Prognostic Factors in Patients Treated with Pembrolizumab as a Second-Line Treatment for Advanced Biliary Tract Cancer

Abstract

Some BTC types respond to pembrolizumab, but there are no known prognostic factors to predict its treatment benefits. In this study, we attempted to identify the prognostic factors associated with pembrolizumab as a second-line treatment for gemcitabine-refractory BTC. This retrospective and single tertiary-center study involved all the consecutive patients (n = 80) with refractory advanced BTC, who were diagnosed as programmed cell death ligand 1-positive and treated with pembrolizumab between August 2017 and February 2021. The overall survival (OS) was analyzed using Cox regression analysis. The median OS was 6.0 months [95% confidence interval (CI): 3.87–8.20]; median progression-free survival was 1.9 months (95% CI: 1.82–1.98); and the response rate was 15.9%. In the multivariate Cox regression analysis, the TB [adjusted hazard ratio (HR) = 2.286; 95% CI: 1.177–4.440; p = 0.015), albumin levels (adjusted HR = 0.392; 95% CI: 0.211–0.725; p = 0.003), ALP levels (adjusted HR = 1.938; 95% CI: 1.105–3.400; p = 0.021), and LMR (adjusted HR = 0.325; 95% CI: 0.173–0.609; p < 0.001) were identified as significant variables associated with the OS. High albumin levels and LMR and low ALP levels and TB were significantly associated with better OS in patients treated with pembrolizumab.

Genomic characterization and immunotherapy for microsatellite instability-high in cholangiocarcinoma

“…In our study, MSI-H status was a protective factor for both OS and PFS of immunotherapy in multivariate analysis. However, another study found that MSI-H ( N = 15) was not an independent protective factor ( P = 0.162) in refractory CCA with PD-L1 positivity (CPS≥ 1 or tumor proportion score (TPS) ≥ 1%) and treated with pembrolizumab, indicating that PD-L1 expression is also another important confounding factor [ 58 ].…”

Comparison of the effectiveness of chemotherapy combined with immunotherapy and chemotherapy alone in advanced biliary tract cancer and construction of the nomogram for survival prediction based on the inflammatory index and controlling nutritional status score

“…Hyerim Ha1 et al [ 26 ] found that patients with high levels of NLR, PLR, and SII had poorer OS by analyzing the hematological indicators of 158 patients with advanced BTC. Chan Su Park et al [ 27 ] also found in a retrospective study that lower MLR was significantly associated with better OS in patients with advanced BTC treated with pembrolizumab in the second line. This result is consistent with the results in the retrospective study we conducted, in which we also found a significant correlation between lower NLR ( p = 0.0083), PLR ( p = 0.020), SII ( p = 0.0161), and MLR ( p < 0.001) and better OS of patients.…”