Danese Mark D, Mody Kabir, Thota Ramya, Lindsey Stacie C, Bachini Melinda, Abdel-Wahab Reham, Audhuy François, Duryea Jennifer, Bobiak Sarah
Outcomes Insights Inc, Agoura Hills, California.
Division of Hematology/Oncology, Mayo Clinic, Jacksonville, Florida.
Gastro Hep Adv. 2023 Jan 21;2(4):580-587. doi: 10.1016/j.gastha.2023.01.009. eCollection 2023.
Biliary tract cancer (BTC) is a rare, lethal, heterogeneous group of cancers often diagnosed at an advanced stage. While gemcitabine plus cisplatin is the standard of care for first-line treatment of locally advanced or metastatic BTC, no globally accepted standard of care currently exists for second-line treatment of BTC following chemotherapy. However, the treatment landscape is evolving with approvals for therapies targeting actionable mutations. This study aimed to characterize treatment patterns and survival in patients with locally advanced or metastatic BTC.
Patients with advanced or metastatic BTC in the Surveillance, Epidemiology, and End Results Medicare database between 2010 and 2015 (N = 2063) were included; patients with nonprimary BTC were excluded. Patient and clinical characteristics, line and type of therapy, and overall survival of patients were analyzed.
Only 45.5% (n = 938) of patients initiated systemic therapy within 90 days of diagnosis. The most common event following diagnosis was initiation of first-line therapy, and the most common event following first-line treatment was death. Median survival ranged from 5.0 months for patients receiving second-line fluoropyrimidine to 9.7 months for patients receiving second-line gemcitabine. Duration of therapy ranged from 0.7 months for patients receiving second-line fluoropyrimidine to 3.7 months for patients receiving first-line gemcitabine plus cisplatin therapy.
Overall survival from diagnosis was poor and influenced by age, sex, stage, mobility limitations, comorbidity burden, poverty, and previous cancer. Treatment patterns varied for patients who progressed following first-line therapy, as there was no consensus second-line treatment for locally advanced or metastatic BTC without clinically targetable mutations.
胆道癌（BTC）是一种罕见、致命且异质性的癌症类型，通常在晚期才被诊断出来。虽然吉西他滨联合顺铂是局部晚期或转移性BTC一线治疗的标准方案，但目前对于BTC化疗后的二线治疗尚无全球公认的标准治疗方案。然而，随着针对可操作突变的疗法获批，治疗格局正在不断演变。本研究旨在描述局部晚期或转移性BTC患者的治疗模式和生存情况。
纳入2010年至2015年间监测、流行病学和最终结果医疗保险数据库中晚期或转移性BTC患者（N = 2063）；排除非原发性BTC患者。分析患者的临床特征、治疗线数和类型以及患者的总生存期。
仅45.5%（n = 938）的患者在诊断后90天内开始全身治疗。诊断后的最常见事件是开始一线治疗，一线治疗后的最常见事件是死亡。接受二线氟嘧啶治疗的患者中位生存期为5.0个月，接受二线吉西他滨治疗的患者中位生存期为9.7个月。治疗持续时间从接受二线氟嘧啶治疗的患者的0.7个月到接受一线吉西他滨联合顺铂治疗的患者的3.7个月不等。
从诊断开始的总生存期较差，且受年龄、性别、分期、行动不便、合并症负担、贫困和既往癌症影响。一线治疗后病情进展的患者治疗模式各不相同，因为对于无临床可靶向突变的局部晚期或转移性BTC，尚无共识性的二线治疗方案。
