Second-line chemotherapy (CT2) for advanced biliary tract cancer (ABTC) seems to be associated with longer survival only in selected patients, a recent study published online this week in the journal Cancer has shown.
A large multicenter study conducted by the Association des Gastro-Entérologues Oncologues examined patients who failed the gemcitabine-platinum combination for ABTC at 17 French institutions. The outcome measures were progression-free survival (PFS) and overall survival (OS).
Out of 603 patients who had already received first-line chemotherapy, 196 received CT2 as either 5-fluorouracil (5-FU) and irinotecan (n=64), 5-FU and oxaliplatin (n=21), 5-FU and cisplatin (n=38), 5-FU or capecitabine (n=40), sunitinib (n= 0), or other various regimens (n=23).
After a median follow-up of 26.4 months, there was no significant difference in PFS (3.2 months) or OS (6.7 months), and fluoropyrimidine-based doublet chemotherapy was not superior to fluoropyrimidine monotherapy. Furthermore, 32% of the patients had grade 3 to 4 toxicity after CT2.
The researchers found that only selected patients with a good performance status, disease control with CT1, and a carbohydrate antigen 19-9 level ≤ 400 IU/mL can benefit from CT2. Additional studies are warranted to call for new treatments for ABTC, as no regimen has been shown to be superior to others.