Advanced biliary tract carcinomas: a retrospective multicenter analysis of first and second-line chemotherapy.

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Fiteni, Frédéric | Jary, Marine | Monnien, Franck | Nguyen, Thierry | Beohou, Eric | Demarchi, Martin | Dobi, Erion | Fein, Francine | Cleau, Denis | Fratté, Serge | Nerich, Virginie | Bonnetain, Franck | Pivot, Xavier | Borg, Christophe | Kim, Stefano

Edité par CCSD ; BioMed Central -

International audience. Background:Gemcitabine/Cisplatin (Gem/CDDP) combination has demonstrated a clear survival advantage overgemcitabine alone and has become a new standard in advanced Biliary Tract Carcinoma (aBTC). However,Gemcitabine/Oxaliplatin (GEMOX) combination and Gemcitabine/Carboplatin (Gem/Carb) combination regimenshave shown efficacy in phase II trials and there is no comparative study between different platinum salts.We assessed the efficacy and safety of different platinum-based chemotherapies at first line in aBTC patients. Wealso analysed the second-line chemotherapy.Methods:Sixty-four consecutive patients with aBTC diagnosed between 1998 and 2010 were included for analysis.At first line chemotherapy, 44 patients received one day GEMOX regimen (gemcitabine 1000 mg/m2and oxaliplatin100 mg/m2Day 1, every 2 weeks), and 20 patients received Gem/Carb regimen (gemcitabine at 1000 mg/m2Days1 and 8 with carboplatin delivered according to an area-under-the-curve (AUC) 5 at day 1, every 3 weeks). Atsecond line, a total of 16 patients received a fluoropyrimidine-based chemotherapy.Results:With GEMOX regimen, median progression-free survival (PFS) was 3.7 months (95%CI, 2.4 to 5) and medianoverall survival (OS) was 10.5 months (95%CI, 6.4 to14.7). The main toxicity was peripheral neuropathy (20% grade 2and 7% grade 3). Grade 3/4 haematological toxicities were rare.With Gem/Carb regimen, PFS was 2.5 months (95%CI, 2.1 to 3.7) and OS was 4.8 months (95%CI, 3.7 to 5.8). Themain grade 3/4 toxicities were haematological: anaemia (45%), thrombocytopenia (45%), and neutropenia (40%).At second-line, fluoropyrimidine-based chemotherapy was feasible in only a fourth of the patients. The median OSwas 5.3 months (95%CI, 4.1 to 6.6), and median PFS was 4.0 months (95%CI, 2.6 to 5.5).Conclusions:One day GEMOX regimen has a favourable toxicity profile and could be an alternative to standardGem/CDDP regimen, in particular in unfit patients for CDDP.At second-line, selective patients may benefit from fluoropyrimidine-based chemotherapy.

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