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About Cholangiocarcinoma

Cholangiocarcinoma (CCA) is a rare, aggressive malignancy with a poor prognosis.1,2 Approximately 8000 people in the US are diagnosed with CCA each year.3

Molecular testing

Abnormal FGFR2 signaling can be an oncogenic driver of CCA4

FGFRs can play a pivotal role in CCA5-9

  • FGFRs 1-4 are involved in cell proliferation, cell differentiation, cell migration, and cell survival5
  • Aberrant FGFR signaling has been linked to the potential development and maintenance of CCA5-9
  • In CCA, genetic alterations, including FGFR2 fusions, are known to play a role in carcinogenesis by promoting cancer cell growth and survival6

FGFR2 is the primary therapeutic target for certain CCA treatments10

  • Treatment that targets FGFR2 may lead to tumor inhibition for patients whose CCA is driven by an FGFR2 fusion or rearrangement10

However, there are off-tumor toxicities associated with inhibition of other FGFRs,5,11 including:

  • Hyperphosphatemia–a pharmacodynamic effect of FGFR inhibition, mainly driven by inhibition of FGFR1 signaling11,12
  • GI effects such as diarrhea–thought to be driven by inhibition of FGFR4 signaling11,13-15

Considering the role of FGFRs and the effects of their inhibition can support treatment decisions5,11

  • Proactive molecular testing for FGFR2 fusions or other rearrangements can help you identify which patients with CCA may be appropriate for targeted therapy16,17
  • FGFR2 fusions are detectable early in disease progression, making identifying these alterations in patients at diagnosis especially important4

FGFR-targeted therapies provide the opportunity for an individualized approach in the treatment of advanced CCA in patients with an FGFR2 fusion or other rearrangement5,11

Molecular testing for CCA

Proactive molecular testing can help you identify which patients may be appropriate for targeted therapy16,17

Chart comparing patients with targetable alterations for cholangiocarcinoma (45%), and patients with F G F R fusions or rearrangements (10%-16%).
FGFR=fibroblast growth factor receptor; GI=gastrointestinal; iCCA=intrahepatic cholangiocarcinoma.

Next-generation sequencing can detect FGFR2 fusions

Patients with FGFR2 fusions and gene rearrangements may be appropriate for targeted therapy with an FGFR inhibitor.4

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) recommend molecular testing for patients with unresectable or metastatic CCA17*†‡

*See the guidelines online at NCCN.org for the full recommendation.

†NCCN makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

‡Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate.

NCCN=National Comprehensive Cancer Network.

FoundationOne® CDx for detection of FGFR2 fusions

Information on FDA-approved test(s) for the detection of FGFR2 fusions or rearrangements in CCA is available at www.fda.gov/CompanionDiagnostics.
FoundationOne is a registered trademark of Foundation Medicine, Inc.

Learn about an FDA-approved treatment.

Learn more about TRUSELTIQ
References:
  1. Valle JW, et al. Cancer Discov. 2017;7(9):943-962
  2. Banales JM, et al. Nat Rev Gastroenterol Hepatol. 2020;17(9):557-588.
  3. American Cancer Society. https://www.cancer.org/cancer/bile-duct-cancer/about/key-statistics. Accessed March 1, 2021
  4. Rizvi S, Borad MJ. J Gastrointest Oncol. 2016;7(5):789-796.
  5. Touat M, et al. Clin Cancer Res. 2015;21(12):2684-2694.
  6. Pellino A, et al. Transl Gastroenterol Hepatol. 2018;3:40.
  7. Javle M, et al. Cancer. 2016;122(24):3838-3847.
  8. Borad MJ, et al. Curr Opin Gastroenterol. 2015;31(3):264-268.
  9. Goyal L, et al. Cancer Discov. 2019;9(8): 1064-1079.
  10. TRUSELTIQ Prescribing Information. Brisbane, CA: QED Therapeutics, Inc.; May 2021.
  11. Chae YK, et al. Oncotarget.2017;8(9):16052-16074.
  12. Lyou Y, et al. Eur Urol. 2020;78(6):916-924.
  13. Hierro C, et al. Semin Oncol. 2015;42(6):801-819.
  14. Mellor HR. Liver Int. 2014;34(6):e1-e9. doi:10.1111/liv.12462.
  15. Kim RD, et al. Cancer Discov. 2019;9:1696-1707.
  16. Avogadri F, et al. Presented at: AACR Virtual Annual Meeting II; June 22-24, 2020.
  17. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Hepatobiliary Cancers V.3.2021. ©National Comprehensive Cancer Network, Inc. 2021. All rights reserved. Accessed June 15, 2021. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.
  18. Lowery MA, et al. Clin Cancer Res. 2018; 24(17):4154-4161. doi:10.1158/1078-0432.CCR-18-0078.
  19. Sia D, et al. Nat Communications. 2015;6:6087. doi: 10.1038/ncomms7087.
  20. Chun YS, et al. Cancer Control. 2017;24(3):1-7.
  21. Ross JS, et al. Oncologist. 2014;19(3):235-242.
  22. Lamarca A, et al. J Clin Med. 2020;9(9):2854. doi:10.3390/jcm9092854.
  23. Arai Y, et al. Hepatology. 2014;59(4):1427-1434.
  24. Kongpetch S, et al. JCO Glob Oncol. 2020;6:628-638.

INDICATION AND IMPORTANT
SAFETY INFORMATION

INDICATION

TRUSELTIQ is indicated for the treatment of adults with previously treated, unresectable, locally advanced or metastatic cholangiocarcinoma with a fibroblast growth factor receptor 2 (FGFR2) fusion or other rearrangement as detected by an FDA-approved test.

Accelerated approval was granted based on overall response rate and duration of response. Continued approval for this indication may be contingent upon verification of clinical benefit in confirmatory trial(s).

IMPORTANT SAFETY INFORMATION

Warnings and precautions

  • Ocular toxicity: Retinal pigment epithelial detachment (RPED), which may cause blurred vision, occurred in 11% of 351 patients treated with TRUSELTIQ, including patients with asymptomatic RPED, with a median onset of 26 days. Perform comprehensive ophthalmological exam including optical coherence tomography prior to initiating, at 1 month, at 3 months, and then every 3 months during treatment with TRUSELTIQ. Urgently evaluate patients for onset of visual symptoms and follow up every 3 weeks until resolved or TRUSELTIQ is discontinued. Withhold TRUSELTIQ as recommended. Dry eye occurred in 29% of 351 patients; treat with ocular demulcents as needed
  • Hyperphosphatemia and soft tissue mineralization: Hyperphosphatemia, which can lead to soft tissue mineralization, cutaneous calcinosis, non-uremic calciphylaxis, vascular calcification, and myocardial calcification, occurred in 82% of 351 patients treated with TRUSELTIQ, with a median time to onset of 8 days (range 1-349); 83% of 351 patients treated with TRUSELTIQ received phosphate binders. Monitor for hyperphosphatemia throughout treatment. Initiate phosphate-lowering therapy for serum phosphate >5.5 mg/dL; withhold TRUSELTIQ and initiate phosphate-lowering therapy for serum phosphate >7.5 mg/dL; withhold, reduce the dose, or permanently discontinue TRUSELTIQ based on duration and severity of hyperphosphatemia
  • Embryo-fetal toxicity: TRUSELTIQ can cause fetal harm. Advise pregnant women of the potential risk to the fetus; advise females of reproductive potential and men who are partnered with women of reproductive potential to use effective contraception during treatment with TRUSELTIQ and for 1 month after the final dose

Adverse reactions

  • Most common adverse reactions (incidence ≥20%, all grades): nail toxicity, stomatitis, dry eye, fatigue, alopecia, palmar-plantar erythrodysesthesia syndrome, arthralgia, dysgeusia, constipation, abdominal pain, dry mouth, eyelash changes, diarrhea, dry skin, decreased appetite, blurred vision, and vomiting
  • Most common laboratory abnormalities (incidence ≥20%, all grades): increased creatinine, increased phosphate, decreased phosphate, increased alkaline phosphatase, decreased hemoglobin, increased alanine aminotransferase, increased lipase, increased calcium, decreased lymphocytes, decreased sodium, increased triglycerides, increased aspartate aminotransferase (AST), increased urate, decreased platelets, decreased leukocytes, decreased albumin, increased bilirubin, and decreased potassium

Drug interactions

  • CYP3A inhibitors: Avoid use with strong and moderate CYP3A inhibitors
  • CYP3A inducers: Avoid use with strong and moderate CYP3A inducers
  • Gastric acid–reducing agents: Avoid coadministration with proton pump inhibitors, histamine-2 receptor antagonists (H2RA), and locally acting antacids. If coadministration of H2RA or locally acting antacids cannot be avoided, separate TRUSELTIQ administration
    • H2RA: Take TRUSELTIQ 2 hours before or 10 hours after
    • Locally-acting antacid: Take TRUSELTIQ 2 hours before or 2 hours after

Dosage and administration

  • Prior to initiating TRUSELTIQ: Confirm FGFR2 fusion or rearrangement; perform comprehensive ophthalmic exam including OCT; confirm negative pregnancy test in females of reproductive potential
  • Starting dose: Take TRUSELTIQ orally once daily on Days 1-21 of 28-day cycles; continue treatment until disease progression or unacceptable toxicity. Take TRUSELTIQ on an empty stomach with a glass of water at least 1 hour before or 2 hours after food
    • No renal or hepatic impairment
      • 125 mg (one 100 mg capsule and one 25 mg capsule)
    • Mild and moderate renal impairment (creatinine clearance 30-89 mL/min)
      • 100 mg (one 100 mg capsule)
    • Mild hepatic impairment (total bilirubin >upper limit of normal [ULN] to 1.5 x ULN or AST > ULN)
      • 100 mg (one 100 mg capsule)
    • Moderate hepatic impairment (total bilirubin >1.5 to 3 x ULN with any AST)
      • 75 mg (three 25 mg capsules)
  • Dose modification: Consult the TRUSELTIQ full Prescribing Information for dose modifications and monitoring recommendations for RPED, hyperphosphatemia, and other Grades 3-4 adverse reactions

Please click here for full Prescribing Information.