Pemigatinib is an FGFR inhibitor used to treat advanced cholangiocarcinoma patients carrying FGFR2 fusion or rearrangement. The treatment course needs to be personalized according to the disease status, treatment response, and tolerance. It is usually used continuously until the disease progresses or intolerable toxicity occurs, with no fixed limit on the number of treatment courses.

1. Standard treatment plan

(1) Initial dose: Take 13.5mg orally once a day, and stop taking the medication for 7 days after 21 consecutive days, forming a 28 day treatment cycle.

(2) Maintenance treatment: If the patient has good tolerance and no disease progression occurs, the cycle of continuous treatment can be repeated.

Adjustment factors for 2 treatment courses

(1) Efficacy evaluation: Tumor response needs to be evaluated through imaging examinations every 2-3 cycles, and patients with complete/partial remission can continue medication.

(2) Adverse reaction management: When grade 3 or above toxicity occurs, medication should be suspended or the dosage adjusted. After recovery, the dosage may be reduced and treatment may be restarted.

3 Indications for discontinuation of medication

(1) Disease progression: including tumor growth or the appearance of new lesions confirmed by imaging.

(2) Intolerable toxicity: serious adverse reactions such as hyperphosphatemia and retinopathy.

4 Considerations for Special Groups

(1) Liver injury patients: Mild injury does not require adjustment, moderate to severe injury should be reduced to 9mg or 6mg per day.

(2) Elderly patients: Age does not affect the course design, but it is necessary to strengthen the monitoring of adverse reactions.