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Turkish Journal of Medical Sciences

Abstract

Background/aim: Biliary tract cancers (BTC) are relatively rare and have a poor prognosis in both localized and metastatic settings. Clinical trials tend to include patients who can tolerate treatments; however, chemotherapy eligibility, patterns, and survival may differ in the real world. The present study provides a 5-year overview of chemotherapy eligibility, patterns, tolerance, and survival in patients with resected and advanced BTCs.

Materials and methods: Included in the study were patients with resectable or advanced BTC (excluding ampullary cancers) diagnosed between 2019 and 2024. The demographic/clinical characteristics, chemotherapy eligibility, patterns, and survival outcomes of the patients were evaluated.

Results: Of the 151 patients included in the study, 61 (40.7%) had resected BTC and 90 (59.3%) had advanced BTC. Among the patients with resected BTC, only 52.5% received adjuvant chemotherapy, 38.7% needed dose reductions, and 29% could not complete the planned cycles. Median recurrence-free survival and overall survival (OS) were 24.1 months (95% confidence interval (CI): 11.4–58.0) and 59 months (95% CI: 38.4–59) in patients with resected BTC, respectively, for all patients. In a multivariable analysis, only the number of adjuvant chemotherapy cycles was associated with OS [Hazard ratio (HR):0.63 (95% CI: 0.39–1.00), p=0.050]. Among the patients with advanced disease, 16.7% were not eligible for first-line chemotherapy, and 70.7% needed dose reduction. The median number of cycles was three (0-18); grade 3–4 adverse events were observed in 52% of the patients; and median progression-free survival and OS were 4.3 months (95% CI: 3.3–5.0) and 9.4 months (95% CI: 5.9–13.7) for all patients, respectively. Only 36.7% were able to receive second-line treatment. The number of first-line chemotherapy cycles [HR: 0.58 (95% CI: 0.45–0.76), p < 0.001]/discontinuation due to toxicity [HR: 3.26 (95% CI: 1.34–7.93), p = 0.009], cisplatin-gemcitabine regimen [HR: 0.10 (95% CI: 0.01–0.58), p<0.001], and receiving second-line chemotherapy [HR: 0.28 (95% CI: 0.11–0.68), p < 0.001] were significantly associated with OS in multivariable analyses.

Conclusion: This study shows that a significant proportion of patients with BTC are not eligible or intolerant to chemotherapy in the real world. Maintaining the planned treatment, even with dose reduction, is associated with better OS

Author ORCID Identifier

ERMAN AKKUŞ: 0000-0002-7531-7817

PINAR KUBİLAY TOLUNAY: 0000-0003-2636-5326

ELİF KÖKSOY: 0000-0002-6590-4444

HATİME YAŞAR: 0000-0002-0545-1383

DOI

10.55730/1300-0144.6102

Keywords

Biliary tract cancers, chemotherapy, eligibility, real-world, survival, tolerance

First Page

1445

Last Page

1458

Publisher

The Scientific and Technological Research Council of Türkiye (TÜBİTAK)

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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