Treatment of Metastatic Biliary Cancers With Irinotecan and 5-Fluorouracil Based Chemotherapy After Platinum/Gemcitabine Progression: A Systematic Review and Meta-Analysis

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2024-06-03 DOI:10.1016/j.clcc.2024.05.009

Ioannis A. Voutsadakis , Stefania Kokkali , Antonia Digklia

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引用次数: 0

Abstract

Background

Biliary tract carcinomas are cancers that, despite a lower prevalence compared with other gastrointestinal cancers, represent a significant public health burden due to their aggressiveness. The metastatic stage of the disease is highly lethal and difficult to treat. Options of systemic therapies, especially beyond the first line are few and less well established.

Methods

We performed a systematic review of literature databases to identify studies of the combination of irinotecan and 5-fluorouracil (5-FU) based chemotherapy as treatment of metastatic biliary tract carcinomas in second line, after first line treatment with platinum/gemcitabine chemotherapy. Both prospective and retrospective designs were admissible. A meta-analysis of identified studies to determine summary estimates for overall response rate (ORR), disease control rate (DCR), progression free survival (PFS) and overall survival (OS) was also performed.

Results

The search was performed in PubMed/Medline and in Embase databases and identified a total of 339 articles. Manual review resulted in 8 articles that were eligible for inclusion in the meta-analysis. Second line irinotecan/5-FU based combinations produced an ORR of 9.1% (95% CI, 5.5%-12.6%) and DCR of 43.3% (95% CI, 15.8%-70.8%). Summary PFS and OS were 2.7 months (95% CI, 2.3-3.1 months) and 6.8 months (95% CI, 5.6-8.0 months), respectively. Treatments appeared to be feasible with adverse effect profiles as expected from the combination.

Conclusion

A moderate activity of second line irinotecan/5-FU based chemotherapy was observed in this meta-analysis. The combination is an option for patients progressing on platinum/gemcitabine chemotherapy, who maintain a sufficient general status to receive active therapy. This combination may also serve as the control arm of second line trials with new targeted agents.

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铂类/吉西他滨治疗进展后使用伊立替康和5-氟尿嘧啶化疗治疗转移性胆道癌：系统回顾和荟萃分析

背景胆道癌是一种癌症，尽管与其他胃肠道癌症相比发病率较低，但由于其侵袭性强，对公共卫生造成了重大负担。这种疾病的转移阶段极具致命性，而且难以治疗。我们对文献数据库进行了系统性回顾，以确定在一线铂/吉西他滨化疗后，二线联合伊立替康和5-氟尿嘧啶（5-FU）化疗治疗转移性胆道癌的研究。前瞻性和回顾性设计均可。还对已确定的研究进行了荟萃分析，以确定总反应率（ORR）、疾病控制率（DCR）、无进展生存期（PFS）和总生存期（OS）的汇总估计值。人工审核后，有8篇文章符合纳入荟萃分析的条件。以伊立替康/5-FU为基础的二线联合治疗的ORR为9.1%（95% CI，5.5%-12.6%），DCR为43.3%（95% CI，15.8%-70.8%）。总的 PFS 和 OS 分别为 2.7 个月（95% CI，2.3-3.1 个月）和 6.8 个月（95% CI，5.6-8.0 个月）。结论在这项荟萃分析中观察到基于伊立替康/5-FU的二线化疗具有适度的活性。对于接受铂/吉西他滨化疗后病情仍有进展，但全身状况足以接受积极治疗的患者来说，这种联合疗法是一种选择。在使用新靶向药物进行二线治疗的试验中，该组合也可作为对照组。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.