Document resource
Background Somatic molecular testing via multigene panel testing (MGPT) is recommended for patients with advanced cholangiocarcinoma (CCA) who are candidates for systemic therapy to identify actionable alterations. The incidence of therapeutic biomarkers has been largely described in Western cohorts. Testing is also often limited by tissue availability and financial considerations. There is limited real-world description on the adoption and utility of MGPT in aCCA patients in the Asian setting. Methods We conducted a retrospective chart review to identify patients with aCCA in our single-centre Asian tertiary centre over the last 12 years, to identify the incidence of MGPT, and to describe the clinicopathological characteristics and profiling results from these patients.Results We identified 322 patients diagnosed with aCCA who were first seen at NCCS between 1st December 2013 and 31st October 2025. Of these 149 (46.3%) patients had their biospecimens sent for molecular profiling, of which 136 (91.3%) received results. Median age of patients was 64.5 (range 29 - 86), most were of ECOG 0 - 1 (91.2%) and had intrahepatic CCA (48.5%). Most patients received results through tissue profiling (90%), with the rest through liquid biopsy. The common alterations were seen in the following genes: TP53 (40.4%), CDKN2A (27.2%), CKDN2B (20.6%), KRAS (19.1%), ARID1A (14.7%) and FGFR2 (14.0%). The most common type of FGFR2 alterations seen were fusions (75%). IDH1 mutations were seen in 9.6% of patients with profiling reports, with R132C being the most common alteration seen (76.9%). The most common KRAS mutation seen was G12D (61.5%). Coalterations were frequently seen between CKDN2A and CDKN2B, ARID1A, MTAP loss and SMAD4 alterations.Conclusions MGPT is feasible and can identify significant actionable alterations in patients with aCCA. Costs of testing, platform optimisation and access to matched therapeutic drugs are key to allowing more patients to benefit from MGPT.