Abstract 57P
Background
While chemotherapy has recently been established as a standard second-line treatment in ABC, its role in the third-line setting is controversial. Indeed, only very sparse data exist in the literature on the topic. In this study, we aim at describing the pattern of care, survival outcome and prognostic factors of ABC patients (pts) receiving third-line chemotherapy in a real-world scenario.
Methods
Institutional registries across three academic medical centers were reviewed to identify ABC pts who had received third-line chemotherapy from September 2005 to January 2020. Pre-treatment demographics, clinicopathologic and biochemical variables of interest were retrieved. Kaplan-Meier estimators were used to calculate survival, while the log-rank test was implemented to make comparisons. The impact of variables on survival was assessed through univariate and multivariate analysis.
Results
Overall, 101 pts were included in the analysis. The median age was 64 years (range 35-84) and 58 (57.4%) were females. Overall, 68 (67.3%), 19 (18.8%) and 14 (13.8%) pts had intrahepatic and extrahepatic cholangiocarcinoma and gallbladder cancer, respectively. A total of 63 (62.3%) pts received monochemotherapy, while 38 (37.6%) were treated with a doublet. The median OS and PFS were 4.4 and 2.8 months, respectively. Disease control rate was achieved in 23 (22.7%) pts, with 2 (2%) partial responses. No difference in efficacy between different third-line regimens has been recorded (p=0.89). Grade 3-4 treatment-related adverse events were reported in 22 (21.7%) pts, more frequently represented by myelotoxicity, fatigue and mucositis. At multivariate analysis, ECOG PS (p<0.001), tumour burden (p=0.01) and lymphocyte-to-monocyte ratio (p=0.02) were independent predictors of survival.
Conclusions
Third-line chemotherapy displayed limited activity in this real-world cohort of ABC, although prognostic factors have been identified that may assist in treatment decision. The results of this multicenter experience, the largest so far, highlight the need for more effective therapies and provide a benchmark for future trials of third-line chemotherapy in ABC.
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.