For metastatic biliary tract cancer patients with short life expectancies, oncologists are more willing to use HER2-targeted therapies despite potential cardiac dysfunction. The risk of long-term cardiotoxicity is secondary to the immediate need for an effective cancer treatment in a palliative setting.
For a 93-year-old frail patient, a European oncologist defaults to best supportive care, whereas US-based counterparts consider targeted therapy. This highlights a cultural difference, with one physician noting the US tendency to "overtreat" in situations where palliative care may be more appropriate.
When a biliary tract tumor has both an FGFR2 fusion and HER2 positivity, oncologists may prioritize targeting the FGFR2 fusion. They reason that fusions are often early, clonal, and homogenous driver events, making them a more reliable therapeutic target than HER2, which can be expressed heterogeneously.