Premium
Second‐line chemotherapy in advanced biliary cancers: A retrospective, multicenter analysis of outcomes
Author(s) -
Lowery Maeve A.,
Goff Laura W.,
Keenan Bridget P.,
Jordan Emmet,
Wang Rui,
Bocobo Andrea G.,
Chou Joanne F.,
O’Reilly Eileen M.,
Harding James J.,
Kemeny Nancy,
Capanu Marianela,
Griffin Ann C.,
McGuire Joseph,
Venook Alan P.,
AbouAlfa Ghassan K.,
Kelley Robin K.
Publication year - 2019
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32463
Subject(s) - medicine , gemcitabine , chemotherapy , regimen , chemotherapy regimen , gallbladder cancer , gallbladder , confidence interval , retrospective cohort study , cohort , intrahepatic cholangiocarcinoma , surgery , cancer , gastroenterology
Background Although gemcitabine plus platinum chemotherapy is the established first‐line regimen for advanced biliary cancer (ABC), there is no standard second‐line therapy. This study evaluated current practice and outcomes for second‐line chemotherapy in patients with ABC across 3 US academic medical centers. Methods Institutional registries were reviewed to identify patients who had received second‐line chemotherapy for ABC from April 2010 to March 2015 along with their demographics, diagnoses and staging, treatment histories, and clinical outcomes. Overall survival from the initiation of second‐line chemotherapy (OS2) was estimated with Kaplan‐Meier methods. Results This study identified 198 patients with cholangiocarcinoma (intrahepatic [61.1%] or extrahepatic [14.1%]) or gallbladder carcinoma (24.8%); 52% received at least 3 lines of systemic chemotherapy. The median OS2 was 11 months (95% confidence interval [CI], 8.8‐13.1 months). The median OS2 for patients with intrahepatic cholangiocarcinoma was 13.4 months (95% CI, 10.7‐17.8 months), which was longer than that for patients with extrahepatic cholangiocarcinoma (6.8 months; 95% CI, 5‐10.6 months) or gallbladder carcinoma (9.4 months; 95% CI, 7.2‐12.3 months; P = .018). The median time to second‐line treatment failure was 2.2 months (95% CI, 1.8‐2.7 months), and it was similar across tumor locations ( P = .60). Conclusions In this large cohort of patients with ABC treated across 3 academic medical centers after the failure of first‐line chemotherapy, the time to treatment failure on standard therapies was short, although the median OS2 was longer than has been reported previously, and more than half of the patients received additional lines of treatment. This multicenter collaboration represents the largest cohort studied to date of second‐line chemotherapy for ABC and provides a contemporary benchmark for future clinical trials.