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BMC Cancer. 2017 Apr 12;17(1):262. doi: 10.1186/s12885-017-3266-9.

Systemic therapy in younger and elderly patients with advanced biliary cancer: sub-analysis of ABC-02 and twelve other prospective trials.

Author information

1
Division of Molecular & Clinical Cancer Sciences, Institute of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, M20 4BX, UK. Mairead.McNamara@christie.nhs.uk.
2
UCL Cancer Institute, London, WCIE 6BT, UK.
3
Cancer Research UK & UCL Cancer Trials Centre, London, WCIE 6BT, UK.
4
Imperial Healthcare, London, WI2 ONN, UK.
5
Institute Gustave Roussy, 94805, Villejuif, France.
6
Vejle Hospital, 7100, Vejle, Denmark.
7
National Cancer Center Hospital, Tokyo, 104-0045, Japan.
8
Princess Margaret Cancer Centre, Toronto, M5G 2M9, Canada.
9
Centre Hospitalier Universitaire Vaudois, CH-1011, Lausanne, Switzerland.
10
Royal Marsden Hospital, London, UK.
11
University of Sydney, Sydney, NSW, 2006, Australia.
12
Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia.
13
Universitätsmedizin Mainz, 55122, Mainz, Germany.
14
Mayo Clinic, Phoenix, AZ, 85054, USA.
15
Division of Molecular & Clinical Cancer Sciences, Institute of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, M20 4BX, UK.

Abstract

BACKGROUND:

Outcomes in younger (<40 years) and elderly (≥70 years) patients with advanced biliary cancer (ABC) receiving palliative chemotherapy are unclear. This study assessed outcomes in those receiving monotherapy or combination therapy in thirteen prospective systemic-therapy trials.

METHODS:

Multivariable analysis explored the impact of therapy on progression-free (PFS) and overall survival (OS) in two separate age cohort groups: <70 years and ≥70 years, and <40 years and ≥40 years.

RESULTS:

Overall, 1163 patients were recruited (Jan 1997-Dec 2013). Median age of entire cohort: 63 years (range 23-85); 36 (3%) were <40, 260 (22%); ≥70. Combination therapy was platinum-based in nine studies. Among patients <40 and ≥70 years, 23 (64%) and 182 (70%) received combination therapy, respectively. Median follow-up was 42 months (95%-CI 37-51). Median PFS for patients <40 and ≥40 years was 3.5 and 5.9 months (P = 0.12), and OS was 10.8 and 9.7 months, respectively (P = 0.55). Median PFS for those <70 and ≥70 years was 6.0 and 5.0 months (P = 0.53), and OS was 10.2 and 8.8 months, respectively (P = 0.08). For the entire cohort, PFS and OS were significantly better in those receiving combination therapy: Hazard Ratio [HR]-0.66, 95%-CI 0.58-0.76, P < 0.0001 and HR-0.72, 95%-CI 0.63-0.82, P < 0.0001, respectively; and in patients ≥70 years: HR-0.54 (95%-CI 0.38-0.77, P = 0.001) and HR-0.60 (95%-CI 0.43-0.85, P = 0.004), respectively. There was no evidence of interaction between age and treatment for PFS (P = 0.58, P = 0.66) or OS (P = 0.18, P = 0.75).

CONCLUSIONS:

In ABC, younger patients are rare, and survival in elderly patients in receipt of systemic therapy for advanced disease, whether monotherapy or combination therapy, is similar to that of non-elderly patients, therefore age alone should not influence decisions regarding treatment.

KEYWORDS:

Biliary cancer; Elderly; Prospective trials; Systemic therapy; Younger patients

PMID:
28403829
PMCID:
PMC5389161
DOI:
10.1186/s12885-017-3266-9
[Indexed for MEDLINE]
Free PMC Article

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