role of IDH1 and Ivosidenib: ClarIDHY Trial - 10 mins (Dr. Ankur Nandan Varshney, Consultant, Medical Oncology at Medanta Hospital Gurugram)
- Case-experience sharing - 10 mins (Dr. Ankur Nandan Varshney)
- Open-house Discussion and Q&A with audience - 10 mins (Shyam Aggarwal)
- Summary and Closing remarks - 5 mins (Dr. Shyam Aggarwal)
- Oncologists
- Pathologists
- Microbiologists
- Consultant Physician
