Outcome of patients receiving chemotherapy for advanced biliary tract or gallbladder cancer

Abstract

15627 Background: Patients with cholangiocarcinoma or gallbladder cancer have poor overall prognosis, and their management is often complex. There is currently no standard chemotherapy for this disease, but several single agents and combinations have shown promising activity. Patients and Method: We conducted a retrospective analysis of all cases of biliary tract of gallbladder cancer treated at 2 academic centres in Lyon, France: 127 cases were identified, 67 underwent primary surgery, 13 of whom were dimmed unresectable upon surgical exploration and were treated medically, 60 patients received medical treatment only. Overall 76 patients received chemotherapy for locally advanced or metastatic disease and are the subject of this report. Results: 43 patients received upfront chemotherapy for unresectable disease, 15 received chemotherapy for disease recurrence within 3 months of surgery and 18 for disease recurrence more than 3 months after surgery. Among the patients receiving chemotherapy for recurrence, 4 had previously received adjuvant chemotherapy. 38 patients received gemcitabine-oxaliplatin (GEMOX) combination, 26 patients received single agent gemcitabine (GEM) and 11 patients received 5FU based regimens, one patient received gemcitabine-cisplatin combination and was analysed with patients receiving GEMOX (=>n=39). Median progression-free survival was 4.1 (95%CI: 2.9–5.3) months for the whole cohort (n=76), 4.9 (95%CI: 2.9–6.9) months for patients receiving GEMOX, 4.2 (95%CI: 1.8–6.5) months for patients receiving GEM and 2.1 (95%CI: 0.8–3.4) months for patients receiving FU-plat ( p=.4341 for GEMOX vs GEM and p=.0004 for GEMOX or GEM vs FU-plat, 4.3 vs 21 months). Eleven patients (14%) interrupted their treatment for toxicity, in 6 cases for neurological toxicity of oxaliplatin (16% of patients receiving GEMOX). Median overall survival was 11.5 (95%CI: 7.9- 15.1) months for the whole cohort. Conclusion: Although retrospective, these data support the use of gemcitabine containing regimens in patients with advanced biliary tract or gallbladder cancer. The benefit of adding oxaliplatin in this setting remains unclear. No significant financial relationships to disclose.