Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India.
Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai, 400 012, India.
J Gastrointest Cancer. 2024 Mar;55(1):263-269. doi: 10.1007/s12029-023-00946-z. Epub 2023 Jun 27.
Locally advanced, inoperable, or metastatic gallbladder cancers (GBC) are treated with either gemcitabine-platinum combinations or gemcitabine alone based on physician discretion. However, the combination of gemcitabine, cisplatin, and nab-paclitaxel (GCNP) has shown increased response rates and prolonged survival in a phase II trial of biliary tract patients.
Consecutive series of patients diagnosed with locally advanced (liver infiltration > 5 cm, large nodes at porta, abutting duodenum), inoperable, and metastatic biliary tract patients between January 2018 and August 2022 were evaluated for first-line chemotherapy GCNP, in the multidisciplinary joint clinic (MDJC). The primary endpoint was ORR, and the major secondary endpoint was event-free survival (EFS).
A total of 142 patients received GCNP during the specified time period. The median age of the cohort was 52 years (range: 21-79), the majority were females (61.3%), and the majority were GB (81.7%). Response rates were available in 137 patients. Complete response, partial response, and stable disease were seen in 9 (6.3%), 87 (61.3%), and 24 (16.9%), respectively, for an ORR of 67.6% and a clinical benefit rate of 84.5%. The median EFS was 9.92 (95% CI, 7.69-12.14) months. Of the 52 patients in whom GCNP was given with NACT intent for locally advanced GBC, 17 patients underwent surgery (34%).
Our study indicates that GCNP leads to improved response rates, increased chances of resectability, and possibly better survival in patients with GBC.
局部晚期、不可切除或转移性胆囊癌（GBC）根据医生的判断，采用吉西他滨联合铂类药物或吉西他滨单药治疗。然而，在胆道系统患者的 II 期试验中，吉西他滨、顺铂和 nab-紫杉醇（GCNP）联合显示出更高的缓解率和延长的生存时间。
连续系列被诊断为局部晚期（肝脏浸润>5cm，门脉大淋巴结，紧贴十二指肠）、不可切除和转移性胆道系统患者的病例，于 2018 年 1 月至 2022 年 8 月在多学科联合诊所（MDJC）接受一线化疗 GCNP 评估。主要终点是客观缓解率（ORR），主要次要终点是无进展生存期（EFS）。
在指定时间内，共有 142 名患者接受了 GCNP 治疗。队列的中位年龄为 52 岁（范围：21-79），大多数为女性（61.3%），大多数为胆囊癌（81.7%）。137 名患者的缓解率可评估。完全缓解、部分缓解和稳定疾病的比例分别为 9（6.3%）、87（61.3%）和 24（16.9%），ORR 为 67.6%，临床获益率为 84.5%。中位 EFS 为 9.92（95%CI，7.69-12.14）个月。在接受 GCNP 联合新辅助化疗（NACT）用于局部晚期 GBC 的 52 名患者中，有 17 名患者（34%）接受了手术。
我们的研究表明，GCNP 可提高 GBC 患者的缓解率、提高可切除性机会，并可能改善生存。
