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Faculty

Angela Lamarca, MD, PhD, MSc

Consultant, Medical Oncology
Department of Medical Oncology
The Christie NHS Foundation Trust
Manchester, United Kingdom

Disclosures

Disclosure: Angela Lamarca, MD, PhD, MSc, has the following relevant financial relationships:
Advisor or consultant for: Eisai; Nutricia Ipsen; QED; Roche
Speaker or a member of a speakers bureau for: Incyte; Ipsen; Merck; Pfizer; QED
Grants for clinical research from: Ipsen; Roche
Other: Travel and educational support from: Bayer; Delcath; Ipsen; Mylan; Novartis; Pfizer; SirtEx

Editors

Keisha Peters, MSc

Medical Education Director, WebMD Global, LLC

Disclosures

Disclosure: Keisha Peters, MSc, has disclosed no relevant financial relationships.

Tristin Abair, PhD

Senior Medical Writer, WebMD Global, LLC

Disclosures

Disclosure: Tristin Abair, PhD, has disclosed no relevant financial relationships.

Content Reviewer

Esther Nyarko, PharmD

Associate Director, Accreditation and Compliance

Disclosures

Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

CPD

Best Practice Treatment of Advanced/Metastatic Cholangiocarcinoma: Case Studies and Expert Perspectives

Authors: Angela Lamarca, MD, PhD, MSc
CPD Released: 11/1/2021
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 11/1/2022, 11:59 PM EST

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Target Audience and Goal Statement

This educational activity is intended for an international audience of non-US gastroenterologists, hematology/oncology specialists, and pathologists.

The goal of this activity is to increase clinicians’ knowledge and competence regarding the diagnosis and treatment of advanced cholangiocarcinoma.

Upon completion of this activity, participants will:

Have greater competence related to
- Identification of patients eligible for molecularly targeted therapies
- Application of molecularly guided therapies in routine practice
Demonstrate greater confidence in their ability to
- Diagnose and manage cholangiocarcinoma

Disclosures

Faculty

Angela Lamarca, MD, PhD, MSc

Consultant, Medical Oncology
Department of Medical Oncology
The Christie NHS Foundation Trust
Manchester, United Kingdom

Disclosures

Disclosure: Angela Lamarca, MD, PhD, MSc, has the following relevant financial relationships:
Advisor or consultant for: Eisai; Nutricia Ipsen; QED; Roche
Speaker or a member of a speakers bureau for: Incyte; Ipsen; Merck; Pfizer; QED
Grants for clinical research from: Ipsen; Roche
Other: Travel and educational support from: Bayer; Delcath; Ipsen; Mylan; Novartis; Pfizer; SirtEx

Editors

Keisha Peters, MSc

Medical Education Director, WebMD Global, LLC

Disclosures

Disclosure: Keisha Peters, MSc, has disclosed no relevant financial relationships.

Tristin Abair, PhD

Senior Medical Writer, WebMD Global, LLC

Disclosures

Disclosure: Tristin Abair, PhD, has disclosed no relevant financial relationships.

Content Reviewer

Esther Nyarko, PharmD

Associate Director, Accreditation and Compliance

Disclosures

Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

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For Physicians

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From Medscape Education

CPD

Best Practice Treatment of Advanced/Metastatic Cholangiocarcinoma: Case Studies and Expert Perspectives

Authors: Angela Lamarca, MD, PhD, MScFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CPD Released: 11/1/2021

Valid for credit through: 11/1/2022, 11:59 PM EST

processing....

The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.

CASE 1: PATIENT HISTORY AND PRESENTATION

Arthur is 71 years old and runs a farm with his 2 sons. He fell while working and presented to his primary care provider 2 days later with mild discomfort in his upper right abdomen. An abdominal ultrasound showed multiple hypoechoic masses in his liver (Table 1). Subsequent computed tomography (CT) scan confirmed multiple liver lesions (largest diameter approximately 5 cm) and no evidence of extrahepatic disease. Blood work shows elevated liver function tests (LFTs). Arthur has no known liver cirrhosis and no history of alcohol or smoking.

Table 1. Arthur’s Initial Workup

Patient information	71 years old Height: 1.8 m; Weight: 88.5 kg BMI: 27.2
Personal and family medical history	History of mild hypertension and well-controlled diabetes, no other health issues Current medications include diltiazem, glimepiride, and vitamin D Non-smoker, no alcohol No allergies No family history of cancer
Physical exam	Mild tenderness in upper right abdomen ECOG PS: 0
Laboratory evaluations	CBC: normal Sodium: 135 mmol/L Potassium: 4.8 mmol/L Urea: 4.7 mmol/L Serum creatinine: 65 µmol/L eGFR: 79 mL/min/1.73m² Calcium: 2.39 mmol/L Phosphate: 1.26 mmol/L Total protein: 64 g/L Albumin: 40 g/L Globulin: 24 g/L Adjusted calcium: 2.51 mmol/L Total bilirubin: 12 µmol/L Alkaline phosphatase: 108 IU/L AST: 48 IU/L LDH: 164 IU/L GGT: 86 IU/L CA 19-9: 116 U/mL
Imaging	Ultrasound: multiple hypoechoic liver masses CT: multiple liver lesions with irregular peripheral enhancement; largest lesion has a diameter of 5 cm and showed some capsular retraction; no evidence of liver cirrhosis

AST = aspartate aminotransferase; BMI = body mass index; CA = carbohydrate antigen; CBC = complete blood count; CT = computed tomography; ECOG = Eastern Cooperative Oncology Group; eGFR = estimated glomerular filtration rate; GGT = gamma-glutamyl transferase; LDH = lactate dehydrogenase; PS = performance status.

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The educational activity presented above may involve simulated, case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient, whether living or deceased, is intended or should be inferred. The material presented here does not necessarily reflect the views of Medscape, LLC, or any individuals or commercial entities that support companies that support educational programming on medscape.org. These materials may include discussion of therapeutic products that have not been authorized by the European Medicines Agency for use in Europe, off-label uses of authorized products, or data that were presented in abstract form. These data should be considered preliminary until published in a peer-reviewed journal. Readers should verify all information and data before treating patients or employing any therapies described in this or any educational activity. A qualified healthcare professional should be consulted before using any therapeutic product discussed herein.

References

Faculty and Disclosures

Faculty

Angela Lamarca, MD, PhD, MSc

Editors

Keisha Peters, MSc

Tristin Abair, PhD

Content Reviewer

Esther Nyarko, PharmD

Peer Reviewer

CPD

Best Practice Treatment of Advanced/Metastatic Cholangiocarcinoma: Case Studies and Expert Perspectives

Target Audience and Goal Statement

Disclosures

Faculty

Angela Lamarca, MD, PhD, MSc

Editors

Keisha Peters, MSc

Tristin Abair, PhD

Content Reviewer

Esther Nyarko, PharmD

Peer Reviewer

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Best Practice Treatment of Advanced/Metastatic Cholangiocarcinoma: Case Studies and Expert Perspectives

CASE 1: PATIENT HISTORY AND PRESENTATION