Second‐line chemotherapy in advanced biliary cancers: A retrospective, multicenter analysis of outcomes

BackgroundAlthough 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.MethodsInstitutional 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.ResultsThis 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).ConclusionsIn 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

Second‐line chemotherapy in advanced biliary cancers: A retrospective, multicenter analysis of outcomes

BACKGROUND: Though gemcitabine plus platinum chemotherapy is the established first line regimen for advanced biliary tract cancer (ABC), there is no standard second line therapy. We evaluated current practice and outcomes for second line chemotherapy in patients with ABC across three US academic medical centers. METHODS: Institutional registries were reviewed to identify patients who had received second line chemotherapy for ABC from 4/2010 to 3/2015, along with demographics, diagnosis and staging, treatment history, and clinical outcomes. Overall survival from initiation of second line chemotherapy (OS2) was estimated using Kaplan-Meier methods. RESULTS: We identified 198 patients with cholangiocarcinoma (intrahepatic, 61.1% and extrahepatic, 14.1%) and gallbladder carcinoma (24.8%); 52% received at least 3 lines of systemic chemotherapy. The median OS2 11 months (95% CI 8.8-13.1). Median OS2 for intrahepatic cholangiocarcinoma was 13.4 months (95% CI: 10.7-17.8), longer than extrahepatic or gallbladder with mOS2 of 6.8 months (95% CI: 5-10.5) and 9.4 months (95% CI: 7.2-12.3), respectively (p=0.018). The median time to second line treatment failure was 2.2 (95% CI: 1.8-2.7) months, similar across tumor locations (p=0.60). CONCLUSIONS: In this large cohort of ABC patients treated across three academic medical centers after failure of first line chemotherapy, the time to treatment failure on standard therapies was short, though median OS2 was longer than has been reported previously, and over half of patients received additional lines of treatment. This multicenter collaboration represents the largest cohort studied to date of second line chemotherapy in ABC and provides a contemporary benchmark for future clinical trials