Third-line treatment of biliary tract cancers in a real-life setting

Abstract

Background

Biliary tract cancers represent rare, aggressive malignancies of the bile duct epithelium. Only 20% cases are eligible for curative surgery because most cases are diagnosed at advanced stages, and prognosis is overall poor. The systemic treatment landscape has evolved, with gemcitabine cisplatin plus immunotherapy being now first-line standard. For second-line treatment, options include targeted therapies or chemotherapy for patients with or without specific actionable genetic alterations, respectively. However, no third-line treatment standard has been validated by randomized clinical trials.

Patients and methods

This retrospective analysis from a specialized French center aimed to assess patient outcomes receiving third-line chemotherapy, from 2012 to 2023.

Results

Overall, 256 patients receiving third-line treatment were included. Treatment distribution was as follows: FOLFIRI (n = 51, 20%), paclitaxel (n = 43, 17%), combinations of 5-FU cisplatin/FOLFOX (n = 32, 13%), molecularly targeted therapy (n = 65, 25%) and others (n = 63, 25%). In patients without actionable alterations, the median overall survival (OS) for patients receiving third-line treatment was 10.2 months. OS was 13 months with paclitaxel and 7 months with FOLFIRI (P = 0.03). The median progression-free survival for the third-line treatments was 3.3 months for paclitaxel and 2.6 months with FOLFIRI.

Conclusion

Paclitaxel seemed better than FOLFIRI as third-line treatment in patients without actionable alteration. This highlights the need for further research, especially in identifying prognostic factors and refining treatment strategies.