Brain Metastases from Biliary Tract Cancer: Case Series and Clinicogenomic Analysis

Authors

Grace N Dodoo
Brian De
Sunyoung S Lee
Joseph Abi Jaoude
Jean-Nicolas Vauthey
Ching-Wei D Tzeng
Hop S Tran Cao
Kalman A Katlowitz
Jacob J Mandel
Thomas H Beckham
Bruce D Minsky
Grace L Smith
Emma B Holliday
Albert C Koong
Prajnan Das
Cullen M Taniguchi
Milind Javle
Eugene J Koay
Ethan B Ludmir

Publication Date

4-6-2023

Journal

The Oncologist

Abstract

BACKGROUND: Limited data from small series have suggested that brain metastases from biliary tract cancers (BrM-BTC) affect ≤2% of patients with BTC. We sought to review our experience with patients with BrM-BTC and to identify associations of tumor-related molecular alterations with outcomes.

MATERIALS AND METHODS: A retrospective review of patients with BTC seen at a tertiary referral center from 2005 to 2021 was performed; patients with BrM-BTC were identified, and clinical and molecular data were collected.

RESULTS: Twenty-one of 823 patients with BTC (2.6%) developed BrM. For patients with BrM-BTC, median follow-up time was 27.9 months after primary BTC diagnosis and 3.1 months after BrM diagnosis. Median time from primary diagnosis to diagnosis of BrM was 14.4 [range, 1.1-66.0] months. Median overall survival (OS) from primary diagnosis was 31.5 [2.9-99.8] months and median OS from BrM diagnosis was 4.2 [0.2-33.8] months. Patients who underwent BrM-directed therapy trended toward longer OS following BrM diagnosis than patients receiving supportive care only (median 6.5 vs 0.8 months, P = .060). The BrM-BTC cohort was enriched for BRAF (30%), PIK3CA (25%), and GNAS (20%) mutations. patients with BrM-BTC with BRAF mutations trended toward longer OS following BrM diagnosis (median 13.1 vs 4.2 months, P = .131).

CONCLUSION: This is the largest series of patients with BrM-BTC to date and provides molecular characterization of this rare subgroup of patients with BTC. Patients with BrM-BTC may be more likely to have BRAF mutations. With advances in targeted therapy for patients with BTC with actionable mutations, continued examination of shifting patterns of failure, with emphasis on BrM, is warranted.

Keywords

cholangiocarcinoma, bile ducts, intrahepatic, bile ducts, extrahepatic, gallbladder, mutation, genomics

Comments

Data Availability Statement

PMID: 36715178