Addressing Knowledge Gaps in Treatment Strategies for Cholangiocarcinoma

An educational activity provided by i3 Health has addressed knowledge gaps and produced expertise pertaining to treatment strategies for cholangiocarcinoma.

Cholangiocarcinoma, also known as bile duct cancer, is a rare malignancy originating in the epithelium of the bile duct. The American Cancer Society estimates that 8,000 cases of bile duct cancer are diagnosed each year, but it is acknowledged that this number could be higher due to the cancer being hard to diagnose and the potential for misclassification. Early detection is difficult because nearly two-thirds of cases are clinically silent, and most patients present with advanced disease. It accounts for only 3% of gastrointestinal tumors and is an aggressive disease with a poor prognosis. While complete resection is the only potentially curative treatment for both intrahepatic and extrahepatic disease, many patients are ineligible for surgery due to advanced disease, the presence of involved lymph nodes, or perineural invasion.

To address the knowledge gaps experienced by medical professionals encompassing updated data and treatment strategies for cholangiocarcinoma, i3 Health provided a continuing medical education (CME)/nursing continuing professional development (NCPD)–approved online activity, Emerging Treatment Strategies for Advanced Cholangiocarcinoma. The activity was led by Lipika Goyal, MD, MPhil, an Assistant Professor of Medicine at Harvard Medical School, and Lead of the Liver Cancer Research Program at Massachusetts General Cancer Center. This activity was supported by independent educational grants from Incyte and Taiho Oncology, Inc.

Learners were able to participate in this activity online via i3 Health’s website or their YouTube channel, from May 24, 2021, until May 23, 2022. A total of 6,640 learners participated, with 532 completing the activity for credit. Most participants were registered nurses (90%), followed by nurse practitioners (3%), advanced practice nurses (2%), physicians (2%), pharmacists (2%), physician assistants (1%), and clinical nurse specialists (1%).

The baseline data collected revealed knowledge gaps in the following areas: discussing the molecular pathogenesis of cholangiocarcinoma and emerging therapeutic targets, differentiating recent study findings on novel therapies for advanced cholangiocarcinoma, and applying strategies to monitor and manage adverse events associated with novel cholangiocarcinoma therapies.

Participants were given a matching pretest and posttest at the beginning and end of the activity, respectively. The pretest revealed knowledge gaps, with only 20% of participants successfully identifying pemigatinib as the appropriate treatment to recommend for a patient with recurrent cholangiocarcinoma experiencing disease progression six months after completing gemcitabine and cisplatin, after molecular profiling reveals a fibroblast growth factor receptor 2 (FGFR2)-BICC1 fusion; 43% of participants successfully identified that it would be advisable to pursue futibatinib as a treatment option for a patient with a FGFR2-POC1B fusion; 17% of participants successfully identified ivosidenib as the correct drug to use for a patient with an IDH1 mutation, pending availability; 22% of participants successfully identified hyperphosphatemia as the most common electrolyte disturbance with FGFR inhibitors that a patient with FGFR1-CLIP1–positive cholangiocarcinoma should be monitored for; and 17% of participants successfully identified that, based on the toxicity profile of selective FGFR inhibitors, an eye exam is need prior to treatment with this class of drugs.

Significant knowledge gains were revealed by the posttest assessment, with 77% more participants successful in understanding treatment selection for recurrent cholangiocarcinoma with an FGFR2 fusion; 44% more successful understanding efficacy of futibatinib for intrahepatic cholangiocarcinoma with FGFR2 fusions/rearrangements; 78% more understood treatment selection for advanced cholangiocarcinoma with an IDH1 mutation; 75% more understood adverse event monitoring for FGFR inhibitor treatment; and 75% more understood that a baseline eye exam before FGFR inhibitor treatment is necessary.

Upon completion of the activity, 87% of participants reported in a post-activity evaluation that they felt more confident in treating their patients with cholangiocarcinoma, and 87% felt that the material presented would be used to improve the outcomes of their patients.

The data revealed by the posttest assessment affirm the effectiveness of the online educational content and the knowledge gains made regarding up-to-date treatment strategies for cholangiocarcinoma. i3 Health has determined that the multidisciplinary team may benefit from CME/NCPD activities that provide education on therapeutic implications of emerging molecular targets for cholangiocarcinoma, efficacy of targeted therapies for advanced cholangiocarcinoma, and management of adverse events associated with novel targeted therapies.


i3 Health (2022). Emerging treatment strategies for advanced cholangiocarcinoma: activity outcomes report. Data on file.

American Cancer Society (2022). Key statistics for bile duct cancer. Available at:

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