Chemotherapy and Targeted Therapy in Advanced Biliary Tract Carcinoma: A Pooled Analysis of Clinical Trials

• Published in: Chemotherapy (Basel) Vol. 60; no. 1; pp. 13 - 23
• Main Authors: Eckel, Florian, Schmid, Roland M.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2014; S. Karger AG
• Subjects: Antimetabolites, Antineoplastic - therapeutic use; Biliary Tract Neoplasms - drug therapy; Biliary Tract Neoplasms - mortality; Biliary Tract Neoplasms - pathology; Biological and medical sciences; Cancer; Carcinoma - drug therapy; Carcinoma - mortality; Carcinoma - pathology; Chemotherapy; Clinical Study; Databases, Factual; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; Disease Progression; Gallbladder; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Staging; Pharmacology. Drug treatments; Survival Rate; Systematic review; Treatment Outcome; Tumors; Molecular targeted therapy; Platinum compounds; Gemcitabine; Bile duct carcinoma; Systematic review; Cholangiocarcinoma; Biliary tract carcinoma; Gallbladder carcinoma; Antineoplastic agent; Biliary tract; Carcinoma; Targeted therapy; Hepatic disease; Review; Biliary tract disease; Platinum compound; Malignant cholangioma; Clinical trial; Advanced stage; Gallbladder; Pyrimidine nucleoside; Human; Malignant tumor; Treatment; Antimetabolic; Analysis; Pyrimidine derivatives; Digestive diseases; Fluorine Organic compounds; Cancer
• ISSN: 0009-3157; 1421-9794
• DOI: 10.1159/000365781

Background: In biliary tract cancer, gemcitabine platinum (GP) doublet palliative chemotherapy is the current standard treatment. The aim of this study was to analyze recent trials, even those small and nonrandomized, and identify superior new regimens. Methods: Trials published in English between January 2000 and January 2014 were analyzed, as well as ASCO abstracts from 2010 to 2013. Results: In total, 161 trials comprising 6,337 patients were analyzed. The pooled results of standard therapy GP (no fluoropyrimidine, F, or other drug) were as follows: the median response rate (RR), tumor control rate (TCR), time to tumor progression (TTP) and overall survival (OS) were 25.9 and 63.5%, and 5.3 and 9.5 months, respectively. GFP triplets as well as G-based chemotherapy plus targeted therapy were significantly superior to GP concerning tumor control (TCR, TTP) and OS, with no difference in RR. Conclusion: Triplet combinations of GFP as well as G-based chemotherapy with (predominantly EGFR) targeted therapy are most effective concerning tumor control and survival.