Hello from GI ASCO

I had posted the below under GI ASCO 2012 and want to place the information in the correct thread for future reference:

Percy, Kim and I attended the AHPBA conference, one day prior to GI ASCO.

Presentations focused on intrahepatic disease with special emphasis on surgical resection (graphic videos) and current updates of treatment protocols.
In contrast to US physicians, surgical resections in other countries vary greatly in their approaches. Some procedures put the patient at high risk in particular with those surgeries replacing delicate portions of the pulmonary artery invaded by cancer cells. Japan, China, South America and Europe (to some extent) do not have to comply with the rigid regulations placed on US physicians.

“Lunch at the movies” included the presentation of numerous, delicate liver resections.

Andrea, Jason, Sara (willow) Percy and I met up the following day for GI ASCO. As mentioned previously little was geared to our cancer other than what Jason and Percy have reported on, but I attended a few poster session.

Analysis of the genomic profile of biphenotypic tumors compared to cholangiocarcinoma and hepatocellular carcinoma.

Poster session included a study on combined HCC/Cholangiocarcinoma. These tumors represent a minority of primary liver cancers. Genetic information for HCC and Cholangiocarcinoma exist, but little is known of the combined version. The purpose of this poster was to demonstrate the results of a targeted next-generation sequencing in regards to the genomic differences of these tumors.

Breakdown of study:
15 patients with combined HCC/CC
7 patients with HCC
6 patients with CC

Variability in immune infiltrates and HLA expression in cholangiocarcinoma.

The study concluded that the combined HCC/CC patients expressed genetically complex tumor expressions shared with the individual features of HCC and of CC but that the specific CTNBB1 was isolated exclusively in Hepatocellular cancer.

Another retrospective study of 18 patients was aimed on understanding whether patients develop an immune response against their own tumors. All patients were resected and showed Tumor-infiltrating lymphocytes (white blood cells that have migrated into a tumor.) The authors suggest that this reflects a patient’s immune response to his/her tumor and their findings provide sound rationale for immunotherapy in the treatment of cholangiocarcinoma.

Effects of the sequential administration of GEMOX followed by FOLFIRI in cholangiocarcinoma.

This study also was retrospective of 35 patients who had been treated with second line systemic therapy consisting of GEMOX and then followed by FOLFORI. Their first line treatment consisted of Gem/Cis.
This sequential treatment protocol proved to be beneficial with overall survival of 1 year.

We must remember that these are relatively small studies warranting large scale studies to prove validity.

Chemoradiation for locally advanced perihilar cholangiocarcinoma.

This study included 52 patients from a single institution – 13 patients were treated with chemo-concurrent radiotherapy and underwent resection. Chemo consisted of gemcitabine or 5-FU. These group of patients showed a significant survival advantage compared to the patients who underwent chemo and radiation alone.

The study concluded that above mentioned treatment should be investigated in large scale studies. A notable value of CA 19-9 after completion of 1 months treatment seemed to indicate a predictive maker of survival.
Further studies regarding the optimal chemotherapy regime and schedule of radiation are warranted.

I attended a closed door session focused on concluded clinical trials in adjuvant setting. The data is expected to be released toward the end of the year. Based on the outcome of these clinical trials subsequent research will conducted within the near future. I believe that many of us would like to know whether adjuvant treatments truly are effective.

I am happy to announce that Sara (Willow) has accepted to take on my position within the NCI sponsored North American Hepatobiliary Task Force. I have served two terms and believe that Sara is a perfect fit for this position as she has a degree in biology and a good understanding of the concept of clinical trials. The physicians within the Task Force as those from the NCI were quite concerned with my stepping away, as it would leave no one representating the Cholangiocarcinoma patient community. We will keep you posted on the developments and hopefully will be able to announce her appointment to the Task Force real soon.

Jason has shown great interest in research advocacy and you will receive numerous updates from him within the near future. Already we are spoiled by his excellent reporting skills and his ability to assimilate clinical information.

Andrea, Jason’s wife, will work with the foundation behind the scene. She fills an enormous void for us and we can’t wait to get her started and learn from her.

As always it was a delight to see Percy. Although we communicate via e-mail or phone calls, nothing beats spending time together as a group focused on our disease.

Although, we did not bring back much conclusive information, we are invigorated by numerous, upcoming developments heading our way.
And, most of all, we had a wonderful time hugging and treasuring the time spent at this year’s GI ASCO 2014.

A few additional notes I picked up throughout speaking with physicians:

In regards to diagnostics:

MRI rules out other diseases
MRCP – aids in the diagnoses
CT – clarifies vascular and distant metastases
Most of all though, much of the evaluation and consequent finding is center dependent. Some prefer one over the other method simply due to the fact that a particular physician(s) is better qualified to interpret the scan results.

In regards to biopsies:

Brushings account for no more than 20% of accuracy
Percutaneous Transluminal biopsy is a reliable technique for examining a variety of biliary tract lesions.
We might see less invasive biopsy procedures.

Resection:

The overall consensus appears to include the removal of 5 nodes while resecting.
Hugs,