Current development and future perspective of IDH1 inhibitors in cholangiocarcinoma

Biliary tract cancer (BTC) represents a major public health problem due to its increasing rates of incidence and mortality, especially the intrahepatic cholangiocarcinoma (IHCCA) subtype. First line palliative systemic treatment with cisplatin and gemcitabine has been the unique level IA evidence option until last few years when a deeper understanding of its molecular landscape has unveiled CCA as a very rich targetable disease. This has revolutionised the patient's scenario and has brought new targeted therapies guided by molecular aberrations. Isocitrate dehydrogenase (IDH)1 mutations are the most prevalent targetable alteration in CCA (13% of IHCCA). Ivosidenib has been very recently approved by FDA for IDH1 mutated CCA patients based on a randomised clinical trial (ClarIDHy).