Second-line systemic treatment for advanced cholangiocarcinoma

Area of Science:

• Oncology
• Gastroenterology

Background:

• Advanced cholangiocarcinoma (aCC) has a dismal 5-10% five-year survival rate.
• Gemcitabine plus platinum (GEM-P) is the standard first-line treatment, yielding an 8-month PFS and 11.7-month OS.
• Second-line treatment options for aCC remain less defined.

Purpose of the Study:

• To describe the outcomes of second-line systemic treatment for advanced cholangiocarcinoma (aCC) at a single institution.
• To evaluate progression-free survival (PFS) as the primary objective.
• To assess overall survival (OS) and disease control rate (DCR) as secondary objectives.

Main Methods:

• Retrospective chart review of aCC patients initiating second-line systemic treatment between 2009 and 2012.
• Classification of second-line regimens into four groups: GEM-P, gemcitabine + fluoropyrimidine (GEM-FU), other FU combination (FU-combo), and others.
• Analysis of PFS, OS, and DCR for each treatment group.

Main Results:

• Fifty-six patients with aCC were included, predominantly with intrahepatic disease.
• Second-line therapies included GEM-P (19.6%), GEM-FU (28.6%), FU-combo (37.5%), and others (14.3%).
• Median PFS was 2.7 months, median OS was 13.8 months, and DCR was 50%, with no significant survival differences between groups.

Conclusions:

• Second-line systemic therapy for aCC demonstrated a 2.7-month PFS and 50% DCR, indicating a potential survival benefit.
• Viable second-line options include GEM-FU, FU-combo, and GEM-P if not used first-line.
• Consideration of targeted therapies like erlotinib or bevacizumab in addition to chemotherapy is recommended.