What's new in HPB oncology: what does the oncologist need from the histopathologist?

Abstract

Oncology care for patients with advanced hepato-pancreato-biliary (HPB) cancer is rapidly evolving. Newest data is supporting the role of Precision Medicine strategies in patients diagnosed with advanced cholangiocarcinoma. In addition to tumour-agnostic targets such as NTRK fusions or MMR de?ciency tumour, there are new targets speci?c to cholangiocarcinoma, such as FGFR2 fusions (present in around 15-20% of intrahepatic cholangiocarcinoma) and IDH-1 mutations (present in around 15/20% of intrahepatic cholangiocarcinoma). Currently, molecular pro?ling is available as part of clinical trials and the above-mentioned treatment strategies do require adequate molecular pro?ling for suitable patients to be identi?ed and to be allocated to these new treatment options. Unfortunately, 1 in every 4 biopsy samples that are sent for molecular pro?ling fail such analysis, with majority failing due to poor quantity of tumour tissue present in the block sent for analysis. We therefore need close collaboration between histopathologist and oncologist at time of selecting best block available for molecular pro?ling so we avoid samples with no tumour being sent for analysis with the subsequent waiting time lost for patients with very poor prognosis for whom delay on treatment could be harmful. Should no suitable tissue be available for analysis, early re-biopsy could also be considered to increase changes of successful molecular pro?ling.