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Updated: Jan 7, 2026
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FOLFOX Versus FOLFIRI as Second-Line Chemotherapy in Patients With Advanced Biliary Tract Cancers: A Multicenter,
Chiara Pircher1, Federico Nichetti2, Mario Domenico Rizzato2
1Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
Summary
FOLFOX (folinic acid, 5-fluorouracil, oxaliplatin) and FOLFIRI (folinic acid, 5-fluorouracil, irinotecan) demonstrated similar efficacy as second-line treatments for biliary tract cancer. Platinum-sensitive patients showed improved outcomes regardless of the regimen used.
Area of Science:
- Oncology
- Gastroenterology
- Medical Research
Background:
- FOLFOX is a standard second-line treatment for biliary tract cancer (BTC).
- FOLFIRI is an alternative combination, particularly for platinum-refractory patients.
- A direct real-world comparison between FOLFOX and FOLFIRI in BTC is lacking.
Purpose of the Study:
- To compare the efficacy of FOLFOX versus FOLFIRI as second-line therapy in advanced BTC.
- To evaluate overall survival (OS) and progression-free survival (PFS) in BTC patients.
- To identify prognostic factors influencing treatment outcomes.
Main Methods:
- Retrospective multicenter analysis of advanced BTC patients.
- Comparison of second-line FOLFOX versus FOLFIRI after first-line cisplatin-gemcitabine.
- Inverse probability of treatment weighting (IPTW) to balance clinical differences.
- Analysis of prognostic factors including platinum sensitivity and BRCAness status.
Main Results:
- 259 patients included: 109 FOLFOX, 150 FOLFIRI.
- No significant difference in PFS (median 3.1 vs. 3.5 months) or OS (median 9.9 vs. 9.0 months) between FOLFOX and FOLFIRI.
- IPTW-adjusted analysis confirmed comparable efficacy.
- Platinum sensitivity and BRCAness status were independent prognostic factors.
Conclusions:
- FOLFOX and FOLFIRI exhibit comparable modest efficacy as second-line treatments for BTC.
- Platinum-sensitive patients benefit from significantly longer PFS and OS.
- Treatment outcomes are independent of the specific second-line regimen (FOLFOX or FOLFIRI) in platinum-sensitive BTC patients.
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