Multivariate prognostic factors analysis for second-line chemotherapy in advanced biliary tract cancer

L Fornaro, S Cereda, G Aprile, S Di Girolamo, D Santini, N Silvestris, S Lonardi, F Leone, M Milella, C Vivaldi, C Belli, F Bergamo, S E Lutrino, R Filippi, M Russano, V Vaccaro, A E Brunetti, V Rotella, A Falcone, M A Barbera, J Corbelli, G Fasola, M Aglietta, V Zagonel, M Reni, E Vasile, G Brandi, L Fornaro, S Cereda, G Aprile, S Di Girolamo, D Santini, N Silvestris, S Lonardi, F Leone, M Milella, C Vivaldi, C Belli, F Bergamo, S E Lutrino, R Filippi, M Russano, V Vaccaro, A E Brunetti, V Rotella, A Falcone, M A Barbera, J Corbelli, G Fasola, M Aglietta, V Zagonel, M Reni, E Vasile, G Brandi

Abstract

Background: The role of second-line chemotherapy (CT) is not established in advanced biliary tract cancer (aBTC). We investigated the outcome of aBTC patients treated with second-line CT and devised a prognostic model.

Methods: Baseline clinical and laboratory data of 300 consecutive aBTC patients were collected and association with overall survival (OS) was investigated by multivariable Cox models.

Results: The following parameters resulted independently associated with longer OS: Eastern Cooperative Oncology Group performance status of 0 (P<0.001; hazard ratio (HR), 0.348; 95% confidence interval (CI) 0.215-0.562), CA19.9 lower than median (P=0.013; HR, 0.574; 95% CI 0.370-0.891), progression-free survival after first-line CT ≥ 6 months (P=0.027; HR, 0.633; 95% CI 0.422-0.949) and previous surgery on primary tumour (P=0.027; HR, 0.609; 95% CI 0.392-0.945). We grouped the 249 patients with complete data available into three categories according to the number of fulfilled risk factors: median OS times for good-risk (zero to one factors), intermediate-risk (two factors) and poor-risk (three to four factors) groups were 13.1, 6.6 and 3.7 months, respectively (P<0.001).

Conclusions: Easily available clinical and laboratory factors predict prognosis of aBTC patients undergoing second-line CT. This model allows individual patient-risk stratification and may help in treatment decision and trial design.

Figures

Figure 1
Figure 1
Survival curves for all patients (A) and according to the risk groups identified at multivariate analysis (B). Abbreviations: N=number; OS=overall survival.

References

    1. André T, Tournigand C, Rosmorduc O, Provent S, Maindrault-Goebel F, Avenin D, Selle F, Paye F, Hannoun L, Houry S, Gayet B, Lotz JP, de Gramont A, Louvet C, GERCOR Group Gemcitabine combined with oxaliplatin (GEMOX) in advanced biliary tract adenocarcinoma: a GERCOR study. Ann Oncol. 2004;15 (9:1339–1343.
    1. Bridgewater J, Palmer D, Cunningham D, Iveson T, Gillmore R, Waters J, Harrison M, Wasan H, Corrie P, Valle J. Outcome of second-line chemotherapy for biliary tract cancer. Eur J Cancer. 2013;49 (6:1511.
    1. Cereda S, Belli C, Rognone A, Mazza E, Reni M. Second-line therapy in advanced biliary tract cancer: what should be the standard. Crit Rev Oncol Hematol. 2013;88 (2:368–374.
    1. Charbel H, Al-Kawas FH. Cholangiocarcinoma: epidemiology, risk factors, pathogenesis, and diagnosis. Curr Gastroenterol Rep. 2011;13 (2:182–187.
    1. de Groen PC, Gores GJ, LaRusso NF, Gunderson LL, Nagorney DM. Biliary tract cancers. N Engl J Med. 1999;341 (18:1368–1378.
    1. Furuse J, Kasuga A, Takasu A, Kitamura H, Nagashima F. Role of chemotherapy in treatments for biliary tract cancer. J Hepatobiliary Pancreatic Sci. 2012;19 (4:337–341.
    1. Glimelius B, Hoffman K, Sjödén PO, Jacobsson G, Sellström H, Enander LK, Linné T, Svensson C. Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol. 1996;7 (6:593–600.
    1. Lee SC, Kim K, Kim H, Kim HJ, Kim SH, Bae SB, Kim CK, Lee N, Lee KT, Park SK, Won JH, Yun J, Hong DS, Park HS.2012Prognostic factor analysis of second-line chemotherapy in advanced biliary tract cancer J Clin Oncol 30abstr e14688.
    1. Marino D, Leone F, Cavalloni G, Cagnazzo C, Aglietta M. Biliary tract carcinomas: from chemotherapy to targeted therapy. Crit Rev Oncol Hematol. 2013;85 (2:136–148.
    1. Okusaka T, Nakachi K, Fukutomi A, Mizuno N, Ohkawa S, Funakoshi A, Nagino M, Kondo S, Nagaoka S, Funai J, Koshiji M, Nambu Y, Furuse J, Miyazaki M, Nimura Y. Gemcitabine alone or in combination with cisplatin in patients with biliary tract cancer: a comparative multicenter study in Japan. Br J Cancer. 2010;103 (4:469–474.
    1. Park I, Lee JL, Ryu MH, Kim TW, Sook Lee S, Hyun Park D, Soo Lee S, Wan Seo D, Koo Lee S, Kim MH. Prognostic factors and predictive model in patients with advanced biliary tract adenocarcinoma receiving first-line palliative chemotherapy. Cancer. 2009;115 (18:4148–4155.
    1. Sharma A, Dwary AD, Mohanti BK, Deo SV, Pal S, Sreenivas V, Raina V, Shukla NK, Thulkar S, Garg P, Chaudhary SP. Best supportive care compared with chemotherapy for unresectable gall bladder cancer: a randomized controlled study. J Clin Oncol. 2010;28 (30:4581–4586.
    1. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG. New guidelines to evaluate the response to treatement in solid tumors. EORTC, NCI USA, NCI Canada. J Natl Cancer Inst. 2000;92 (3:205–216.
    1. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, Madhusudan S, Iveson T, Hughes S, Pereira SP, Roughton M, Bridgewater J, ABC-02 Trial Investigators Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362 (14:1273–1281.
    1. Walter T, Horgan AM, McNamara M, McKeever L, Min T, Hedley D, Serra S, Krzyzanowska MK, Chen E, Mackay H, Feld R, Moore M, Knox JJ. Feasibility and benefits of second-line chemotherapy in advanced biliary tract cancer: a large retrospective study. Eur J Cancer. 2013;49 (2:329–335.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere