Abstract 313P
Background
Gemcitabine plus cisplatin (GC) was standard first-line treatment for advanced biliary tract cancers until recently, supported by the UK ABC-02 study. However, TOPAZ-1 showed survival improvement with Durvalumab plus GC. Nevertheless, a significant proportion of patients face challenges with GC tolerability, prompting into alternatives such as gemcitabine and carboplatin (GCb). Moreover, there remains a paucity of stratified data pertaining to cholangiocarcinomas (CCA). We analyzed 5-year trends to determine treatment rates and cisplatin use in the real world.
Methods
Multicenter study at four hospitals included unresectable/metastatic CCA patients diagnosed from 2018 to 2023, with follow-up until March 2024. Patient records were consulted.
Results
Were included 80 patients, 71.3% male, 28.7% female, median age 67 [40-86]. There were 28 Extrahepatic CCA (ehCCA) comprised 35%, intrahepatic (ihCCA) 60%, and 5% undefined. Metastatic disease was found in 54 patients (33.3% ehCCA, 66.7% ihCCA), mainly in the liver (66.7% overall). Was observed lymph node metastasis (24.1% overall, 33.3% ehCCA, 20% ihCCA), bone (13.0% overall, 5.6% ehCCA, 17.1% ihCCA), peritoneum (9.3% overall, 16.7% ehCCA, 5.7% ihCCA) and lung (9.3% overall, 5.6% ehCCA, 11.4% ihCCA). About 21.25% were ineligible for treatment due to ECOG PS ≥ 3. Concerning the treated (78.75%, n=63), 55.6% received GC, 11.1% GCb, 22.3% gemcitabine, and 11.1% other protocols. 4.5% had FOLFIRINOX for conversion, and 27.0% received GEM or CAP monotherapy due to ineligibility for platinum-based regimen. Twenty-six patients (41.3%) received 2nd ChT.
Conclusions
Observations revealed a distribution of 1/3 ehCCA and 2/3 ihCCA cases. Notably, ehCCA exhibited a higher prevalence of lymph node and peritoneal metastases, while ihCCA showed higher bone and lung metastases. 1/5 of patients were ineligible for treatment, with only half receiving GC. Due to the recent approval of durvalumab association, only 2 received immunotherapy; Among those initiated on treatment, there was an attrition rate of 40% between 1st to 2nd palliative treatment. This could limit access to immunotherapy combinations unless other ChT protocols prove beneficial. Moreover, the low percentage of patients receiving 2nd-line treatment emphasizes the importance of selecting the most effective initial treatment.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.