title: Feasibility and benefits of second-line chemotherapy in advanced biliary tract cancer: a large retrospective study.
abstract: BACKGROUND
  First-line chemotherapy (CT1) is effective in advanced biliary tract cancer (ABTC). The benefits of second-line chemotherapy (CT2) are unclear.
  
  
  METHODS
  We retrospectively studied all patients starting at least one line of chemotherapy for ABTC at our institution between 1991 and 2011. We analysed patient and chemotherapy characteristics in order to: (1) characterise patients eligible for CT2; (2) evaluate the efficacy of CT2.
  
  
  RESULTS
  Three hundred and seventy-eight received CT1 and 96 (25%) patients received CT2. Primary tumour location was the gallbladder (29%), intraphepatic (20%), perihilar (16%), distal common bile duct (19%) and ampulla of Vater (14%). Ninety percent had a baseline performance status (PS) of 0-1 prior to CT1. Females (p=0.03), ages ≤ 60 years (p=0.001) and patients with progression free survival (PFS) ≥ 6 months following CT1 (p=0.01) were more likely to be offered CT2. Objective response rates and stable disease with CT2 were 9% and 34%, respectively. Median PFS and median overall survival (OS) from the beginning of CT2 were 2.8 and 7.5 months, respectively. Prognostic factors impacting PFS with CT2 were the regimen type (doublet versus monotherapy, p=0.001) and PS<2 (p<0.0001).
  
  
  CONCLUSIONS
  Among patients with ABTC, 25% received CT2, typically younger patients and those with longer PFS following CT1. Disease control occurred in 43% of patients, and more often with a doublet than a single agent. However, clearly more effective therapies must be found.
authors.affiliation: Princess Margaret Hospital, Toronto, Ontario, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Walter
authors.forename: Anne M
authors.initials: AM
authors.lastname: Horgan
authors.forename: Mairead
authors.initials: M
authors.lastname: McNamara
authors.forename: Liz
authors.initials: L
authors.lastname: McKeever
authors.forename: Trisha
authors.initials: T
authors.lastname: Min
authors.forename: David
authors.initials: D
authors.lastname: Hedley
authors.forename: Stefano
authors.initials: S
authors.lastname: Serra
authors.forename: Monika K
authors.initials: MK
authors.lastname: Krzyzanowska
authors.forename: Eric
authors.initials: E
authors.lastname: Chen
authors.forename: Helen
authors.initials: H
authors.lastname: Mackay
authors.forename: Ronald
authors.initials: R
authors.lastname: Feld
authors.forename: Malcolm
authors.initials: M
authors.lastname: Moore
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Knox
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult