Amit Mahipal, MD

Panelists discuss how immune-related adverse events typically occur between 3 and 15 weeks of treatment, with hepatitis being particularly concerning in patients with cirrhosis and requiring careful differentiation from disease progression or worsening cirrhosis, while high-dose steroids remain first-line treatment with consideration of steroid-sparing agents and potential rechallenge strategies for responding patients.

Panelists discuss how dual checkpoint inhibitors demonstrate significantly higher immune-related adverse event rates (nearly 30% grade 3-4) compared with atezolizumab-bevacizumab, but this increased toxicity is accompanied by meaningfully improved response rates, and the addition of anti-CTLA4 therapy roughly doubles response rates compared with anti-PD1 monotherapy in HCC.

Panelists discuss how the early survival curve crossing observed in the CheckMate 9DW trial likely reflects lenvatinib’s superior short-term disease control, while emphasizing that the real strength of nivolumab-ipilimumab lies in achieving durable complete responses and unprecedented long-term survival tails.

Panelists discuss how approximately half of patients have soft contraindications to specific regimens, with bevacizumab being avoided in patients with recent bleeding, uncontrolled hypertension, or cardiovascular events, while dual checkpoint inhibitors may be contraindicated in patients with poorly controlled autoimmune diseases.

Panelists discuss how all 3 approved immunotherapy doublets (atezolizumab-bevacizumab, durvalumab-tremelimumab, and nivolumab-ipilimumab) demonstrate superiority over tyrosine kinase inhibitor therapy, with each regimen offering distinct advantages—atezolizumab-bevacizumab for disease control, and dual checkpoint inhibitors for durable complete responses and long-term survival tails.

Panelists discuss how immunotherapy-based regimens have transformed HCC treatment by achieving median survivals of 16 to 24 months and enabling long-term survival with meaningful percentages of patients living 3 to 5 years, representing a dramatic improvement over the historical 2- to 3-month survival benefit seen with sorafenib.

Panelists discuss how patients with unresectable HCC present with dual challenges of managing both the cancer and underlying cirrhotic liver disease, emphasizing the complexity of applying clinical trial data from patients with Child-Pugh A status to the more heterogeneous Child-Pugh B population commonly seen in practice.

Panelists discuss how recent research presentations and data updates at the latest scientific meeting have advanced the understanding and treatment landscape of biliary tract cancer (BTC).

Panelists discuss how significant challenges remain in HER2-positive biliary tract cancer (BTC), including optimizing sequencing of targeted therapies, addressing resistance mechanisms, improving biomarker testing accessibility, and developing strategies for brain metastases.

Panelists discuss how treatment selection among HER2-targeted agents for biliary tract cancer (BTC) depends on multiple factors including patient characteristics and prior therapies, while also considering the role of traditional chemotherapy regimens such as FOLFOX in specific clinical scenarios.

Panelists discuss how the MyPathway study and SGNTUC-019 basket trial demonstrated the clinical activity of trastuzumab plus pertuzumab and tucatinib, respectively, in HER2-positive biliary tract cancer (BTC), highlighting key efficacy metrics and safety profiles that inform treatment selection.

Panelists discuss how the HERIZON-BTC-302 study demonstrated zanidatamab's efficacy in HER2-positive biliary tract cancer (BTC) with key end points presented at ASCO GI, while sharing insights on optimal dosing strategies and early real-world experience with this newly approved agent in the second-line setting.

Panelists discuss how the DESTINY-PanTumor 02 trial demonstrated significant efficacy of trastuzumab deruxtecan in HER2-amplified biliary tract cancer (BTC), with promising response rates and durability that support its use as a treatment option for these patients.

Panelists discuss how molecular testing strategies at disease progression are evolving in biliary tract cancer (BTC), with particular focus on HER2-amplification detection methods including immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and next-generation sequencing (NGS), while noting that HER2 positivity occurs in approximately 5% to 15% of cases.

Panelists discuss how emerging clinical trial data for immunotherapy combinations in first-line advanced biliary tract cancer (BTC) can be effectively translated into real-world treatment decisions, weighing factors such as biomarker status, safety profiles, and treatment sequencing.

Panelists discuss how the practice-changing TOPAZ-1 trial established durvalumab plus gemcitabine/cisplatin as a first-line standard for advanced biliary tract cancer (BTC) while exploring key clinical factors that influence the choice between durvalumab and pembrolizumab-based combinations following the KEYNOTE-966 results.

Panelists discuss how circulating tumor DNA (ctDNA) testing in biliary tract cancer (BTC) presents unique technical and interpretative challenges, including considerations around sensitivity, timing of collection, and clinical validation of results.

Panelists discuss how clinicians are increasingly utilizing both tissue and liquid biopsies with comprehensive DNA/RNA next-generation sequencing (NGS) for biomarker testing in biliary tract cancer (BTC), while noting variations in testing practices across different treatment centers.

Panelists discuss how comprehensive molecular profiling and biomarker testing are critical for guiding targeted therapy decisions in advanced biliary tract cancer (BTC), citing recent real-world data presented at ASCO GI that demonstrated improved outcomes with matched targeted therapies.

Panelists discuss how physicians typically communicate survival outcomes and prognosis to patients with newly diagnosed advanced biliary tract cancer (BTC), focusing on setting realistic expectations while maintaining hope.