Nora Schweitzer1,2, Martha M Kirstein1, Anna-Maria Kratzel1,3, Young-Seon Mederacke1, Mareike Fischer1,4, Michael P Manns1, Arndt Vogel1. 1. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. 2. Department of Internal Medicine I, University Hospital Halle (Saale), Halle (Saale), Germany. 3. Department of Internal Medicine and Gastroenterology, Sankt Bernward Hospital Hildesheim, Hildesheim, Germany. 4. Department of Cardiology, Angiology and Intensive Care, Klinikum Hildesheim, Hildesheim, Germany.
Abstract
BACKGROUND & AIMS: The prognosis of biliary tract cancer (BTC) is poor. Standard treatment for advanced BTC is a chemotherapy (CT) with gemcitabine and cisplatin. Phase III evidence for a second-line (2L) CT is lacking. We aimed to investigate the feasibility of a 2L CT, to estimate the outcome and to identify prognostic markers. METHODS: Patients of our institution with advanced BTC between 2000 and 2015 receiving CT were included. Data were analysed in univariate and multivariate analysis. RESULTS: Three-hundred and fifteen and 144 patients (45.7%) received first-line (1L) and 2L CT respectively. The OS of patients receiving 2L CT was 16.67 and 9.9 months from the beginning of 1L and 2L CT respectively. The overall response rate and the disease control rate after 3 months were 9.7% and 33.6% respectively. Adverse events of grade 3 or more were observed in 26.1%. One patient died of gemcitabine-related haemolytic uraemic syndrome. Age of more than 70 years was not associated with a poor outcome. In multivariate analysis, CEA levels of >3 µg/L (P = 0.004, hazard ratio [HR] 1.89, 95% CI 1.22, 2.91), cholinesterase (CHE) levels of <5 kU/L (P = 0.001, HR 2.11, 95% CI 1.34, 3.31) and leukocytosis (P = 0.001, HR 2.90, 95% CI 1.51, 5.56) were associated with poor survival. CONCLUSIONS: Despite a relevant toxicity, our data suggest that 2L CT may be feasible in fit BTC patients. CEA elevation, leukocytosis and low CHE levels are unfavourable prognostic markers. Results from prospective randomized trials are urgently awaited.
BACKGROUND & AIMS: The prognosis of biliary tract cancer (BTC) is poor. Standard treatment for advanced BTC is a chemotherapy (CT) with gemcitabine and cisplatin. Phase III evidence for a second-line (2L) CT is lacking. We aimed to investigate the feasibility of a 2L CT, to estimate the outcome and to identify prognostic markers. METHODS:Patients of our institution with advanced BTC between 2000 and 2015 receiving CT were included. Data were analysed in univariate and multivariate analysis. RESULTS: Three-hundred and fifteen and 144 patients (45.7%) received first-line (1L) and 2L CT respectively. The OS of patients receiving 2L CT was 16.67 and 9.9 months from the beginning of 1L and 2L CT respectively. The overall response rate and the disease control rate after 3 months were 9.7% and 33.6% respectively. Adverse events of grade 3 or more were observed in 26.1%. One patient died of gemcitabine-related haemolytic uraemic syndrome. Age of more than 70 years was not associated with a poor outcome. In multivariate analysis, CEA levels of >3 µg/L (P = 0.004, hazard ratio [HR] 1.89, 95% CI 1.22, 2.91), cholinesterase (CHE) levels of <5 kU/L (P = 0.001, HR 2.11, 95% CI 1.34, 3.31) and leukocytosis (P = 0.001, HR 2.90, 95% CI 1.51, 5.56) were associated with poor survival. CONCLUSIONS: Despite a relevant toxicity, our data suggest that 2L CT may be feasible in fit BTC patients. CEA elevation, leukocytosis and low CHE levels are unfavourable prognostic markers. Results from prospective randomized trials are urgently awaited.
Authors: Sara Massironi; Lorenzo Pilla; Alessandra Elvevi; Raffaella Longarini; Roberta Elisa Rossi; Paolo Bidoli; Pietro Invernizzi Journal: Cells Date: 2020-03-11 Impact factor: 6.600
Authors: José J G Marin; Maria Giuseppina Prete; Angela Lamarca; Simona Tavolari; Ana Landa-Magdalena; Giovanni Brandi; Oreste Segatto; Arndt Vogel; Rocío I R Macias; Pedro M Rodrigues; Adelaida La Casta; Joachim Mertens; Cecilia M P Rodrigues; Maite G Fernandez-Barrena; Ana Da Silva Ruivo; Marco Marzioni; Giulia Mentrasti; Pilar Acedo; Patricia Munoz-Garrido; Vincenzo Cardinale; Jesus M Banales; Juan W Valle; John Bridgewater; Chiara Braconi Journal: Br J Cancer Date: 2020-07-22 Impact factor: 7.640