Real-world outcomes among patients with advanced or metastatic biliary tract cancers initiating second-line treatment.

Abstract

Limited data are available regarding second-line (2L) treatment for advanced or metastatic biliary tract cancers (BTC) in the US real-world setting. This study explores the rapidly evolving and growing treatment landscape in the 2L setting for advanced or metastatic BTC with a large cohort of patients treated in a community oncology setting. Adult patients with BTC initiating 2L treatment after a platinum-containing first-line between 1/1/10- and 6/30/19 were identified from the US Oncology Network electronic healthcare record database and followed through 12/31/19. Baseline patient and treatment characteristics were analyzed descriptively, including overall response rate (ORR) in the real-world clinical setting. Kaplan-Meier methods were used to measure duration of response, progression-free survival (PFS), and overall survival (OS). The overall population (N=160) included 74 patients (46.3%) with intrahepatic cholangiocarcinoma, 41 (25.6%) with extrahepatic cholangiocarcinoma, and 45 (28.1%) with gallbladder cancer. Thirty unique 2L regimens were recorded for the study population, with folinic acid, fluorouracil and oxaliplatin (FOLFOX, 34.4%) and capecitabine monotherapy (20.0%) being the most common. ORR was 7.5% (95% CI, 3.9%-12.7%). From 2L initiation, median PFS was 2.8months (95% CI, 2.4-3.3months), and median OS was 5.2months (95% CI, 4.2-6.7months). Results from this study provide real-world evidence that although patients treated in the community oncology setting receive a wide variety of 2L treatments, the regimens are consistent with those recommended by guidelines. Although responses are observed with 2L treatment, duration is brief and associated with poor OS in patients with advanced or metastatic disease.