Help with targeted therapy after cisplatin/gemcitabine

Hi everyone,

I posted this under Introductions about a week ago, but didn’t get any responses. I’m re-posting here hoping for some help.

We live in metropolitan Australia. My mother-in-law is 72 years old and was diagnosed with a 9.9cm solitary intrahepatic cholangiocarcinoma in January 2015. The tumour originated in the right lobe of the liver, but has pushed into the left lobe and is close to the portal vein (we don’t know if it has invaded the portal vein or not), making operation difficult. Her liver function tests have been slightly elevated, but she has no hepatitis or cirrhosis. Her tumour markers were all normal at diagnosis. CT chest / abdo / pelvis suggested no macroscopic spread outside of the liver. She has no other significant medical conditions.

My mother-in-law received 3 cycles of gemcitabine plus cisplatin, with minimal response. The tumour stayed the same size. In late May, she had Sir-spheres inserted into her liver, and the PET scan to determine response will be in mid-July.

Meanwhile, she has had molecular testing results come back from Foundation One. Four genetic changes were identified (FDA-approved therapies in other tumour types are in parentheses):
– CDK4 amplification – equivocal (Palbociclib)
– ERBB2 amplification – equivocal (Ado-trastuzumab emtansine; Afatinib; Lapatinib; Pertuzumab; Trastuzumab)
– IDH1 – R132C (Azacitidine; Decitabine)
– APC – A2122_C2123insA (none)

My MIL’s oncologist believes that the ERBB2 and IDH1 genetic changes hold the most potential for targeted therapy.

Here are my questions:
(1) I was wondering if anyone on this board also had one or both of these genetic changes with their molecular testing?
(2) If so, which chemo agent(s) worked best?
(3) Does a poor response to gemcitabine mean that there is less likely to be a good response to azacitidine or decitabine?

Thanks in advance!

Aussie83