Bertrand Brieau1, Laetitia Dahan2,3, Yann De Rycke4, Tarek Boussaha5, Philippe Vasseur6,7, David Tougeron6,7, Thierry Lecomte8,9, Romain Coriat1,10, Jean-Baptiste Bachet11,12, Pierre Claudez13, Aziz Zaanan14,15, Pauline Soibinet16, Jérome Desrame17, Anne Thirot-Bidault18, Isabelle Trouilloud19, Florence Mary20, Lysiane Marthey21, Julien Taieb14,15, Wulfran Cacheux22, Astrid Lièvre23,24. 1. Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, Paris, France. 2. Digestive Oncology Unit, La Timone Hospital, Marseille, France. 3. Faculty of Medicine-Timone, Aix-Marseille University, Marseille, France. 4. Public Health Department, Curie Institute, Paris, France. 5. Gastroenterology Unit, Saint Antoine Hospital, Paris, France. 6. Gastroenterology Unit, Poitiers Teaching Hospital, Poitiers, France. 7. Laboratory of Inflammation, Epithelial Tissues, and Cytokines (EA 4331), Poitiers University, Poitiers, France. 8. Gastroenterology Unit, Tours Teaching Hospital, Tours, France. 9. Faculty of Medicine, Francois Rabelais University, Tours, France. 10. Cochin-Port Royal Faculty of Medicine, Paris Descartes University, Paris, France. 11. Gastroenterology Unit, La Pitié Salpêtrière Hospital, Paris, France. 12. Faculty of Medicine, Pierre and Marie Curie University, Paris, France. 13. Gastroenterology and Hepatology Unit, Saint Etienne Teaching Hospital, North Hospital, Saint-Priest-en-Jarez, France. 14. Gastroenterology and Digestive Unit, Georges Pompidou European Hospital, Paris, France. 15. Paris Descartes University-Sorbonne Paris Cité, Paris, France. 16. Gastroenterology Unit, Reims Teaching Hospital, Reims, France. 17. Gastroenterology Unit, Jean Mermoz Hospital, Lyon, France. 18. Gastroenterology Unit, Kremlin-Bicêtre Hospital, Le Kremlin-Bicêtre, France. 19. Gastroenterology Unit, Amboise Paré Hospital, Boulogne-Billancourt, France. 20. Gastroenterology Unit, Avicenne Hospital, Bobigny, France. 21. Gastroenterology Unit, Antoine Béclère Hospital, Clamart, France. 22. Department of Medical Oncology, Curie Institute Hospital, Paris, France. 23. Department of Medical Oncology, René Huguenin Hospital, Curie Institute, Saint-Cloud, France. 24. Faculty of Health Sciences, Versailles Saint-Quentin-en-Yvelines University, Montigny-Le-Bretonneux, France.
Abstract
BACKGROUND: Few data are available on second-line chemotherapy (CT2) for advanced biliary tract cancer (ABTC). The aim of this multicenter study was to describe the CT2 regimens used, the response rates, and the outcomes of patients treated with various CT2 regimens. METHODS: Patients who received CT2 for ABTC at 17 French institutions after the failure of the gemcitabine-platinum combination were retrospectively studied. Progression-free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method. Cox models were used for multivariate analyses. RESULTS: Among 603 patients who received first-line chemotherapy (CT1) for ABTC, 196 received CT2: 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 = 10), or other various regimens (n = 23). Among the 186 assessable patients, there were 22 partial responses and 70 stabilizations. After a median follow-up of 26.4 months, the median PFS and OS were 3.2 and 6.7 months, respectively. There was no significant difference in PFS or OS between CT2 regimens. Fluoropyrimidine-based doublet chemotherapy was not superior to fluoropyrimidine alone in terms of OS and PFS. In a multivariate analysis, a performance status of 0 to 1, disease control with CT1, and a carbohydrate antigen 19-9 (CA 19-9) level ≤ 400 IU/mL were significantly associated with longer PFS and OS. Grade 3 to 4 toxicity occurred in 32% of the patients. CONCLUSIONS: CT2 might provide disease control for selected patients with ABTC after the failure of gemcitabine-platinum, but the prognosis remains poor. No particular regimen seems superior to others, and this calls for new treatments. A good performance status, disease control with CT1, and a low level of CA 19-9 were associated with longer survival.
BACKGROUND: Few data are available on second-line chemotherapy (CT2) for advanced biliary tract cancer (ABTC). The aim of this multicenter study was to describe the CT2 regimens used, the response rates, and the outcomes of patients treated with various CT2 regimens. METHODS:Patients who received CT2 for ABTC at 17 French institutions after the failure of the gemcitabine-platinum combination were retrospectively studied. Progression-free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method. Cox models were used for multivariate analyses. RESULTS: Among 603 patients who received first-line chemotherapy (CT1) for ABTC, 196 received CT2: 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 = 10), or other various regimens (n = 23). Among the 186 assessable patients, there were 22 partial responses and 70 stabilizations. After a median follow-up of 26.4 months, the median PFS and OS were 3.2 and 6.7 months, respectively. There was no significant difference in PFS or OS between CT2 regimens. Fluoropyrimidine-based doublet chemotherapy was not superior to fluoropyrimidine alone in terms of OS and PFS. In a multivariate analysis, a performance status of 0 to 1, disease control with CT1, and a carbohydrate antigen 19-9 (CA 19-9) level ≤ 400 IU/mL were significantly associated with longer PFS and OS. Grade 3 to 4 toxicity occurred in 32% of the patients. CONCLUSIONS:CT2 might provide disease control for selected patients with ABTC after the failure of gemcitabine-platinum, but the prognosis remains poor. No particular regimen seems superior to others, and this calls for new treatments. A good performance status, disease control with CT1, and a low level of CA 19-9 were associated with longer survival.
Authors: Milind Javle; Maeve Lowery; Rachna T Shroff; Karl Heinz Weiss; Christoph Springfeld; Mitesh J Borad; Ramesh K Ramanathan; Lipika Goyal; Saeed Sadeghi; Teresa Macarulla; Anthony El-Khoueiry; Robin Kate Kelley; Ivan Borbath; Su Pin Choo; Do-Youn Oh; Philip A Philip; Li-Tzong Chen; Thanyanan Reungwetwattana; Eric Van Cutsem; Kun-Huei Yeh; Kristen Ciombor; Richard S Finn; Anuradha Patel; Suman Sen; Dale Porter; Randi Isaacs; Andrew X Zhu; Ghassan K Abou-Alfa; Tanios Bekaii-Saab Journal: J Clin Oncol Date: 2017-11-28 Impact factor: 44.544
Authors: Jennifer Yang; Matthew R Farren; Daniel Ahn; Tanios Bekaii-Saab; Gregory B Lesinski Journal: Expert Opin Ther Targets Date: 2017-03-17 Impact factor: 6.902
Authors: Maeve A Lowery; Laura W Goff; Bridget P Keenan; Emmet Jordan; Rui Wang; Andrea G Bocobo; Joanne F Chou; Eileen M O'Reilly; James J Harding; Nancy Kemeny; Marianela Capanu; Ann C Griffin; Joseph McGuire; Alan P Venook; Ghassan K Abou-Alfa; Robin K Kelley Journal: Cancer Date: 2019-08-27 Impact factor: 6.860
Authors: Maeve A Lowery; Howard A Burris; Filip Janku; Rachna T Shroff; James M Cleary; Nilofer S Azad; Lipika Goyal; Elizabeth A Maher; Lia Gore; Antoine Hollebecque; Muralidhar Beeram; Jonathan C Trent; Liewen Jiang; Bin Fan; Elia Aguado-Fraile; Sung Choe; Bin Wu; Camelia Gliser; Samuel V Agresta; Shuchi S Pandya; Andrew X Zhu; Ghassan K Abou-Alfa Journal: Lancet Gastroenterol Hepatol Date: 2019-07-09