title: Systemic treatment in advanced biliary cancers: A multicenter Australian analysis and review.
abstract: OBJECTIVE
  While first-line palliative chemotherapy (CT1) improves survival and quality of life in advanced biliary cancer (ABC), there is no randomized evidence to support second-line chemotherapy (CT2) in ABC. We aim to explore to role of CT2 in ABC.
  
  
  METHODS
  We performed a retrospective review of all patients who received one or more lines of chemotherapy for ABC at four Australian cancer centers between 2008 and 2011. A Cox proportional hazard model was developed to determine the impact of clinicopathologic variables on overall survival (OS) from time of progression on CT1.
  
  
  RESULTS
  We identified 73 patients who received palliative chemotherapy for ABC. Twenty-five patients (34%) received two or more lines of chemotherapy. Patients with a preserved performance status on progression on first-line chemotherapy (CT1) were more likely to receive second-line chemotherapy (CT2) (P < 0.001). Disease control rate with CT2 was 36%, and mean progression-free survival was 3.2 months (95% confidence interval 1.5-4.9 months). The following variables were significant in the univariate analysis of OS from time of progression on CT1: lines of chemotherapy (P = 0.0001), Eastern Cooperative Oncology Group performance status at progression on CT1 (P < 0.0001) and disease control with CT1 (P = 0.027). Lines of chemotherapy received and performance status remained significant in the multivariate analysis for OS from progression on CT1.
  
  
  CONCLUSIONS
  Second-line chemotherapy is feasible in a subset of patients with ABC. Even after accounting for confounding variables, CT2 appears to increase OS in ABC, although we are unable to exclude other unmeasured factors such as tumor biology. These findings warrant further evaluation with prospective trials.
authors.affiliation: Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.|School of Biological Sciences, University of Wollongong, Wollongong, New South Wales, Australia.|Illawarra Cancer Centre, Wollongong Hospital, Wollongong, New South Wales, Australia.|University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brungs
authors.affiliation: Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.|School of Biological Sciences, University of Wollongong, Wollongong, New South Wales, Australia.|Illawarra Cancer Centre, Wollongong Hospital, Wollongong, New South Wales, Australia.
authors.forename: Morteza
authors.initials: M
authors.lastname: Aghmesheh
authors.affiliation: St George Hospital, Sydney, New South Wales, Australia.|Sutherland Hospital, Sydney, New South Wales, Australia.
authors.forename: Katrin
authors.initials: K
authors.lastname: Sjoquist
authors.affiliation: University of New South Wales, Sydney, New South Wales, Australia.|Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001661:Biliary Tract Neoplasms / Q000473:pathology / Q000628:therapy*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: advanced biliary cancer; chemotherapy; second line