119P - Management of biliary tract cancers in older patients: A French multicenter cohort study

Background

Biliary tract cancers (BTC) including cholangiocarcinomas (CCA) and gallbladder cancer (GBC) are uncommon tumors with poor prognosis, often diagnosed after age of 70, where comorbidities and altered performance status (PS) are more frequent. We aimed to compare clinical characteristics, molecular profile, and outcomes of patients (pts) with BTC < and ≥ 70 years old.

Methods

A retrospective chart review was performed in treated BTC pts in 16 French centers from 2003 to 2021. Data on demographics, therapeutic management, molecular profile, progression-free survival (PFS) and overall survival (OS) were collected.

Results

Overall, 1256 pts with BTC were included (male, 52%; median age, 64.5 years), including 384 pts (31%) over 70. Older pts had poorer PS (PS ≥2, 17% vs 8%; p<0.0001) and more comorbidities (≥1 comorbidity, 89% vs. 78%; p<0.0001). They were diagnosed more frequently with extrahepatic CCA and GBC (respectively, 18% vs.12% and 16% vs. 13%, p=0.0073) and less advanced disease stage at diagnosis (bilobar liver involvement, 29% vs 37%; p=0.008). They were offered less frequently first-line systemic therapy (87% vs 97%, p<0.0001)(gemcitabine 3% vs 0.3%; gemcis 31% vs 35%; gemox 54% in 2 groups; p=0.007) and molecular profiling (43% vs 65%, p<0.0001) than pts <70. Proportions of actionable alterations were significantly different, with more HER2 amplifications and less IDH1 mutations and FGFR2 fusions in older patients (p=0.0419). MSI status were similar between groups. OS after resection was similar in older and younger pts (median OS, 47.0 months (mo) [95%CI: 37.8-71.9] vs 48.8 mo [95%CI 41.4-57.3]), but shorter in older pts at advanced stage (14.6 [95%CI 12.7-16.5] vs. 17.4 mo [95%CI 16.1-18.9), p<0.0001). First-line PFS did not differ (median, 6.6 mo [95%CI 5.5-7.2] vs 5.8 mo [95%CI, 5.3-6.2), p=0.61).

Conclusions

Older BTC pts presented more frequently eCCA and GBC and a less advanced disease at diagnosis. At advanced stages, older pts had poorer OS and received less often first-line chemotherapy. If treated, PFS of older pts was similar to younger pts. Molecular profiling was less often performed in older pts.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.