Treatment of Locally Advanced or Metastatic Ampullary Adenocarcinoma — Proficient Mismatch Repair (pMMR), Intestinal Subtype

This protocol applies to patients with locally advanced or metastatic ampullary carcinoma whose tumour has been characterised as proficient mismatch repair (pMMR), intestinal (INT) subtype, with an ECOG performance status of 2 or less.

Clinical Scenario

The patient presents with locally advanced or metastatic disease. Mismatch repair testing confirms proficient (pMMR) status, ruling out the dMMR/MSI-H subpopulation. Tumour histology is classified as the intestinal (INT) subtype. ECOG performance status is ≤ 2, indicating eligibility for active systemic therapy.

In pMMR ampullary carcinoma, first-line chemotherapy selection is adapted to the patient's general condition and tumour subtype — INT, pancreaticobiliary (PB), or mixed (MT).

Treatment Approach (Partial Overview)

Treatment decisions are guided by the molecular alteration profile of the tumour, with targeted and chemotherapy-based strategies available depending on specific biomarker findings.

The complete regimen options, sequencing, and all clinical criteria are in the full structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.dld.2024.04.027

For pMMR AC, first line chemotherapy may be adapted according to general condition, and INT / PB / MT subtype.
For dMMR/MSI-H AC: when not used in first line, ICI is a valid option (grade C).
For Her2 positive AC: FOLFOX or 5FU and antiHer2 therapy (expert agreement).
For FGFR2 translocation: FGFR2 inhibitors (expert agreement).
For AC harboring NTRK fusions: larotrectinib or entrectinib (expert agreement).
Irinotecan based: FOLFIRI (expert opinion).
Gemcitabine based (expert opinion).
Taxane based (expert opinion) if contraindication for oxaliplatin.

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