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).

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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. 


  1. Brieau B, Dahan L, De Rycke Y, et al. Second-line chemotherapy for advanced biliary tract cancer after failure of the gemcitabine-platinum combination: a large multicenter study by the Association des Gastro-Enterologues Oncologues. Cancer. 2015. [Epub ahead of print]. doi: 10.1002/cncr.29471.