Journal Article

Advanced biliary tract carcinomas: a retrospective multicenter analysis of first and second-line chemotherapy

Kim, Stefano, Dobi, Erion, Fiteni, Frédéric, Jary, Marine, Fein, Francine, Nguyen, Thierry, Demarchi, Martin, Nerich, Virginie, Cleau, Denis, Fratté, Serge, Borg, Christophe, Pivot, Xavier, Monnien, Franck, Beohou, Eric, Bonnetain, Franck

2014

Overview

Background Gemcitabine/Cisplatin (Gem/CDDP) combination has demonstrated a clear survival advantage over gemcitabine alone and has become a new standard in advanced Biliary Tract Carcinoma (aBTC). However, Gemcitabine/Oxaliplatin (GEMOX) combination and Gemcitabine/Carboplatin (Gem/Carb) combination regimens have shown efficacy in phase II trials and there is no comparative study between different platinum salts. We assessed the efficacy and safety of different platinum-based chemotherapies at first line in aBTC patients. We also analysed the second-line chemotherapy. Methods Sixty-four consecutive patients with aBTC diagnosed between 1998 and 2010 were included for analysis. At first line chemotherapy, 44 patients received one day GEMOX regimen (gemcitabine 1000 mg/m 2 and oxaliplatin 100 mg/m 2 Day 1, every 2 weeks), and 20 patients received Gem/Carb regimen (gemcitabine at 1000 mg/m 2 Days 1 and 8 with carboplatin delivered according to an area-under-the-curve (AUC) 5 at day 1, every 3 weeks). At second line, a total of 16 patients received a fluoropyrimidine-based chemotherapy. Results With GEMOX regimen, median progression-free survival (PFS) was 3.7 months (95%CI, 2.4 to 5) and median overall survival (OS) was 10.5 months (95%CI, 6.4 to14.7). The main toxicity was peripheral neuropathy (20% grade 2 and 7% grade 3). Grade 3/4 haematological toxicities were rare. With Gem/Carb regimen, PFS was 2.5 months (95%CI, 2.1 to 3.7) and OS was 4.8 months (95%CI, 3.7 to 5.8). The main grade 3/4 toxicities were haematological: anaemia (45%), thrombocytopenia (45%), and neutropenia (40%). At second-line, fluoropyrimidine-based chemotherapy was feasible in only a fourth of the patients. The median OS was 5.3 months (95%CI, 4.1 to 6.6), and median PFS was 4.0 months (95%CI, 2.6 to 5.5). Conclusions One day GEMOX regimen has a favourable toxicity profile and could be an alternative to standard Gem/CDDP regimen, in particular in unfit patients for CDDP. At second-line, selective patients may benefit from fluoropyrimidine-based chemotherapy.

• Publisher: BioMed Central,Springer Nature B.V
• Subject: Adenocarcinoma - drug therapy / Adenocarcinoma - pathology / Aged / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Bile Duct Neoplasms - drug therapy / Bile Duct Neoplasms - pathology / Bile Ducts, Extrahepatic - pathology / Bile Ducts, Intrahepatic - pathology / Cancer / Capecitabine / Carboplatin - administration & dosage / Cisplatin - administration & dosage / Deoxycytidine - administration & dosage / Deoxycytidine - analogs & derivatives / Disease-Free Survival / Female / Fluorouracil - administration & dosage / Fluorouracil - analogs & derivatives / Gallbladder Neoplasms - drug therapy / Gallbladder Neoplasms - pathology / Gastroenterology / Hepatobiliary and pancreatic disorders / Hepatology / Humans / Internal Medicine / Leucovorin - administration & dosage / Life Sciences / Male / Medicine / Medicine & Public Health / Middle Aged / Organoplatinum Compounds - administration & dosage / Research Article / Retrospective Studies / Treatment Outcome