Second-line chemo improves survival in advanced biliary tract, gallbladder cancers

Second-line chemotherapy may prolong the life of real-world patients with advanced biliary tract and gallbladder cancers and must therefore be provided to those who are potential candidates for chemotherapy, suggests a study.

“Limited evidence is available regarding the survival benefit of second-line therapy in real-world patients with advanced biliary tract and gallbladder cancer,” the investigators said. “Until very recently, there was a lack of randomized clinical trials to address this important question.”

To address this, a population-based retrospective cohort study was conducted among patients with biopsy-proven advanced biliary tract and gallbladder cancer who were diagnosed between 2006 and 2015 and had received first-line chemotherapy. The survival benefit of second-line therapy was determined through Cox proportional multivariate analysis.

A total of 136 patients (median age, 66 years) were identified, of whom 68 percent had metastatic disease. The primary tumour sites were intrahepatic cholangiocarcinoma (36 percent), gallbladder (31 percent), extrahepatic bile duct (23 percent), and ampullary cancer (10 percent).

Thirty-seven percent of patients received second-line therapy. The treatment group had a median overall survival of 17 months (95 percent confidence interval [CI], 12.5–21.5) compared with 7 months (95 percent CI, 5.3–8.7) in the control group (p<0.0001). Patients on combination chemotherapy had a longer median overall survival (20 months, 95 percent CI, 14.0–26.1) than those who received a single-agent second-line therapy (17 months, 95 percent CI, 14.0–26.1; p=0.73).

In multivariate analysis, second-line therapy (hazard ratio [HR], 0.55, 95 percent CI, 0.36–0.83) and neutrophil to lymphocyte ratio >2 (HR, 1.10, 95 percent CI, 1.05–1.15) were significantly associated with survival.