Outcomes in patients receiving palliative chemotherapy for advanced biliary tract cancer

Purpose To evaluate the effects of palliative chemotherapy with gemcitabine plus capecitabine (GemCap) on patient-reported outcomes measured using clinical benefit response (CBR) and quality-of-life (QOL) measures in patients with advanced biliary tract cancer. Patients and Methods Patients had to manifest symptoms of advanced biliary tract cancer and have at least one of the following: impaired Karnofsky performance score (60 to 80), average analgesic consumption ≥ 10 mg of morphine equivalents per day, and average pain intensity score of ≥ 20 mm out of 100 mm. Treatment consisted of oral capecitabine 650 mg/m2 twice daily on days 1 through 14 plus gemcitabine 1,000 mg/m2 as a 30-minute infusion on days 1 and 8 every 3 weeks until progression. The primary end point was the number of patients categorized as having a CBR or stable CBR (SCBR) during the first three treatment cycles. Results Forty-four patients were enrolled (bile duct cancer, n = 36; gallbladder cancers, n = 8). The main grade 3 or 4 adverse events included hematologic toxicity and fatigue. After three cycles, 36% of patients achieved a CBR, and 34% achieved an SCBR. Over the full course of treatment, 57% of patients achieved a CBR, and 18% achieved an SCBR. Improved QOL was observed in patients with a CBR or SCBR. The objective response rate was 25%. Median time to progression and overall survival times were 7.2 months and 13.2 months, respectively. Conclusion Chemotherapy with GemCap is well tolerated and effective and leads to a high CBR rate. Patient-reported outcomes are useful for evaluating the effects of palliative chemotherapy in patients with biliary tract cancer.

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The impact of age and comorbidity in advanced or recurrent biliary tract cancer receiving palliative chemotherapy

Journal of Gastroenterology and Hepatology ◽

10.1111/jgh.15066 ◽

2020 ◽

Vol 35 (10) ◽

pp. 1828-1835

Author(s):

Naminatsu Takahara ◽

Yousuke Nakai ◽

Kei Saito ◽

Takashi Sasaki ◽

Yukari Suzuki ◽

...

Keyword(s):

Biliary Tract ◽

Biliary Tract Cancer ◽

Palliative Chemotherapy ◽

Tract Cancer ◽

The Impact

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Long-term responders to palliative chemotherapy for advanced biliary tract cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.391 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 391-391 ◽

Cited By ~ 1

Author(s):

Mark Doherty ◽

Mairead G McNamara ◽

Priya Aneja ◽

Anne M. Horgan ◽

Raymond Woo-Jun Jang ◽

...

Keyword(s):

Biliary Tract ◽

Biliary Tract Cancer ◽

Palliative Chemotherapy ◽

Progression Free Survival ◽

Analysis Data ◽

First Line ◽

Tract Cancer ◽

Tumour Shrinkage ◽

Third Line

391 Background: Standard palliative chemotherapy (PC) in patients (pts) with Advanced Biliary Tract Cancer (ABTC) since publication of ABC-02 study in 2010 is cisplatin/gemcitabine (cis/gem), with median overall survival (OS) of 11.7 months. Prior to this, institutional standard was gemcitabine/fluoropyrimidine combination. From the ABC-02 study, 8 cycles of PC is standard. Some pts benefit from continuing PC longer than 8 cycles. Methods: Pts treated for ABTC in Princess Margaret Cancer Centre between 06/1987 and 09/2015, receiving > 8 cycles of PC were included for analysis. Data was collected on demographics, clinicopathologic features, PC regimen, toxicities, and survival. Results: Of 553 pts who received PC, 119 pts met inclusion criteria of PC > 8 cycles. Median age was 60 (range 27-80). Site of tumour was ampullary in 11, distal bile duct in 14, gallbladder in 28, intrahepatic in 37, perihilar in 26, and unspecified in 3 pts. 61 (51%) required biliary stenting. 30 (25%) had definitive surgical resection at diagnosis, while 89 (75%) presented with ABTC. First-line PC regimens were cis/gem in 44 and gemcitabine/capecitabine in 62. Other regimens included gemcitabine and 5-fluorouracil alone or combined. Median time on first line PC was 10 months, with median of 12 cycles (range 9-47). 22 pts (19%) had treatment breaks > 8 weeks then restarted same PC. Any tumour shrinkage was seen in 73 pts (61%). The majority of pts discontinued PC due to disease progression (69), however 16 stopped due to toxicity such as thrombocytopenia, neutropenia, fatigue and neuropathy. At time of analysis, 103 pts had progressive disease, with median progression free survival of 11.8 months. 51 and 21 pts received second and third line chemotherapy, respectively. 27 pts are alive; median OS for the whole group was 22 months (95%CI 18.7-27.3 months). Conclusions: A cohort of ABTC pts continued to derive benefit from chemotherapy beyond 8 cycles, with median OS considerably greater than that seen in clinical trials. Toxicities were mostly manageable, with treatment breaks from PC for relief of side-effects observed. Further exploration of factors prognostic and predictive for continued benefit from PC will be explored and updated at presentation.

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Soluble programmed death-ligand 1 (sPDL1) and neutrophil-to-lymphocyte ratio (NLR) predicts survival in advanced biliary tract cancer patients treated with palliative chemotherapy

Oncotarget ◽

10.18632/oncotarget.12810 ◽

2016 ◽

Vol 7 (47) ◽

pp. 76604-76612 ◽

Cited By ~ 35

Author(s):

Hyerim Ha ◽

Ah-Rong Nam ◽

Ju-Hee Bang ◽

Ji-Eun Park ◽

Tae-Yong Kim ◽

...

Keyword(s):

Cancer Patients ◽

Biliary Tract ◽

Biliary Tract Cancer ◽

Palliative Chemotherapy ◽

Neutrophil To Lymphocyte Ratio ◽

Programmed Death Ligand 1 ◽

Lymphocyte Ratio ◽

Tract Cancer ◽

Programmed Death

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Usefulness of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and their dynamic changes during chemotherapy to predict prognosis of advanced biliary tract cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.416 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 416-416

Author(s):

Kyoung Min Cho ◽

Hyunkyung Park ◽

Do-Youn Oh ◽

Tae Yong Kim ◽

Kyung-Hun Lee ◽

...

Keyword(s):

Biliary Tract ◽

Systemic Inflammation ◽

Biliary Tract Cancer ◽

Palliative Chemotherapy ◽

Dynamic Change ◽

Neutrophil To Lymphocyte Ratio ◽

Platelet To Lymphocyte Ratio ◽

Primary Tumor Site ◽

Lymphocyte Ratio ◽

Tract Cancer

416 Background: Systemic inflammation is known to promote carcinogenesis in biliary tract cancer (BTC). Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are indicative of systemic inflammation. We evaluated the clinical significance of systemic inflammation measured by NLR and PLR in patients with advanced BTC. Additionally, we also co-analyzed the dynamics of NLR and PLR during chemotherapy. Methods: We reviewed 554 patients with advanced BTC receiving palliative chemotherapy. NLR and PLR were obtained before initiation of palliative chemotherapy. Changes in NLR, PLR were obtained by subtracting the initial value from the value obtained after progression of chemotherapy. Results: Higher systemic inflammation status also had relation with a primary tumor site ( p = 0.044) and higher levels of CEA ( p = 0.041). The ROC cut-off values of NLR and PLR for predicting overall survival (OS) were 3.8 and 121, respectively. Patients with a high NLR or PLR had worse OS independently in multivariate analysis (7.10 vs. 10.23 months, p < 0.001; 8.43 vs. 11.87 months, p = 0.001, respectively). High NLR with increased NLR after chemotherapy is associated with worse OS and progression-free survival (PFS) ( p = 0.014, p= 0.020 respectively). Results are similar for PLR. Conclusions: Systemic inflammation represented by NLR and PLR, predicts the OS of patients with advanced BTC who are receiving palliative chemotherapy. In addition, considering NLR/PLR with a dynamic change of NLR/PLR during chemotherapy might help to predict a more accurate prognosis.

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Skeletal muscle depletion to predict survival of patients with advanced biliary tract cancer undergoing palliative chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.460 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 460-460

Author(s):

Kyoung Min Cho ◽

Do-Youn Oh ◽

Tae Yong Kim ◽

Kyung-Hun Lee ◽

Sae-Won Han ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Weight ◽

Prognostic Factors ◽

Prognostic Factor ◽

Biliary Tract ◽

Biliary Tract Cancer ◽

Palliative Chemotherapy ◽

Cross Sectional ◽

Skeletal Muscle Index ◽

Tract Cancer

460 Background: Reports regarding sarcopenia as a prognostic factor in advanced biliary tract cancer (BTC) are rare. Furthermore, no study has investigated the dynamics of body weight with body muscle mass as a prognostic factor in advanced BTC patients undergoing palliative chemotherapy. Hence, we investigated whether sarcopenia affects survival in patients with BTC, with a co-analysis of body weight loss and body mass index (BMI). Methods: We consecutively enrolled patients with advanced BTC who received palliative chemotherapy between 2003 and 2013. Total muscle cross-sectional area (cm2) at the L3 level assessed by computed tomography was analyzed. We defined sarcopenia as a skeletal muscle index (SMI) < 48.5 cm2/m2 (men) and < 39.5 cm2/m2(women) using ROC curves. Results: The proportion of patients with sarcopenia upon diagnosis was 52.4% and 42.2% for men and women, respectively. By multivariate analysis, sarcopenia at diagnosis and decreased SMI during chemotherapy ( P = 0.008 and P < 0.001, respectively) were poor prognostic factors for overall survival (OS). Subgroup analysis revealed that sarcopenic patients who were overweight or obese (BMI ≥ 25 kg/m2) showed worse OS ( P < 0.001). Additionally, patients with both decreased BMI and SMI during chemotherapy had worse OS ( P < 0.001). Furthermore, patients with decreased SMI had shorter survival regardless of change in BMI. However, for patients with SMI maintained during chemotherapy, decreased BMI had no effect on survival ( P = 0.576). Conclusions: Sarcopenia, sarcopenic obesity and muscle depletion during palliative chemotherapy are meaningful prognostic factors in advanced BTC. Considering muscle depletion with weight change could help to more accurately predict prognosis of patients with BTC.

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