Feasibility and benefits of second-line chemotherapy in advanced biliary tract cancer: A large retrospective study.

Abstract

e14524 Background: Chemotherapy is effective in advanced biliary tract cancer (ABTC). The benefits of second-line chemotherapy (CT2) are unclear. Methods: We retrospectively studied all patients starting at least one line of chemotherapy for ABTC at our institution between 1991 and 2011. We analyzed patient and chemotherapy characteristics in order to: 1) characterize patients eligible for CT2; 2) evaluate the efficacy of CT2. Results: Three hundred and ninety five, 100 (25%), and 25 (6%) patients received CT1, CT2, and CT3, respectively. Primary tumor location was the gallbladder (29%), intraphepatic (19%), perihilar (17%), distal common bile duct (19%), and ampulla of Vater (14%). Ninety-one percent had a baseline performance status (PS) of 0-1 prior to CT1. Females (p=0.005), age≤60 years (p=0.009), and patients with progression free survival (PFS) >6 months following CT1 (p=0.01) were more likely to be offered CT2. Objective response rates and stable disease with CT2 were 10% and 35%, respectively. Median PFS and median overall survival (OS) from the beginning of CT2 were 2.8 and 8.0 months, respectively. Prognostic factors impacting PFS with CT2 were the regimen type (doublet versus monotherapy, p=0.004) and PS<2 (p<0.0001). Conclusions: Among patients with ABTC, 25% received CT2, typically younger patients and those with longer PFS following CT1. Disease control occurred in 45% of patients, and more often with a doublet than single agent. However, clearly more effective therapies must be found.