RSNA2023 Leading Through Change
Daily Bulletin

Imaging To Determine Tumor Response in Biliary Tract Cancer

Wednesday, Nov. 29, 2023

By Mary Henderson

During a Tuesday morning science session in the Learning Center Theater, Christian Reinert, MD, reported on the role of whole-body imaging in assessing the response of patients with cholangiocarcinoma (CAC) to molecular targeted therapy.



CAC, or cancer of the biliary tract, is relatively common, accounting for up to 15% of all primary liver cancers worldwide. The treatment remains challenging both in patients who are candidates for surgery and those undergoing systemic treatment. The five-year overall survival is 7-20%. Because almost 40% of all CAC harbors actionable genetic alterations, genetic testing is recommended.

“Traditional chemotherapy was the standard treatment of CAC until the gemcitabine-cisplatin and immune checkpoint inhibitors,” said Dr. Reinert, a radiologist at University Hospital Tübingen in Germany. “These treatment options are very expensive so it’s very important to analyze the patient’s early response, including complications, with follow-up imaging.”

Dr. Reinert’s study investigated the imaging response of patients with CAC to personalized evidence-based treatment recommendations from molecular tumor boards at two tertiary comprehensive cancer centers in Germany.

“Molecular treatment boards propose evidence-based treatment recommendations in patients with advanced tumor stages when standard of care options have been exhausted,” he said. “Imaging serves to characterize the disease response to treatment.”

Molecular Tumor Boards Can Identify Aggressive Disease and Plan Treatment

The study included patients who were referred to the molecular tumor boards between May 2019 and September 2021, based on their medical history and prior molecular diagnostics. After diagnostic analyses, patients received individual treatment and follow-up recommendations.

Of the 583 patients referred to the molecular tumor boards, 35 had CAC (18 females, median age 60.2 years). Of these patients, 28 received treatment recommendations including 15 that received molecular targeted therapy.

Imaging follow-up data were available for 27 patients: 22 underwent CT, 5 had 18F-FDG-PET/CT, and one had MRI.

Standardized response assessment was evaluated using the RECIST guidelines (version 1.1) tool. Two patients achieved an objective response: one with a partial response to pemigatinib, an anti-cancer medication used for the treatment of bile duct cancer, and one with tumor vaccination.

“The personalized cancer treatment shows potential for disease stabilization and maintained progression-free survival despite a trend toward more advanced tumor stages,” he said. “Standardized whole-body imaging is essential for assessing the tumor response of new targeted therapies.”

Dr. Reinert said his long-term goal is to identify imaging markers that are predictive of therapy response and disease progression. His research will require more patients for further analyses of patterns of therapy responses.

Access the presentation, “Genomic-Based Personalized Therapies and Precision Imaging in Cholangiocarcinoma Patients: A Study at Two German Comprehensive Cancer Centers,” (T3-STCE2-3) on demand at .