East Genomics

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Integrating genomic testing into Biliary Tract Cancer management (BTC) pathway

This project aims to steer uptake of genomic testing, monitoring and driving targeted chemotherapy informed by genomic testing in the Biliary Tract Cancer management (BTC) pathway at Nottingham University Hospitals (NUH) NHS Trust.

What are we doing?

Our objectives are to:

  1. collect/audit the past 2-3 years of genomic data on BTC patients who received palliative chemotherapy,
  2. establish a standard regional BTC pathway to drive widespread adoption and acceptance of genomic testing among hepato-bilary (HPB) MDTs
  3. disseminate information through organising a regional teaching event, and
  4. audit genomic testing practice in 1-2 years after implementation of pathway.

Why are we doing it?

Biliary Tract Cancer, a rare cancer of unmet need with limited treatment options and dismal prognosis, poses significant challenges, and the NHS mission is to leverage cutting-edge genomics to tailor treatment strategies.

NICE recommens Larotrectinib for treating NTRK fusion-positive solid tumours (27 May 2020), Pemigatinib for relapsed or refractory advanced cholangiocarcinoma with FGFR2 fusion or rearrangement (25 Aug 2021), Pembrolizumab for previously treated biliary cancer with high microsatellite instability or mismatch repair deficiency (20th Sep 2023) and Ivosidenib as an option for treating locally advanced/ metastatic cholangiocarcinoma with an IDH1 R132 mutation in adults after 1 or more systemic treatments (14 Dec 2023).

Targeted therapies optimize efficacy and minimise side effects. These tests are now done in-house at NUH.

This project will be a transformative step towards precision medicine in BTC care, improving patient outcomes by integration of genomics into BTC management pathway.

Who are we working with?

Our goal is to ensure regional HPB teams are committed to advancing cancer care and recognise the transformative potential of genomic testing in personalized medicine.

The team delivering this project will include:

  • Project Lead, Arvind Arora,
  • East GMSA Medical Lead, Guru Aithal
  • HPB MDT Lead, Suresh Venkatachalapathy
  • Pathology GLH lead, Tom Mcculloch
  • Data collectors/analysts (Oncology SpR)
  • Regional HPB Oncologists, Sean Dulloo and Catherine Shankland
  • Senior Pharmacist, Emma Dring

Collaboration with regional HPB teams will enhance impact; we will maintain continuous communication and feedback loops.

Progress and next steps

  • Drafting/Agreement of BTC Pathway
  • Analyst to look at retrospective BTC data
  • Regional Educational Event

Meet our team