Outcomes in patients receiving palliative chemotherapy for advanced biliary tract cancer

Felix Thol; Simon Johannes Gairing; Carolin Czauderna; Thomas Thomaidis; Thomas Gamstätter; Yvonne Huber; Johanna Vollmar; Johanna Lorenz; Maurice Michel; Fabian Bartsch; Lukas Müller; Roman Kloeckner; Peter Robert Galle; Marcus-Alexander Wörns; Jens Uwe Marquardt; Markus Moehler; Arndt Weinmann; Friedrich Foerster

doi:10.1016/j.jhepr.2021.100417

Outcomes in patients receiving palliative chemotherapy for advanced biliary tract cancer

JHEP Rep. 2021 Dec 16;4(3):100417. doi: 10.1016/j.jhepr.2021.100417. eCollection 2022 Mar.

Authors

Felix Thol¹, Simon Johannes Gairing¹, Carolin Czauderna^{1

2}, Thomas Thomaidis¹, Thomas Gamstätter¹, Yvonne Huber¹, Johanna Vollmar¹, Johanna Lorenz¹, Maurice Michel¹, Fabian Bartsch³, Lukas Müller⁴, Roman Kloeckner⁴, Peter Robert Galle¹, Marcus-Alexander Wörns¹, Jens Uwe Marquardt^{1

2}, Markus Moehler¹, Arndt Weinmann¹, Friedrich Foerster¹

Affiliations

¹ Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
² Department of Medicine I, University Hospital Schleswig-Holstein, Lübeck, Germany.
³ Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
⁴ Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.

Abstract

Background & aims: Advanced biliary tract cancer (ABTC) is associated with a poor prognosis. Real-world data on the outcome of patients with ABTC undergoing sequential chemotherapies remain scarce, and little is known about treatment options beyond the established first- and second-line treatments with gemcitabine + cisplatin and FOLFOX. This study aimed to evaluate the outcome of patients with regard to different oncological therapies and to identify prognostic factors.

Methods: From January 2010 until December 2019, 142 patients started palliative chemotherapy at our tertiary care liver center. Overall survival (OS) was calculated using Kaplan-Meier plots. Prognostic factors were evaluated using cox proportional-hazards.

Results: Patients received a median number of 2 lines of chemotherapy. Median OS was 6.7, 15.2 and 18.2 months for patients who received 1, 2 and 3 lines of chemotherapy, respectively. Patients treated with FOLFIRINOX had a significantly extended OS of 23.8 months (log-rank test: p = 0.018). The univariate cox regression analysis identified several clinical parameters associated with survival (e.g. albumin, bilirubin, carcinoembryonic antigen, carbohydrate antigen 19-9 levels).

Conclusions: Our study provides real-world data on the prognosis of ABTC including survival times for patients receiving third and later lines of chemotherapy.

Lay summary: Real-world data depicting the outcome of patients with advanced biliary tract cancer outside the framework of controlled trials remain rare despite being extremely important for clinical decision-making. This study therefore provides important real-world data on the established first- and second-line treatments with gemcitabine + cisplatin and FOLFOX, as well as on other chemotherapy regimens or later lines of chemotherapy. It further demonstrates that the use of FOLFIRINOX is associated with promising survival and that there is an association between various clinical parameters such as pre-therapeutic albumin, bilirubin or carbohydrate antigen 19-9 levels and survival.

Keywords: ABTC, advanced biliary tract cancer; CA19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; CT1, first-line chemotherapy; CT2, second-line chemotherapy; CT3, third-line chemotherapy; ECOG PS, Eastern Cooperative Oncology Group performance status; FGFR, fibroblast growth factor receptor; GBC, gallbladder cancer; GemCis, gemcitabine + cisplatin; GemOx, gemcitabine + oxaliplatin; IDH, isocitrate dehydrogenase; OS, overall survival; UICC, Union for International Cancer Control; cholangiocarcinoma; iCCA, intrahepatic cholangiocarcinoma; metastasis; pCCA, perihilar cholangiocarcinoma; primary liver cancer; survival; treatment.