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Spatial immune profiling complements genomic sequencing in biliary tract cancer: hypothesis-generating use cases
M Barsch1, I Godbole1, P Metzger2
1Clinic for Internal Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Disease, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
ESMO Gastrointestinal Oncology
|April 6, 2026
Summary
Personalized therapies for biliary tract cancer (BTC) with homologous recombination deficiency (HRD) are emerging. Integrating genomic and immune profiling may guide tailored treatments for BTC patients with BRCA2 or BAP1 alterations.
Area of Science:
- Oncology
- Genomics
- Immunotherapy
Background:
- Personalized therapy for biliary tract cancer (BTC) targeting homologous recombination deficiency (HRD) is under-investigated.
- The role of BRCA1-associated protein 1 (BAP1) alterations in BTC treatment requires further clarification.
Purpose of the Study:
- To explore hypothesis-generating use cases of HRD-related mutations in BTC.
- To demonstrate how integrated genomic and spatial immune profiling can inform treatment strategies.
Main Methods:
- Case study of three BTC patients with HRD-related mutations.
- Integration of multiplexed imaging mass cytometry for spatial immune profiling with genomic sequencing.
Main Results:
- A patient with BRCA2 mutation and HRD responded to platinum-based therapy and PARP inhibition.
- A patient with BAP1 loss, characterized by a CD8+ T-cell enriched microenvironment, showed long-term response to immune checkpoint inhibition and tyrosine kinase inhibitors.
Conclusions:
- Integrated genomic and spatial immune profiling offers a rationale for personalized treatment in BTC.
- Further prospective validation is needed to confirm these findings in BTC patients.
