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Vedolizumab Refractory ICI Colitis — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyVedolizumab Refractory ICI ColitisSCE Medical Oncology

A patient in England with metastatic intrahepatic cholangiocarcinoma progresses after cisplatin-gemcitabine-durvalumab. Profiling shows IDH1 R132C, with no FGFR2 fusion, BRAF V600E or HER2 amplification. Which molecularly matched next-line option is routinely commissioned by NICE?

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Correct answer: D — Offer ivosidenib as the NICE-commissioned treatment for the confirmed IDH1 mutation

NICE TA948 recommends ivosidenib after prior systemic treatment for IDH1 R132-mutant advanced cholangiocarcinoma. Pemigatinib requires an FGFR2 fusion or rearrangement rather than an intrahepatic site alone. IDH-associated homologous-recombination biology does not create a routine olaparib indication. Dabrafenib-trametinib requires BRAF V600E. Continuing durvalumab beyond progression and adding ivosidenib is not the commissioned regimen.

Reference: NICE TA948 ivosidenib for IDH1-mutant cholangiocarcinoma (Published January 2024; current NICE TA): https://www.nice.org.uk/guidance/ta948/chapter/1-Recommendations