Fluropyrimidine single agent or doublet chemotherapy as second line treatment in advanced biliary tract cancer

Cindy Neuzillet (1, 2) , Andrea Casadei‐gardini (3) , Bertrand Brieau (4) , Caterina Vivaldi (5) , Giovanni Brandi (6) , David Tougeron (7) , Roberto Filippi (8) , Angélique Vienot (9) , Nicola Silvestris (10) , Anne‐laure Pointet (11) , Sara Lonardi (12) , Benoît Rousseau (13) , Mario Scartozzi (14) , Laetitia Dahan (15) , Giuseppe Aprile (16) , Samuel Le Sourd (17) , Ludovic Evesque (18) , Aurélia Meurisse (9) , Astrid Lièvre (19) , Dewi Vernerey (9)

1 Institut Curie [Paris]
2 UVSQ Santé - Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil
3 UNIMORE - Università degli Studi di Modena e Reggio Emilia = University of Modena and Reggio Emilia
4 Hôpital Cochin [AP-HP]
5 University of Pisa - Università di Pisa
6 Policlinico S. Orsola-malpighi
7 CHU Poitiers - Centre hospitalier universitaire de Poitiers
8 UNITO - Università degli studi di Torino = University of Turin
9 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
10 UNIBA - Università degli studi di Bari Aldo Moro = University of Bari Aldo Moro
11 HEGP - Hôpital Européen Georges Pompidou [APHP]
12 IRCCS - Istituti di Ricovero e Cura a Carattere Scientifico
13 CHU Henri Mondor [Créteil]
14 UniCa - Università degli Studi di Cagliari = University of Cagliari
15 TIMONE - Hôpital de la Timone [CHU - APHM]
16 Università degli Studi di Udine - University of Udine [Italie]
17 CRLCC - CRLCC Eugène Marquis
18 UNICANCER/CAL - Centre de Lutte contre le Cancer Antoine Lacassagne [Nice]
19 COSS - Chemistry, Oncogenesis, Stress and Signaling

Fluoropyrimidine (FP) plus platinum chemotherapy has been recently established as a second-line (L2) preferred option in advanced biliary tract cancer (aBTC) (ABC-06 phase III trial). However, the overall survival (OS) benefit was limited and comparison with FP monotherapy was not available. Our aim was to assess the OS of patients treated with a FP monotherapy compared to a doublet with irinotecan or platinum in L2. We performed a retrospective analysis of two large multicenter prospective cohorts: a French cohort (28 centers) and an Italian cohort (9 centers). All consecutive patients with aBTC receiving FP-based L2 after gemcitabine plus cisplatin/gemcitabine plus oxaliplatin L1 between 2003 and 2016 were included. A subgroup analysis according to performance status (PS) and an exploratory analysis according to platinum sensitivity in L1 were planned. In the French cohort (n = 351), no significant OS difference was observed between the FP monotherapy and doublet groups (median OS: 5.6 vs 6.8 months, P = .65). Stratification on Eastern Cooperative Oncology Group (ECOG) PS showed similar results in PS 0-1 and 2. Median OS was not different between FP monotherapy, platinum- and irinotecan-based doublets (5.6 vs 7.1 vs 6.7 months, P = .68). Similar findings were observed in the Italian cohort (n = 174) and in the sensitivity analysis in pooled cohorts (n = 525). No L2 regimen seemed superior over others in the platinum resistant/refractory or sensitive subgroups. Our results suggest that FP monotherapy is as active as FP doublets in aBTC in L2, regardless of the patient PS and country, and could be a therapeutic option in this setting.

Keywords: cholangiocarcinoma; combination chemotherapy; monotherapy; overall survival; palliative chemotherapy

Domains: Life Sciences [q-bio]; Cancer

Cindy Neuzillet, Andrea Casadei‐gardini, Bertrand Brieau, Caterina Vivaldi, Giovanni Brandi, et al.. Fluropyrimidine single agent or doublet chemotherapy as second line treatment in advanced biliary tract cancer. International Journal of Cancer, 2020, 147 (11), pp.3177-3188. ⟨10.1002/ijc.33146⟩. ⟨hal-02929354⟩