Systemic therapy in younger and elderly patients with advanced biliary cancer: sub-analysis of ABC-02 and twelve other prospective trials.
View/ Open
Date
2017-04-12Author
McNamara, MG
Bridgewater, J
Lopes, A
Wasan, H
Malka, D
Jensen, LH
Okusaka, T
Knox, JJ
Wagner, D
Cunningham, D
Shannon, J
Goldstein, D
Moehler, M
Bekaii-Saab, T
Valle, JW
Type
Journal Article
Metadata
Show full item recordAbstract
Background Outcomes in younger (<40 years) and elderly (≥70 years) patients with advanced biliary cancer (ABC) receiving palliative chemotherapy are unclear. This study assessed outcomes in those receiving monotherapy or combination therapy in thirteen prospective systemic-therapy trials.Methods Multivariable analysis explored the impact of therapy on progression-free (PFS) and overall survival (OS) in two separate age cohort groups: <70 years and ≥70 years, and <40 years and ≥40 years.Results Overall, 1163 patients were recruited (Jan 1997-Dec 2013). Median age of entire cohort: 63 years (range 23-85); 36 (3%) were <40, 260 (22%); ≥70. Combination therapy was platinum-based in nine studies. Among patients <40 and ≥70 years, 23 (64%) and 182 (70%) received combination therapy, respectively. Median follow-up was 42 months (95%-CI 37-51). Median PFS for patients <40 and ≥40 years was 3.5 and 5.9 months (P = 0.12), and OS was 10.8 and 9.7 months, respectively (P = 0.55). Median PFS for those <70 and ≥70 years was 6.0 and 5.0 months (P = 0.53), and OS was 10.2 and 8.8 months, respectively (P = 0.08). For the entire cohort, PFS and OS were significantly better in those receiving combination therapy: Hazard Ratio [HR]-0.66, 95%-CI 0.58-0.76, P < 0.0001 and HR-0.72, 95%-CI 0.63-0.82, P < 0.0001, respectively; and in patients ≥70 years: HR-0.54 (95%-CI 0.38-0.77, P = 0.001) and HR-0.60 (95%-CI 0.43-0.85, P = 0.004), respectively. There was no evidence of interaction between age and treatment for PFS (P = 0.58, P = 0.66) or OS (P = 0.18, P = 0.75).Conclusions In ABC, younger patients are rare, and survival in elderly patients in receipt of systemic therapy for advanced disease, whether monotherapy or combination therapy, is similar to that of non-elderly patients, therefore age alone should not influence decisions regarding treatment.
Collections
Subject
Humans
Biliary Tract Neoplasms
Cisplatin
Carboplatin
Antineoplastic Combined Chemotherapy Protocols
Disease-Free Survival
Treatment Outcome
Survival Analysis
Prospective Studies
Adult
Aged
Aged, 80 and over
Middle Aged
Female
Male
Young Adult
Research team
Medicine (RMH Smith Cunningham)
Language
eng
Date accepted
2017-04-05
License start date
2017-04-12
Citation
BMC cancer, 2017, 17 (1), pp. 262 - ?