Chemotherapy for cholangiocarcinoma: An update

Ramírez-Merino, Natalia; Aix, Santiago Ponce; Cortés, Javier

doi:10.4251/wjgo.v5.i7.171

Cited by 124 publications

(109 citation statements)

References 15 publications

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“…Since the ABC-02 trial, GC is the most commonly used regimen for treating advanced BTC in United States (10). There are other authors who have questioned the role of combination therapy such as a Korean retrospective study that showed that gemcitabine alone might also be an option for advanced BTC (11).…”

Section: Introductionmentioning

confidence: 99%

Advanced biliary tract cancer: clinical outcomes with ABC-02 regimen and analysis of prognostic factors in a tertiary care center in the United States

Agarwal

Sendilnathan

Siddiqi

et al. 2016

J. Gastrointest. Oncol.

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Background: Gemcitabine plus cisplatin (GC) is currently the standard regimen for advanced biliary tract cancers (BTC) based on the outcomes in ABC-02 trial. Multiple factors can affect outcomes in these patients. This retrospective review evaluates the University of Cincinnati experience with GC in advanced intrahepatic (IHC)/ extrahepatic cholangiocarcinoma (EHC) and gall bladder carcinoma (GBC). Methods: In this study approved by University of Cincinnati IRB, retrospective analysis of advanced BTC patients seen between 01/2008 and 01/2015 was done. Kaplan Meyer method was used to calculate progression free survival (PFS), and overall survival (OS). Cox model was used to test the association between baseline variables and OS/PFS, adjusting for gender and age at diagnosis. Patients were identified using ICD code for BT tumors, 26 patients met inclusion criteria: histologically proven advanced BTC that received GC as their initial chemotherapy. GC was given as per ABC-02 protocol with appropriate modifications until disease progression or unacceptable toxicities. Results: Median age at diagnosis was 62 years (range, 31-81 years). Eighteen (69%) were IHC, 5 EHC, 3 GBC, 61% male, 73% whites. Performance status (PS): 0-1: 69%, PS 2: 31%. Baseline CA19-9 data was available for 21 patients, (range 1 to 69,543), and abnormal CA19-9 was seen in 14 patients (54%). PFS was 4.5 months (95% CI: 3.1-8.9 months) and OS was 10.5 months (95 % CI: 7.9-18.8 months). OS at 6 and 12 months was 69% (18/26) and 42% (11/26). Thirty-eight percent (10/26) received 2nd line chemotherapy, of these 9/10 received 5FU based chemotherapy. Eleven percent (3/26) received 3rd line chemotherapy. Increase in baseline carcinoembryonic antigen (CEA), alanine aminotransferase, alkaline phosphatase (ALP) and total bilirubin was associated with increased risk of death while increase in baseline CEA and ALP was associated with increased risk of progression (P valve <0.05). In the group of patients who had all three major risk factors (PS ≥2, CEA >3, and stage IVb), the median survival was 2.9 months (95% CI: 2.6-9.3 months), which was significantly worse compared to rest of the population [median 18 months (95% CI: 5.4-19.5 months), P<0.01]. Conclusions: Our data supports the use of GC as a first line regimen for advance BTC in a non-clinical trial setting. Results are comparable to those reported in ABC-02 trial, despite inclusion of PS 2 patients whom constituted 31% of our population. In the patient population studied, baseline CEA and liver function test appeared able to predict response to GC in advanced BTC. Patients with all three high risk factors (PS ≥2, CEA >3, and stage IVb) did poorly and may need careful selection prior to initiating chemotherapy.

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Section: Introductionmentioning

confidence: 99%

Advanced biliary tract cancer: clinical outcomes with ABC-02 regimen and analysis of prognostic factors in a tertiary care center in the United States

Agarwal

Sendilnathan

Siddiqi

et al. 2016

J. Gastrointest. Oncol.

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“…Curative treatment has historically been with surgical resection, with extrahepatic cholangiocarcinoma having the highest chance for resectability (2,3). For extrahepatic cholangiocarcinoma patients who have undergone curative resection, the 5-year survival rate ranges from 16-50% (2).…”

Section: Introductionmentioning

confidence: 99%

Second-line systemic treatment for advanced cholangiocarcinoma.

Rogers

Law

Nguyen

et al. 2014

JCO

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Background: Gemcitabine plus platinum (GEM-P) combination chemotherapy is standard treatment for first-line advanced cholangiocarcinoma (aCC). GEM-P first-line therapy reports a progression-free survival (PFS) of 8 months and overall survival (OS) of 11.7 months. Treatment in the second-line setting is less clear.Five-year survival for aCC remains dismal at 5-10%. The purpose of this study was to describe the outcomes with second-line systemic treatment at our institution. Results: Fifty-six patients were included and the majority had intrahepatic aCC. A total of 80% received first-line gemcitabine-based therapy. Second-line therapy consisted of GEM-P (19.6%), GEM-FU (28.6%), FU-combo (37.5%), and others (14.3%). Median PFS was 2.7-month (95% CI, 2.3-3.8 months) with a median OS of 13.8 months (95% CI, 12-19.3 months) and a disease control rate of 50%. No significant difference in survival was identified between the four treatment groups.Conclusions: This study revealed a 2.7-month PFS, 50% disease control rate, and potential survival benefit with second-line treatment. Options for second-line systemic therapy include GEM-FU, FU-combo, GEM-P if not given in the first-line setting. Targeted therapy with erlotinib or bevacizumab could be considered in addition to chemotherapy.

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“…Patients with unresectable cholangiocarcinoma undergoing chemotherapy alone (cisplatingemcitabine combination) in one study achieved a median overall survival of 11.7 months and a median progression free survival of 8 months [5,6]. External beam radiation alone has been studied as a palliative measure for biliary decompression has shown modest survival benefit at 1 and 2 years (36% and 5.2 %) versus no therapy (19% and 4.7%) [7]. The data for a combination of chemotherapy and radiation has shown mixed results thus far and is another potential area which could be further studied [8].…”

Section: Discussionmentioning

confidence: 99%