Review Article

Practical Management of Adverse Events Associated With FGFR Inhibitors for Cholangiocarcinoma for the Advanced Practice Provider

Gabriel Schwartz,(1) MSN, FNP-BC, AOCNP®, and Julianne O. Darling,(2) PharmD, BCOP

From (1)University of California San Francisco, San Francisco, California; (2)National Community Oncology Dispensing Association, Cazenovia, New York

Authors’ disclosures of conflicts of interest are found at the end of this article.

Correspondence to: Julianne O. Darling, PharmD, BCOP, NCODA, 3013 Overton Road Birmingham, AL 35223 E-mail: julianne.darling@ncoda.org

Cholangiocarcinoma is a cancer of the bile duct frequently diagnosed at a late stage with a poor prognosis. Selective fibroblast growth factor receptor (FGFR) inhibitors have demonstrated efficacy in the treatment of cholangiocarcinoma with FGFR2 fusions or rearrangements, but are associated with hyperphosphatemia, fatigue, and ocular, dermatologic, and gastrointestinal adverse events (AEs). Treatment adherence and patient outcomes can be improved by anticipating and effectively managing the AEs associated with FGFR inhibitors and providing appropriate intervention and patient education. The multidisciplinary care team for patients with cholangiocarcinoma can involve optometrists and advanced practice providers, including nurse practitioners, physician assistants, pharmacists. This review provides practical insights for advanced practice providers on the management of these common AEs associated with selective FGFR inhibitors in the real-world setting, focusing on pemigatinib and futibatinib. Impacts of renal or hepatic impairment, drug–drug interactions, and drug–food interactions are discussed. Also presented are practical recommendations for prophylaxis and supportive care measures, and resources for health-care professionals and patients.

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