Hypercalcemia IDH1 Cholangiocarcinoma intrahepatic Bisphosphonates molecular profiling Tumor Mutation Burden
The following is a review of a recent article translated into a more patient-centric style, including an obvious observation on TMB-High.
Hypercalcemia in Patients With Cholangiocarcinoma
By Matthew Stenger
But firstly what is Hypercalcemia?
Hypercalcemia is a medical condition in which there is an abnormally high level of calcium in the blood. This can be caused by several factors, including cancer, and can lead to a range of symptoms such as fatigue, nausea, and confusion. Hypercalcemia can be managed with medication and treatment of the underlying cause.
How does this occur in CCA patients?
Hypercalcemia can occur in cholangiocarcinoma patients due to the cancer cells producing substances that increase calcium levels in the blood. In addition, bone metastases (the spread of cancer to the bones) can lead to the release of calcium from the bones into the bloodstream. The prevalence of hypercalcemia in cholangiocarcinoma patients increases over time, especially in patients with IDH1-mutant intrahepatic cholangiocarcinoma.
Reviewing the article
This article reports on a study examining the prevalence and significance of hypercalcemia (high levels of calcium in the blood) in patients with cholangiocarcinoma, a type of cancer that affects the bile ducts. The study found that hypercalcemia was more common in patients with IDH1-mutant intrahepatic cholangiocarcinoma and was associated with a higher tumor burden and poor prognosis. Bisphosphonates can be used to manage hypercalcemia, and molecular profiling is crucial to assess treatment options, especially for IDH1 mutations associated with hypercalcemia. The findings highlight the importance of molecular profiling in evaluating the suitability of IDH1 inhibitors in cholangiocarcinoma patients with hypercalcemia.
- Cholangiocarcinoma patients should be aware of hypercalcemia, which is when there are high levels of calcium in the blood, as it can impact treatment options.
- Hypercalcemia is more common in patients with IDH1-mutant intrahepatic cholangiocarcinoma and gets worse over time.
- Hypercalcemia is associated with poor prognosis, high tumor burden in intrahepatic disease, and poor tumor differentiation in extrahepatic disease.
- Bisphosphonates can help manage hypercalcemia, and molecular profiling is important to assess treatment options, especially for IDH1 mutations.
- Patients with hypercalcemia and higher tumor burden may be more likely to respond well to immune checkpoint inhibitors.
The study found that:
- “11% of cholangiocarcinoma patients had hypercalcemia at diagnosis, but the prevalence increased to 31% at any time during the disease course.”
- “IDH1-mutant intrahepatic cholangiocarcinoma patients had a higher risk of hypercalcemia than those with IDH1 wild-type or extrahepatic disease.”
- “Patients with hypercalcemia had a higher tumor burden in intrahepatic disease and poor tumor differentiation in extrahepatic disease.”
- “Hypercalcemia was linked to a poor prognosis, with a median overall survival of 4.9 months for patients with intrahepatic disease and 1.8 months for those with extrahepatic disease.”
- “Bisphosphonates were used less frequently when hypercalcemia was not documented.”
- “44% of cases with hypercalcemia based on corrected calcium levels had normal uncorrected calcium levels.”
- “The study highlights the importance of molecular profiling in evaluating treatment options, particularly for IDH1 mutations associated with hypercalcemia, in cholangiocarcinoma patients.” – Absolutely correct, and a crucial take-away from the study.
Bisphosphonates are a class of drugs used to treat conditions related to bone loss and can also be used to manage high levels of calcium in the blood.
An observation: Tumor Mutation Burden
In patients with hypercalcemia and higher tumor burden, immune checkpoint inhibitors may be a promising treatment option. Immune checkpoint inhibitors help the immune system attack cancer cells and may be more effective in patients with a higher tumor burden. You may also like to view theyoutube below”short-clip” which explains TMB-high very well.
Revisit the original article
Lipika Goyal, MD
Simplifying and distilling medical information in a way that we as patients can understand and act on is the beginning of patient empowerment and ‘informed choice.’ Understanding creates confidence and leads to better decision-making and confidence. Please share your thoughts and questions about the article in the comments section below so I can continue to simplify it.
Ps if you would like a template of the questions that you should ask your oncologist or surgeon, then drop me an email and I will send you a copy.