FOLFIRI as second-line treatment of metastatic biliary tract cancer patients.
FOLFIRI as second-line treatment of metastatic biliary tract cancer patients.
复制标题
DOI：
10.4322/acr.2019.087
复制
发表时间：
2019-04-01
影响因子：
--
通讯作者：
Hendlisz, Alain
中科院分区：
文献类型：
--
作者：
Caparica, Rafael;Lengele, Adrien;Hendlisz, Alain
顺铂联合吉西他滨是转移性胆道癌（BTC）患者的标准一线治疗方案。二线化疗对这些患者的益处是有争议的。本研究旨在评估转移性BTC患者一线铂和吉西他滨化疗失败后FOLFIRI（氟尿嘧啶和伊立替康）的活性。我们提出了一项单机构、回顾性队列研究。局部晚期或转移性BTC患者在2007年至2017年期间在我院连续治疗至少一条化疗线后进展。主要终点是无进展生存期（PFS），次要终点是总生存期（OS）、临床获益率（CBR）和FOLFIRI的安全性。12例患者纳入分析，中位随访时间为5个月（95% CI 2.77-7.20）。接收的周期数中位数为3（范围为1至9）。记录4例3级毒性；无4级毒性，无治疗相关死亡发生。中位PFS为1.7个月（95% CI; 0.66-2.67），中位OS为5个月（95% CI; 2.77-7.20）。2例患者病情稳定，CBR为17%。我们的结论是，FOLFIRI在进展到铂和吉西他滨的转移性BTC患者中具有良好的毒性和适度的活性，并且可以考虑用于能够耐受其他化疗线的患者。根据肿瘤基因组谱选择免疫治疗和靶向治疗是改善BTC二线治疗结果的有希望的替代方案。
The combination of cisplatin and gemcitabine is the standard first-line treatment of metastatic biliary tract cancer (BTC) patients. The benefit of second-line chemotherapy in these patients is controversial. This study aims to evaluate the activity of FOLFIRI (fluorouracil and irinotecan) after failure to the first-line platinum and gemcitabine-based chemotherapy in metastatic BTC patients. We present a single-institution, retrospective cohort study. Patients with locally advanced or metastatic BTC who progressed after at least one line of chemotherapy, consecutively treated at our Institution between 2007 and 2017 were included. The primary endpoint was progression-free survival (PFS), and the secondary endpoints were overall survival (OS), clinical benefit rate (CBR) and safety profile of FOLFIRI. Twelve patients were included in the analysis, with a median follow up of 5 months (95% CI 2.77-7.20). The median number of cycles received was 3 (range 1 to 9). Four grade 3 toxicities were recorded; no grade 4 toxicities and no treatment-related deaths occurred. The median PFS was 1.7 months (95% CI; 0.66-2.67), and median OS was 5 months (95% CI; 2.77-7.20). Two patients presented stable disease, providing a CBR of 17%. We concluded that FOLFIRI presented a favorable toxicity profile and a modest activity in metastatic BTC patients who had progressed to platinum and gemcitabine and may be considered in patients who are able to tolerate additional lines of chemotherapy. Immunotherapy and targeted therapies selected according to the tumoral genomic profile are promising alternatives to improve the outcomes of second-line treatment in BTC.