Open Access Research article

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

Frédéric Fiteni12, Marine Jary1, Franck Monnien3, Thierry Nguyen1, Eric Beohou2, Martin Demarchi14, Erion Dobi13, Francine Fein5, Denis Cleau6, Serge Fratté4, Virginie Nerich78, Franck Bonnetain28, Xavier Pivot13, Christophe Borg139 and Stefano Kim149*

Author Affiliations

1 Department of Medical Oncology, Jean Minjoz University Teaching Hospital, 3 Boulevard Alexander Fleming, Besançon F-25030, France

2 University Hospital of Besançon, Methodology and quality of life in oncology unit, Besançon, France

3 INSERM, Unit 1098, University of Franche-Comté, Besançon, Besançon, France

4 Hospital of Belfort-Montbeliard, Department of Medical Oncology, Montbeliard, France

5 Department of 344 Gastroenterology, University Hospital of Besançon, Besançon, France

6 Hospital of Vesoul, Department of Gastroenterology, Vesoul, France

7 University Hospital of Besançon, Department of Pharmacy, Besançon, France

8 EA 3181 University of Franche-Comté, Besançon, France

9 Clinical Investigational Center, CIC-1431, University Hospital of Besançon, Besançon, France

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BMC Gastroenterology 2014, 14:143  doi:10.1186/1471-230X-14-143

Published: 13 August 2014

Abstract

Background

Gemcitabine/Cisplatin (Gem/CDDP) combination has demonstrated a clear survival advantage over gemcitabine alone and has become a new standard in advanced Biliary Tract Carcinoma (aBTC). However, Gemcitabine/Oxaliplatin (GEMOX) combination and Gemcitabine/Carboplatin (Gem/Carb) combination regimens have 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. We also 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/m2 and oxaliplatin 100 mg/m2 Day 1, every 2 weeks), and 20 patients received Gem/Carb regimen (gemcitabine at 1000 mg/m2 Days 1 and 8 with carboplatin delivered according to an area-under-the-curve (AUC) 5 at day 1, every 3 weeks). At second 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 median overall survival (OS) was 10.5 months (95%CI, 6.4 to14.7). The main toxicity was peripheral neuropathy (20% grade 2 and 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). The main 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 OS was 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 standard Gem/CDDP regimen, in particular in unfit patients for CDDP.

At second-line, selective patients may benefit from fluoropyrimidine-based chemotherapy.