VIDEO: Early genetic testing maximizes treatment options for cholangiocarcinoma

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There are a number of challenges. I mean, one is you wanna make sure that you get tissue to get this genetic testing done really early on, really make sure that you leave no stones unturned in terms of all the treatment options for the patient. Now, I shared the outcomes for some of the progress in the targeted therapy space. So we've made a lot of progress with immunotherapy now being part of frontline, targeted therapies in the second line and beyond, and really making a difference for the patients that are eligible. But one thing with this disease, it's an aggressive disease. So you know, to give you a sense, about 85% of patients who actually receive frontline therapy, and we're talking about patients with advanced metastatic disease, so those patients, about 85% of them will receive a frontline chemotherapy, chemoimmunotherapy-based systemic therapy. But in the second line, probably only about half, so probably 46% would actually initiate second line therapy, and then only about 17% will actually make it to third line therapy, so, and the median time on treatment in the frontline is about three months, in the second line and below, probably two or three months. So while we've made a lot of progress, that progress unfortunately is not available for all patients, it's only for a minority of patients. This is a disease that can be rapidly progressive, and so we need to make sure that in the early on that we maximize the benefit for the patients because there's a window of opportunity that if we miss, because of the nature of the disease, how it progresses in the liver, liver failure occurs, that that window of opportunity could close. So it's very important early on in the treatment course to really make sure that you have all the option and you give them the best option while they're still fit to receive it. That's one thing that clinically, it's been a challenge to do, but I think it's a work in progress. The other challenge, obviously we're talking about targeted therapy here, but immunotherapy is the other treatment modality, and that's become part of incorporated with frontline chemotherapy. We know that it doesn't benefit everybody, immunotherapy. Unfortunately, as of today, we don't have good predictive or prognostic biomarkers to determine who will receive benefit from immunotherapy, so we're giving that to all patients. But one area of research is really looking at, okay, what are the markers that could help us determine the patients that are gonna do better with immunotherapy alone or in combination with chemotherapy? So that's another area of ongoing research. And then obviously looking ahead, I shared some of the data for targeted therapy. Most of them are in the second line and beyond. Now we're trying to see, 'cause I mean, for EGFR two, for example, we're seeing the benefit in the second line. Maybe we know that is there an opportunity to even start with targeted therapy alone or in combination with chemotherapy? And there are a lot of clinical trials that are moving in that direction, in the frontline space, whether it be targeted therapy alone or in combination with chemotherapy. Again it's a challenge because those are large phase three, randomized phase three trials, and accrual is an issue in a disease, a rare disease with rare targets, so it really requires global efforts to really accrue in these trials. That's part of the reason why we don't have that data yet, but I'm hopeful that in the future, near future with some of the ongoing trials, you know, we'll get that data.