Retrospective analysis of systemic chemotherapy for unresectable advanced biliary tract cancer

Abstract

4159 Background: Standard chemotherapy for biliary tract cancer (BTC) has not yet established. This study retrospectively examined the results of non-surgical treatments in patients with advanced BTC in order to clarify the relationship between treatment methods and prognosis following chemotherapy using historical controls. Methods: All patients receiving non-surgical treatments between April 2000 and March 2003 were examined in a multi-center review. The treatment methods, results and prognoses were analyzed. Survival from the start of the treatment was calculated by the Kaplan-Meier method. Results: Four hundred-twenty nine patients were recorded; 129 intrahepatic cholangiocarcinomas, 102 extrahepatic cholangiocarcinomas, 177 gall bladder cancers (GBC), and 22 ampulary papilla of Vater cancers. Systemic chemotherapy was administered to 211 (49.2%) patients, best supportive care to 143 (33.3%), radiotherapy or chemoradiotherapy to 62 (14.4%), hepatic arterial infusion chemotherapy to 11 (2.6%), and treatment was unknown in 2 (0.5%). Systemic chemotherapy regimens consisted of gemcitabine alone in 66 patients, CDDP-based in 47, 5FU-based in 34, FAM in 30, S-1 in 22, and other agents in 12. The overall response rate was 9.5% (20 partial responses), while the response rates of S-1 and FAM were both over 15%; S-1 was 18% and FAM 17%. The overall median survival time was 8.1 months, and the 1-year survival rate was 29.3%. There was no significant difference in survival among the regimens. Prognosis of GBC patients was significantly poorer than those with other BTCs. Conclusions: The response to chemotherapy and the prognosis of unresectable BTC patients were comparable to those of locally advanced or metastatic pancreatic cancer patients. A multi-center clinical trial is now on planning to optimize the use of BTC cancer resources in Japan. No significant financial relationships to disclose.