Prognostic and predictive factors for Taiwanese patients with advanced biliary tract cancer undergoing frontline chemotherapy with gemcitabine and cisplatin: a real-world experience

Background: Gemcitabine and oxaliplatin (GemOx) is a standard combination regimen in advanced biliary tract cancer (BTC). There is limited evidence on its efficacy and safety in real life. Methods: A retrospective multicentre cohort study in the South East Region of Sweden, covering nine years (2011–2020) and three hospitals where GemOx was treatment of choice, was designed. Clinicopathological prognostic parameters were explored. Results: One hundred and twenty-one patients with advanced BTC were identified. Median overall and progression-free survival (OS and PFS) were 8.9 (95% CI = 7.2–10.6) and 5.3 (95% CI = 3.8–6.7) months. Performance status according to Eastern Cooperative Oncology Group (PS according to ECOG) 1–2 and primary gallbladder carcinoma were independent predictors for poor OS. PS and derived neutrophil/lymphocyte ratio were predictive for PFS. The most common severe type of myelosuppresion was grade 3 neutropenia that was recorded in 8%. Fifty-three (43.8%) experienced at least one episode of unplanned hospitalisation. One hundred and seventeen (97%) received oxaliplatin with lower dosage than was utilized in previous phase III trials (80–85 vs. 100 mg/m2) and a majority received further dose reductions of oxaliplatin and/or gemcitabine. Conclusion: The outcome of GemOx in advanced BTC appears comparable in controlled trials and real-world contexts. A lower dose of oxaliplatin seems more tolerable without compromising the outcome.

show abstract

“…Notably, a similarly conducted real-world study on Taiwanese patients [ 15 ], but treated with GemCis, reported almost identical data to ours.…”

Section: Discussionsupporting

confidence: 84%

Real-World Evidence on Palliative Gemcitabine and Oxaliplatin (GemOx) Combination Chemotherapy in Advanced Biliary Tract Cancer

Lagenfelt

Blomstrand

Elander

2021

Cancers

View full text Add to dashboard Cite

show abstract

“…Biliary tract cancers (BTCs) including intrahepatic cholangiocarcinoma (iCCA), extrahepatic cholangiocarcinoma (eCCA), gallbladder cancer, and ampullary cancer are a group of relatively rare cancers arising from the epithelium of the biliary tract [1][2][3][4] and have aggressive biological behavior, as they are diagnosed at an advanced stage with poor prognosis and have a high recurrence rate after primary surgery [5,6]. Gemcitabine and cisplatin have been the standard treatments in first-line chemotherapy since the ABC-02 trial was published in 2010 [7].…”

Section: Current Treatment For Biliary Tract Cancers (Btcs): Chemothementioning

confidence: 99%

“…Clinical trials have evaluated molecular targeted therapies in combination with chemotherapy; however, none of the completed phase III trials [8][9][10][11] and phase II studies [12][13][14][15] have demonstrated significant improvement in progression-free survival (PFS) and overall survival (OS) in patients with advanced BTCs [16]. Real word experience has confirmed the feasibility and safety of gemcitabine and cisplatin in advanced BTCs [6,17].…”

Section: Current Treatment For Biliary Tract Cancers (Btcs): Chemothementioning

confidence: 99%

Targeting P53 as a Future Strategy to Overcome Gemcitabine Resistance in Biliary Tract Cancers

Pan

Yeh

et al. 2020

Biomolecules

Self Cite

View full text Add to dashboard Cite

Gemcitabine-based chemotherapy is the current standard treatment for biliary tract cancers (BTCs) and resistance to gemcitabine remains the clinical challenge. TP53 mutation has been shown to be associated with poor clinicopathologic characteristics and survival in patients with BTCs, indicating that p53 plays an important role in the treatment of these cancers. Herein, we comprehensively reviewed previous BTC preclinical research and early clinical trials in terms of p53, as well as novel p53-targeted treatment, alone or in combination with either chemotherapy or other targeted therapies in BTCs. Preclinical studies have demonstrated that p53 mutations in BTCs are associated with enhanced gemcitabine resistance, therefore targeting p53 may be a novel therapeutic strategy for treatment of BTCs. Directly targeting mutant p53 by p53 activators, or indirectly by targeting cell cycle checkpoint proteins (Chk1, ataxia telangiectasia related (ATR), and Wee1) leading to synthetic lethality, may be potential future strategies for gemcitabine-resistant p53 mutated BTCs. In contrast, for wild-type p53 BTCs, activation of p53 by inhibition of its negative regulators (MDM2 and wild-type p53-induced phosphatase 1 (WIP1)) may be alternative options. Combination therapies consisting of standard cytotoxic drugs and novel small molecules targeting p53 and related signaling pathways may be the future key standard approach to beat cancer.

show abstract

“…Many studies have shown that in ammation is related to the occurrence, development and metastasis of malignant tumors [7][8][9][10][11]. Because the leukocyte count and various types of white blood cells are indicators of systemic in ammation and immune response, these values may be good candidate biomarkers for predicting aggressive tumors.…”

Section: Discussionmentioning

confidence: 99%

The Value of Inflammatory Cell Count and Its Ratio in the Diagnosis of Prostate Cancer

Duan¹,

Xu²,

Deng³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Inflammatory cells play an important role in the occurrence and development of cancer. In recent years, the value of inflammatory cell count and its ratio in the diagnosis of prostate cancer has been controversial.Methods: A retrospective analysis of 475 patients with transrectal prostate puncture with TPSA>4 ng/ml in the Third Affiliated Hospital of Xi’an Jiaotong University. Univariate analysis, multivariate analysis and Receiver Operating Characteristics curve analysis were performed to analysis the factor of age, TPSA, FPSA, PV, NC, LC, PC, NLR, PLR in the diagnosis value of prostate cancer, and further analysis the value of inflammatory cell count and its ratio in different TPSA groups of prostate cancer (4 ng/ml <TPSA ≤ 10 ng/ml, 10 ng/ml ＜TPSA ≤ 20 ng/ml, TPSA ＞ 20 ng/ml). Results: The results of Univariate analysis in the overall data showed that Age, TPSA, PV, NC, PLC were influencing factors in the diagnosis of prostate cancer. The Area Under the Curve (AUC) of NC was 56.2% with a sensitivity of 72.2% and specificity of 41.5% in the cut -off point of 4.52 (p = 0.021). The PLC cut-off point of 205.5 gives 55.6% AUC with 67.2% sensitivity and 4.2% specificity. Multivariate binary logistic regression analysis results showed that Age, TPSA, PV, NC were independent influencing factors for the diagnosis of prostate cancer; In different TPSA group studies, it was found that NC, NLR, and PLR were valuable for the diagnosis of prostate cancer when TPSA>20 ng/ml，at the NC cut-off point of 4.52 with 67.3% AUC, 71.2% sensitivity and 62.5% specificity(p＜0.001), at the NLR cut-off point of 3.14 with 65.4% AUC, 67.2% sensitivity and 61.1% specificity (p＜0.001), and at the PLR cut-off point of 135.8 with 62.8% AUC , 57.6% sensitivity and 66.7% specificity (p＜0.001). Multivariate binary logistic regression analysis results showed that when TPSA>20 ng/ml, the higher Age, TPSA , Low PV and NC are independent risk factors affecting the diagnosis of prostate cancer. Conclusion: NC has promising value in predicting prostate cancer, especially when TPSA>20 ng/ml. A further prospective study in validating its diagnostic value was needed.

show abstract

Prognostic and predictive factors for Taiwanese patients with advanced biliary tract cancer undergoing frontline chemotherapy with gemcitabine and cisplatin: a real-world experience

Cited by 17 publications

References 27 publications

Real-World Evidence on Palliative Gemcitabine and Oxaliplatin (GemOx) Combination Chemotherapy in Advanced Biliary Tract Cancer

Real-World Evidence on Palliative Gemcitabine and Oxaliplatin (GemOx) Combination Chemotherapy in Advanced Biliary Tract Cancer

Targeting P53 as a Future Strategy to Overcome Gemcitabine Resistance in Biliary Tract Cancers

The Value of Inflammatory Cell Count and Its Ratio in the Diagnosis of Prostate Cancer

Contact Info

Product

Resources

About