Advancing Diagnostic Certainty in Biliary Tract Cancers (BTC)

Now FDA-approved in BTC
PATHWAY anti-HER2/neu (4B5)
Rabbit Monoclonal Primary Antibody
The need for targeted therapies
Innovative HER2 testing is elevating hope for patients with Biliary Tract Cancer (BTC) that has progressed after first-line therapy. There is a significant unmet need for targeted therapies that can potentially improve survival.

Approximately, 60%-70% of patients present with locally advanced or metastatic cancer at diagnosis and are ineligible for surgery1
The median overall survival for patients is <12 months2
Why HER2 testing is important
HER2 is an important target for identifying BTC patients that have progressed after first-line therapy who may benefit from ZIIHERA® (zanidatamab).
*Based on a meta-analysis of published data in BTC showed that among 38 studies (including 3839 patients that reported HER2 positivity assessed by IHC)

HER2 positivity is key to determining eligibility for ZIIHERA® (zanidatamab)
Treatment with zanidatamab led to a median duration of response (DOR) of 14.9 months (95% CI: 7.4-not estimable) and a median overall survival (OS) of 18.1 (95% CI, 12.2-23.2) months in patients with IHC3+ tumors, and the 6- and 12-month OS rates were 90.1% (95% CI, 79.2%-95.4%) and 65.0% (95% CI, 51.6%-75.6%), respectively8
Staining characteristics for biliary tract cancer

Staining strength
Weak to moderate to strong staining is counted toward total % tumor cell membrane staining (resection)*9
Staining strength tumor cell cluster
Weak to moderate to strong staining is counted toward total tumor cell cluster membrane staining (biopsy)*9
*Refer to the PATHWAY HER2/neu (4B5) Rabbit Monoclonal Primary Antibody Interpretation Guide for Biliary Tract Cancer for scoring/interpretation guidance
BTC Scoring Algorithm
PATHWAY anti-HER2/neu (4B5) Rabbit Monoclonal Primary Antibody

Staining
- Lateral, basolateral and complete membrane staining all count towards IHC score
- For 2+ score, include cells with membrane staining of weak to moderate intensity

Scoring
- Scoring methods for biopsies and resections are the same but utilize different cut-points
- Resection Specimens: >10% tumor cells with membranous staining
- Biopsy Specimens: >5 contiguous tumor cells with membranous staining

Decisions
- For decision making, 4x and 20x objectives are the most important
Decision making
For decision making, 4x and 20x objectives are the most important in Her2 scoring of BTC
Resection specimens objective/magnification method decision tree9
Resection Specimens

Biopsy specimens objective/magnification method flow diagram9

Find a HER2 for BTC testing site
Bilary tract testing with PATHWAY HER2 (4B5) is the latest expansion of Roche’s market-leading portfolio of IHC/ISH companion diagnostics designed to provide critical insights that enable more informed clinical decisions and diagnostic certainty in HER2 testing.
Caris Life Sciences
4610 S 44th Pl.
Phoenix, AZ 85040
Sources
- Tella SH, et al. Lancet Oncol. 2020;21(1):e29–e41.
- Mirallas O, et al. ESMO Open. 2022;7(3):100503.
- American Cancer Society, "Survival Rates for Bile Duct Cancer" - Accessed October 2024.
- American Cancer Society, "Survival Rates for Gallbladder Cancer" - Accessed October 2024.
- Kang MJ, et al. Sci Rep. 2022;12(1):10206.
- Koshiol J, et al. BMC Cancer. 2022;22(1):1178–1189. 6. Azizi AA, et. al. Crit Rev Oncol Hematol. 2021 Jul;163:103328.
- Galdy, S, et al. Cancer and Metastasis Reviews. 2017;36:141-57. PMID: WOS:000399178000011
- Harding JJ, et al. Lancet Oncol. 2023: 24:772-82. Publication on phase 2b trial of zani in patients with HER-amplified BTC (HERIZON-BTC-01)
- PATHWAY HER2/neu Rabbit Monoclonal Primary Antibody Interpretation Guide for Biliary Tract Cancer
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