The clinical benefit of second-line
chemotherapy in advanced
biliary tract cancers is currently unknown. We investigated the role of
platinum re-challenge in a selected cohort of patients who progressed after first-line
gemcitabine/
cisplatin (GemCis)
chemotherapy. We retrospectively analysed seventy-four patients treated between January 2008 and September 2012 at Nottingham University Hospitals. Demographics, treatment data, radiological response and survival data were captured. Univariate and multivariate analysis of survival outcomes were evaluated.
Platinum sensitive disease was defined as tumours that progress after 12 weeks of completion of first-line GemCis
chemotherapy. Seventy-four patients (median age = 67 years) had received first-line
chemotherapy (
gemcitabine alone = 21/74, Gem/Cis combination = 53/74). Best response to GemCis
chemotherapy was as follows; partial response (PR) (17 %), stabilisation of disease (SD) (39.6 %), disease control rate (DCR) (56.6 %) and
disease progression (43.4 %). 18/74 patients received second-line
chemotherapy [GemCis (12/18), 5-FU/
cisplatin (4/18),
gemcitabine (2/8)]. Best response to GemCis second-line
chemotherapy was as follows: PR (33.3 %), SD (33.3 %) and DCR (66.6 %). The median overall survival in patients who received second-line
chemotherapy was 29 months compared to 10.6 months in patients who received first-line
therapy only (p = 0.00001). The data suggest that patients who progress after 12 weeks of completion of first-line
therapy may remain
platinum sensitive and benefit from second-line
platinum re-challenge. Prospective multicentre studies are warranted to explore this possibility further.