Second-line chemotherapy in advanced biliary cancers: A retrospective, multicenter analysis of outcomes Journal Article


Authors: Lowery, M. A.; Goff, L. W.; Keenan, B. P.; Jordan, E.; Wang, R.; Bocobo, A. G.; Chou, J. F.; O’Reilly, E. M.; Harding, J. J.; Kemeny, N.; Capanu, M.; Griffin, A. C.; McGuire, J.; Venook, A. P.; Abou-Alfa, G. K.; Kelley, R. K.
Article Title: Second-line chemotherapy in advanced biliary cancers: A retrospective, multicenter analysis of outcomes
Abstract: 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. © 2019 American Cancer Society
Keywords: adult; cancer chemotherapy; controlled study; aged; treatment failure; unclassified drug; major clinical study; overall survival; cancer localization; fluorouracil; advanced cancer; cancer combination chemotherapy; monotherapy; treatment duration; united states; gemcitabine; chemotherapy; cancer staging; antineoplastic agent; cancer diagnosis; clinical practice; treatment indication; demography; cohort analysis; retrospective study; irinotecan; cancer registry; biliary cancer; bile duct carcinoma; cholangiocarcinoma; kaplan meier method; gallbladder carcinoma; oxaliplatin; university hospital; floxuridine; gallbladder cancer; bile duct cancer; medical history; clinical outcome; second line chemotherapy; time to treatment; second line; very elderly; human; male; female; priority journal; article; advanced biliary cancer; 5 fluorouracil plus irinotecan
Journal Title: Cancer
Volume: 125
Issue: 24
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2019-12-15
Start Page: 4426
End Page: 4434
Language: English
DOI: 10.1002/cncr.32463
PUBMED: 31454426
PROVIDER: scopus
DOI/URL:
Notes: Source: Scopus
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MSK Authors
  1. Joanne Fu-Lou Chou
    190 Chou
  2. James Joseph Harding
    101 Harding
  3. Ghassan Abou-Alfa
    291 Abou-Alfa
  4. Marinela Capanu
    252 Capanu
  5. Maeve Aine Lowery
    125 Lowery
  6. Eileen O'Reilly
    403 O'Reilly
  7. Nancy Kemeny
    414 Kemeny
  8. Rui Wang
    14 Wang
  9. Emmet John Jordan
    42 Jordan