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Cholangiocarcinoma — SCE Medical Oncology MCQ

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ModerateGI CancersCholangiocarcinomaSCE Medical Oncology

A 60-year-old man with advanced cholangiocarcinoma receives gemcitabine + cisplatin + durvalumab. After 8 cycles, cisplatin is stopped due to cumulative nephrotoxicity. What maintenance therapy continues?

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Correct answer: C — Gemcitabine + durvalumab maintenance

In the TOPAZ-1 trial protocol, after 8 cycles of gemcitabine-cisplatin-durvalumab, treatment continues with gemcitabine + durvalumab maintenance until progression. Cisplatin is typically limited to 8 cycles due to cumulative toxicity (nephrotoxicity, neuropathy, ototoxicity). The durvalumab component continues beyond platinum cessation. Some clinicians use gemcitabine + durvalumab maintenance, while others transition to durvalumab alone if gemcitabine toxicity also accumulates.

Reference: NICE TA985 Durvalumab + GemCis for BTC; TOPAZ-1 protocol