A survey of oncologists has found that more education is clearly needed regarding cholangiocarcinoma. Specifically, more education would be beneficial regarding testing and targeting the mutations which cause the condition (IDH2 and FGFR2), and regarding emerging therapies (ivosidenib and penigatinib).

Not all oncologists have the same level of knowledge, confidence, and competence regarding the condition, and this can lead to gaps in care.

These results were recently presented at the Gastrointestinal Cancers Symposium. The presenters were Arndt Vogel from Germany and Kinjal Parikh from New York.

The Survey

This survey included a total of 104 oncologists. At the end of the survey, all participants were given feedback regarding how they did and what aspects could be improved. Of the participants-

• 61% – were currently practicing in the community
• 70% – saw not just cholangiocarcinoma patients, but also patients with other kinds of cancer
• 50% – saw between 3-5 cholangiocarcinoma patients each month
• 25% – saw fewer than 3 patients with cholangiocarcinoma each month

Here are some of the most notable results of the study.

• Over 50% said they were not confident in both recognizing disease targets and applying target agents
• Around 20% have not used next-generation sequencing and biomarkers
• 32% have used next-generation sequencing and biomarkers in those patients who had progressive disease
• 35% were unaware that not every panel detects FGFR2 translocations or fusions
• Around 30% have tested for the IDH mutations
• 60% knew the incidence of IDH mutations in cholangiocarcinoma
• 56% have tested for FGFR2 mutations
• 55% knew HER2 gene mutations happen between 5-8% of patients
• 62% were able to identify correctly drugs which target vascular endothelial growth factor which hold strong potential
• Over 50% understood that common side effects for ivosidenib are cough and diarrhea
• 30% understood that hypophosphatemia is the most common adverse event which was grade 3 for pemigatinib
• 30% had knowledge that there are currently three different agents under evaluation for FGFR2 translocations and FGFR2 fusions.
• There was some awareness of the clinical trial data for ivosidenib and pemigatinib

Ways Pharmacists Can Help

Thankfully, many of these gaps in knowledge regarding genomic targets and potential agents can be improved with help from pharmacists. They can-

• Provide education to healthcare providers on the necessary genomic testing
• Encourage early testing
• Provide education to healthcare providers on drugs
• Ensure their own knowledge of current drug approvals
• Assist patients with insurance approval concerns for ivosidenib and pemigatinib
• Assist patients in finding financial assistance when they need it
• Ensure patients receive their treatment in a timely manner
• Provide education to healthcare providers on treatment side effects

With increased collaboration between providers and pharmacists, we can improve patient care and ensure more patients get the treatment they need as soon as they need it.

You can read more about this survey and how the gaps in knowledge may be improved here.