Propensity Score Analysis of Second-Line Chemotherapy Outcome in Advanced Biliary Tract Cancer

Area of Science:

• Oncology
• Medical Oncology
• Gastroenterology

Background:

• Advanced biliary tract cancer (BTC) has limited treatment options after first-line therapy failure.
• Evidence on second-line chemotherapy efficacy, especially in Thai populations, is scarce.
• Established second-line treatments include chemotherapy and targeted therapies.

Purpose of the Study:

• To evaluate the efficacy of second-line chemotherapy in advanced BTC patients.
• To compare overall survival (OS) and restricted mean survival time (RMST) between second-line chemotherapy and best supportive care (BSC).

Main Methods:

• Retrospective, single-institution study of advanced BTC patients (Jan 2017-Dec 2019).
• Patients received either second-line chemotherapy plus BSC (2LCMT + BSC) or BSC alone.
• Propensity score matching using inverse probability of treatment weighting (IPTW) was applied.

Main Results:

• 110 patients included: 69 in 2LCMT + BSC group, 41 in BSC alone group.
• Median OS was 5.3 months (2LCMT + BSC) vs. 1.0 month (BSC alone).
• IPTW-adjusted analysis showed a 53% reduced risk of death with 2LCMT + BSC (p=0.009).

Conclusions:

• Second-line chemotherapy offers a significant OS benefit for advanced BTC patients.
• RMST analysis confirmed prolonged survival with second-line chemotherapy.
• Findings support second-line chemotherapy as a valuable treatment option for advanced BTC.