SECOND-LINE CHEMOTHERAPY AND FACTORS THAT AFFECTED OVERALL SURVIVAL IN PATIENTS WITH METASTATIC CHOLANGIOCARCINOMA PROGRESSED AFTER CISPLATIN AND GEMCITABINE AS FIRST-LINE CHEMOTHERAPY IN CHIANGRAI PRACHANUKROH HOSPITAL
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Abstract
BACKGROUND: Patients with metastatic biliary tract cancer who progressed after first-line chemotherapy, especially Cisplatin and Gemcitabine regimen, has not specified for Second-line chemotherapy protocol and result of that protocol.
OBJECTIVE: To study the result of second-line chemotherapy and factors that affected overall survival in patients with metastatic cholangiocarcinomaprogressed after cisplatin and gemcitabine as first-line chemotherapy
Methods: This retrospective study included patients with metastatic biliary tract cancer who were previously treated with Cisplatin and Gemcitabine regimen or in Chiangrai Prachanukroh Hospital between 2014 and 2018. Survival analysis was done using the Kaplan-Meier method and the log-rank test. Factors that affected overall survival were analyzed with univariate and multivariate analysis.
Results: A total of 143 patients with metastatic biliary tract cancer that failed first-line chemotherapy were included, the median age was 59 ± 8.14 years and 57.30% of patients were male. The intrahepatic subtype was more common than other subtypes (65.70%). The median overall survival (OS) was 6.20 months in patients who received second-line chemotherapy and 2.25 months in patients who did not (hazard ratio 0.25; 95%CI, 0.17 to 0.37). Factors that affected OS in multivariate analysis were history of primary tumor resection, achieved the post-treatment status of at least stable disease after first-line chemotherapy, white blood cell (WBC) ≥ 10,000 cell/mm3, neutrophil-lymphocyte ratio (NLR) ≥ 4, total bilirubin ≥ 3 g/dL and received second-line chemotherapy, especially combination regimen.
ConclusionS AND Reccomentation: Patients with metastatic biliary tract cancer who progressed after cisplatin and gemcitabine as first-line chemotherapy had a benefit in overall survival after receiving second-line chemotherapy. These findings may support adding Thai guidelines for second-line chemotherapy protocol for metastatic biliary tract cancer.
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