Systemic therapy in younger and elderly patients with advanced biliary cancer: sub-analysis of ABC-02 and twelve other prospective trials
Identifieur interne : 000A34 ( Pmc/Curation ); précédent : 000A33; suivant : 000A35Systemic therapy in younger and elderly patients with advanced biliary cancer: sub-analysis of ABC-02 and twelve other prospective trials
Auteurs : Mairéad Geraldine Mcnamara ; John Bridgewater ; Andre Lopes ; Harpreet Wasan ; David Malka [France] ; Lars Henrik Jensen [Danemark] ; Takuji Okusaka [Japon] ; Jennifer J. Knox ; Dorothea Wagner [Suisse] ; David Cunningham [Royaume-Uni] ; Jenny Shannon ; David Goldstein ; Markus Moehler [Allemagne] ; Tanios Bekaii-Saab [États-Unis] ; Juan W. ValleSource :
- BMC Cancer [ 1471-2407 ] ; 2017.
Abstract
Outcomes in younger (<40 years) and elderly (≥70 years) patients with advanced biliary cancer (ABC) receiving palliative chemotherapy are unclear. This study assessed outcomes in those receiving monotherapy or combination therapy in thirteen prospective systemic-therapy trials.
Multivariable analysis explored the impact of therapy on progression-free (PFS) and overall survival (OS) in two separate age cohort groups: <70 years and ≥70 years, and <40 years and ≥40 years.
Overall, 1163 patients were recruited (Jan 1997-Dec 2013). Median age of entire cohort: 63 years (range 23–85); 36 (3%) were <40, 260 (22%); ≥70. Combination therapy was platinum-based in nine studies. Among patients <40 and ≥70 years, 23 (64%) and 182 (70%) received combination therapy, respectively. Median follow-up was 42 months (95%-CI 37–51). Median PFS for patients <40 and ≥40 years was 3.5 and 5.9 months (
In ABC, younger patients are rare, and survival in elderly patients in receipt of systemic therapy for advanced disease, whether monotherapy or combination therapy, is similar to that of non-elderly patients, therefore age alone should not influence decisions regarding treatment.
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DOI: 10.1186/s12885-017-3266-9
PubMed: 28403829
PubMed Central: 5389161
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Mairéad Geraldine Mcnamara<affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.412917.8</institution-id><institution>Division of Molecular & Clinical Cancer Sciences,</institution><institution>Institute of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust,</institution></institution-wrap>Manchester, M20 4BX UK</nlm:aff><wicri:noCountry code="subfield">M20 4BX UK</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.83440.3b</institution-id><institution></institution><institution>UCL Cancer Institute,</institution></institution-wrap>London, WCIE 6BT UK</nlm:aff><wicri:noCountry code="subfield">WCIE 6BT UK</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.11485.39</institution-id><institution></institution><institution>Cancer Research UK & UCL Cancer Trials Centre,</institution></institution-wrap>London, WCIE 6BT UK</nlm:aff><wicri:noCountry code="subfield">WCIE 6BT UK</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff4">Imperial Healthcare, London, WI2 ONN UK</nlm:aff><wicri:noCountry code="subfield">WI2 ONN UK</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff8"><institution-wrap><institution-id institution-id-type="GRID">grid.415224.4</institution-id><institution></institution><institution>Princess Margaret Cancer Centre,</institution></institution-wrap>Toronto, M5G 2M9 Canada</nlm:aff><wicri:noCountry code="subfield">M5G 2M9 Canada</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff11"><institution-wrap><institution-id institution-id-type="GRID">grid.1013.3</institution-id><institution></institution><institution>University of Sydney,</institution></institution-wrap>Sydney, NSW 2006 Australia</nlm:aff><wicri:noCountry code="subfield">NSW 2006 Australia</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff12"><institution-wrap><institution-id institution-id-type="GRID">grid.1005.4</institution-id><institution>Prince of Wales Clinical School,</institution><institution>University of New South Wales,</institution></institution-wrap>Sydney, NSW 2052 Australia</nlm:aff><wicri:noCountry code="subfield">NSW 2052 Australia</wicri:noCountry></affiliation><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.412917.8</institution-id><institution>Division of Molecular & Clinical Cancer Sciences,</institution><institution>Institute of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust,</institution></institution-wrap>Manchester, M20 4BX UK</nlm:aff><wicri:noCountry code="subfield">M20 4BX UK</wicri:noCountry></affiliation>Le document en format XML
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Valle</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.412917.8</institution-id><institution>Division of Molecular & Clinical Cancer Sciences,</institution><institution>Institute of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust,</institution></institution-wrap>Manchester, M20 4BX UK</nlm:aff><wicri:noCountry code="subfield">M20 4BX UK</wicri:noCountry></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28403829</idno><idno type="pmc">5389161</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5389161</idno><idno type="RBID">PMC:5389161</idno><idno type="doi">10.1186/s12885-017-3266-9</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">000A57</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000A57</idno><idno type="wicri:Area/Pmc/Curation">000A34</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000A34</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Systemic therapy in younger and elderly patients with advanced biliary cancer: sub-analysis of ABC-02 and twelve other prospective trials</title><author><name sortKey="Mcnamara, Mairead Geraldine" sort="Mcnamara, Mairead Geraldine" uniqKey="Mcnamara M" first="Mairéad Geraldine" last="Mcnamara">Mairéad Geraldine Mcnamara</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.412917.8</institution-id><institution>Division of Molecular & Clinical Cancer Sciences,</institution><institution>Institute of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust,</institution></institution-wrap>Manchester, M20 4BX UK</nlm:aff><wicri:noCountry code="subfield">M20 4BX UK</wicri:noCountry></affiliation></author><author><name sortKey="Bridgewater, John" sort="Bridgewater, John" uniqKey="Bridgewater J" first="John" last="Bridgewater">John Bridgewater</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.83440.3b</institution-id><institution></institution><institution>UCL Cancer Institute,</institution></institution-wrap>London, WCIE 6BT UK</nlm:aff><wicri:noCountry code="subfield">WCIE 6BT UK</wicri:noCountry></affiliation></author><author><name sortKey="Lopes, Andre" sort="Lopes, Andre" uniqKey="Lopes A" first="Andre" last="Lopes">Andre Lopes</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.11485.39</institution-id><institution></institution><institution>Cancer Research UK & UCL Cancer Trials Centre,</institution></institution-wrap>London, WCIE 6BT UK</nlm:aff><wicri:noCountry code="subfield">WCIE 6BT UK</wicri:noCountry></affiliation></author><author><name sortKey="Wasan, Harpreet" sort="Wasan, Harpreet" uniqKey="Wasan H" first="Harpreet" last="Wasan">Harpreet Wasan</name><affiliation><nlm:aff id="Aff4">Imperial Healthcare, London, WI2 ONN UK</nlm:aff><wicri:noCountry code="subfield">WI2 ONN UK</wicri:noCountry></affiliation></author><author><name sortKey="Malka, David" sort="Malka, David" uniqKey="Malka D" first="David" last="Malka">David Malka</name><affiliation wicri:level="1"><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="GRID">grid.14925.3b</institution-id><institution></institution><institution>Institute Gustave Roussy,</institution></institution-wrap>94805 Villejuif, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>94805 Villejuif</wicri:regionArea></affiliation></author><author><name sortKey="Jensen, Lars Henrik" sort="Jensen, Lars Henrik" uniqKey="Jensen L" first="Lars Henrik" last="Jensen">Lars Henrik Jensen</name><affiliation wicri:level="1"><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="GRID">grid.417271.6</institution-id><institution></institution><institution>Vejle Hospital,</institution></institution-wrap>7100 Vejle, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>7100 Vejle</wicri:regionArea></affiliation></author><author><name sortKey="Okusaka, Takuji" sort="Okusaka, Takuji" uniqKey="Okusaka T" first="Takuji" last="Okusaka">Takuji Okusaka</name><affiliation wicri:level="1"><nlm:aff id="Aff7"><institution-wrap><institution-id institution-id-type="GRID">grid.272242.3</institution-id><institution></institution><institution>National Cancer Center Hospital,</institution></institution-wrap>Tokyo, 104-0045 Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Tokyo</wicri:regionArea></affiliation></author><author><name sortKey="Knox, Jennifer J" sort="Knox, Jennifer J" uniqKey="Knox J" first="Jennifer J." last="Knox">Jennifer J. Knox</name><affiliation><nlm:aff id="Aff8"><institution-wrap><institution-id institution-id-type="GRID">grid.415224.4</institution-id><institution></institution><institution>Princess Margaret Cancer Centre,</institution></institution-wrap>Toronto, M5G 2M9 Canada</nlm:aff><wicri:noCountry code="subfield">M5G 2M9 Canada</wicri:noCountry></affiliation></author><author><name sortKey="Wagner, Dorothea" sort="Wagner, Dorothea" uniqKey="Wagner D" first="Dorothea" last="Wagner">Dorothea Wagner</name><affiliation wicri:level="1"><nlm:aff id="Aff9"><institution-wrap><institution-id institution-id-type="GRID">grid.8515.9</institution-id><institution></institution><institution>Centre Hospitalier Universitaire Vaudois,</institution></institution-wrap>CH-1011 Lausanne, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>CH-1011 Lausanne</wicri:regionArea></affiliation></author><author><name sortKey="Cunningham, David" sort="Cunningham, David" uniqKey="Cunningham D" first="David" last="Cunningham">David Cunningham</name><affiliation wicri:level="1"><nlm:aff id="Aff10"><institution-wrap><institution-id institution-id-type="GRID">grid.424926.f</institution-id><institution></institution><institution>Royal Marsden Hospital,</institution></institution-wrap>London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London</wicri:regionArea></affiliation></author><author><name sortKey="Shannon, Jenny" sort="Shannon, Jenny" uniqKey="Shannon J" first="Jenny" last="Shannon">Jenny Shannon</name><affiliation><nlm:aff id="Aff11"><institution-wrap><institution-id institution-id-type="GRID">grid.1013.3</institution-id><institution></institution><institution>University of Sydney,</institution></institution-wrap>Sydney, NSW 2006 Australia</nlm:aff><wicri:noCountry code="subfield">NSW 2006 Australia</wicri:noCountry></affiliation></author><author><name sortKey="Goldstein, David" sort="Goldstein, David" uniqKey="Goldstein D" first="David" last="Goldstein">David Goldstein</name><affiliation><nlm:aff id="Aff12"><institution-wrap><institution-id institution-id-type="GRID">grid.1005.4</institution-id><institution>Prince of Wales Clinical School,</institution><institution>University of New South Wales,</institution></institution-wrap>Sydney, NSW 2052 Australia</nlm:aff><wicri:noCountry code="subfield">NSW 2052 Australia</wicri:noCountry></affiliation></author><author><name sortKey="Moehler, Markus" sort="Moehler, Markus" uniqKey="Moehler M" first="Markus" last="Moehler">Markus Moehler</name><affiliation wicri:level="1"><nlm:aff id="Aff13"><institution-wrap><institution-id institution-id-type="GRID">grid.410607.4</institution-id><institution></institution><institution>Universitätsmedizin Mainz,</institution></institution-wrap>55122 Mainz, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>55122 Mainz</wicri:regionArea></affiliation></author><author><name sortKey="Bekaii Saab, Tanios" sort="Bekaii Saab, Tanios" uniqKey="Bekaii Saab T" first="Tanios" last="Bekaii-Saab">Tanios Bekaii-Saab</name><affiliation wicri:level="2"><nlm:aff id="Aff14"><institution-wrap><institution-id institution-id-type="GRID">grid.417468.8</institution-id><institution></institution><institution>Mayo Clinic,</institution></institution-wrap>Phoenix, AZ 85054 USA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arizona</region></placeName><wicri:cityArea>Phoenix</wicri:cityArea></affiliation></author><author><name sortKey="Valle, Juan W" sort="Valle, Juan W" uniqKey="Valle J" first="Juan W." last="Valle">Juan W. Valle</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.412917.8</institution-id><institution>Division of Molecular & Clinical Cancer Sciences,</institution><institution>Institute of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust,</institution></institution-wrap>Manchester, M20 4BX UK</nlm:aff><wicri:noCountry code="subfield">M20 4BX UK</wicri:noCountry></affiliation></author></analytic><series><title level="j">BMC Cancer</title><idno type="eISSN">1471-2407</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Outcomes in younger (<40 years) and elderly (≥70 years) patients with advanced biliary cancer (ABC) receiving palliative chemotherapy are unclear. This study assessed outcomes in those receiving monotherapy or combination therapy in thirteen prospective systemic-therapy trials.</p></sec><sec><title>Methods</title><p>Multivariable analysis explored the impact of therapy on progression-free (PFS) and overall survival (OS) in two separate age cohort groups: <70 years and ≥70 years, and <40 years and ≥40 years.</p></sec><sec><title>Results</title><p>Overall, 1163 patients were recruited (Jan 1997-Dec 2013). Median age of entire cohort: 63 years (range 23–85); 36 (3%) were <40, 260 (22%); ≥70. Combination therapy was platinum-based in nine studies. Among patients <40 and ≥70 years, 23 (64%) and 182 (70%) received combination therapy, respectively. Median follow-up was 42 months (95%-CI 37–51). Median PFS for patients <40 and ≥40 years was 3.5 and 5.9 months (<italic>P</italic> = 0.12), and OS was 10.8 and 9.7 months, respectively (<italic>P</italic> = 0.55). Median PFS for those <70 and ≥70 years was 6.0 and 5.0 months (<italic>P</italic> = 0.53), and OS was 10.2 and 8.8 months, respectively (<italic>P</italic> = 0.08). For the entire cohort, PFS and OS were significantly better in those receiving combination therapy: Hazard Ratio [HR]-0.66, 95%-CI 0.58–0.76, <italic>P</italic> < 0.0001 and HR-0.72, 95%-CI 0.63–0.82, <italic>P</italic> < 0.0001, respectively; and in patients ≥70 years: HR-0.54 (95%-CI 0.38–0.77, <italic>P</italic> = 0.001) and HR-0.60 (95%-CI 0.43–0.85, <italic>P</italic> = 0.004), respectively. There was no evidence of interaction between age and treatment for PFS (<italic>P</italic> = 0.58, <italic>P</italic> = 0.66) or OS (<italic>P</italic> = 0.18, <italic>P</italic> = 0.75).</p></sec><sec><title>Conclusions</title><p>In ABC, younger patients are rare, and survival in elderly patients in receipt of systemic therapy for advanced disease, whether monotherapy or combination therapy, is similar to that of non-elderly patients, therefore age alone should not influence decisions regarding treatment.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Siegel, R" uniqKey="Siegel R">R Siegel</name></author><author><name sortKey="Naishadham, D" uniqKey="Naishadham D">D Naishadham</name></author><author><name sortKey="Jemal, A" uniqKey="Jemal A">A Jemal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Valle, J" uniqKey="Valle J">J Valle</name></author><author><name sortKey="Wasan, H" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Cancer</journal-id><journal-id journal-id-type="iso-abbrev">BMC Cancer</journal-id><journal-title-group><journal-title>BMC Cancer</journal-title></journal-title-group><issn pub-type="epub">1471-2407</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28403829</article-id><article-id pub-id-type="pmc">5389161</article-id><article-id pub-id-type="publisher-id">3266</article-id><article-id pub-id-type="doi">10.1186/s12885-017-3266-9</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Systemic therapy in younger and elderly patients with advanced biliary cancer: sub-analysis of ABC-02 and twelve other prospective trials</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>McNamara</surname><given-names>Mairéad Geraldine</given-names></name><address><phone>+44 (0)161 446 8106</phone><email>Mairead.McNamara@christie.nhs.uk</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Bridgewater</surname><given-names>John</given-names></name><address><email>j.bridgewater@ucl.ac.uk</email></address><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Lopes</surname><given-names>Andre</given-names></name><address><email>andre.lopes@ucl.ac.uk</email></address><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Wasan</surname><given-names>Harpreet</given-names></name><address><email>h.wasan@imperial.ac.uk</email></address><xref ref-type="aff" rid="Aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Malka</surname><given-names>David</given-names></name><address><email>David.Malka@gustaveroussy.fr</email></address><xref ref-type="aff" rid="Aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Jensen</surname><given-names>Lars Henrik</given-names></name><address><email>Lars.Henrik.Jensen@rsyd.dk</email></address><xref ref-type="aff" rid="Aff6">6</xref></contrib><contrib contrib-type="author"><name><surname>Okusaka</surname><given-names>Takuji</given-names></name><address><email>tokusaka@ncc.go.jp</email></address><xref ref-type="aff" rid="Aff7">7</xref></contrib><contrib contrib-type="author"><name><surname>Knox</surname><given-names>Jennifer J.</given-names></name><address><email>Jennifer.Knox@uhn.ca</email></address><xref ref-type="aff" rid="Aff8">8</xref></contrib><contrib contrib-type="author"><name><surname>Wagner</surname><given-names>Dorothea</given-names></name><address><email>Dorothea.Wagner@chuv.ch</email></address><xref ref-type="aff" rid="Aff9">9</xref></contrib><contrib contrib-type="author"><name><surname>Cunningham</surname><given-names>David</given-names></name><address><email>David.Cunningham@rmh.nhs.uk</email></address><xref ref-type="aff" rid="Aff10">10</xref></contrib><contrib contrib-type="author"><name><surname>Shannon</surname><given-names>Jenny</given-names></name><address><email>Jenny.Shannon@health.nsw.gov.au</email></address><xref ref-type="aff" rid="Aff11">11</xref></contrib><contrib contrib-type="author"><name><surname>Goldstein</surname><given-names>David</given-names></name><address><email>d.goldstein@unsw.edu.au</email></address><xref ref-type="aff" rid="Aff12">12</xref></contrib><contrib contrib-type="author"><name><surname>Moehler</surname><given-names>Markus</given-names></name><address><email>Markus.Moehler@unimedizin-mainz.de</email></address><xref ref-type="aff" rid="Aff13">13</xref></contrib><contrib contrib-type="author"><name><surname>Bekaii-Saab</surname><given-names>Tanios</given-names></name><address><email>tanios.saab@gmail.com</email></address><xref ref-type="aff" rid="Aff14">14</xref></contrib><contrib contrib-type="author"><name><surname>Valle</surname><given-names>Juan W.</given-names></name><address><email>Juan.Valle@christie.nhs.uk</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><aff id="Aff1"><label>1</label><institution-wrap><institution-id institution-id-type="GRID">grid.412917.8</institution-id><institution>Division of Molecular & Clinical Cancer Sciences,</institution><institution>Institute of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust,</institution></institution-wrap>Manchester, M20 4BX UK</aff><aff id="Aff2"><label>2</label><institution-wrap><institution-id institution-id-type="GRID">grid.83440.3b</institution-id><institution></institution><institution>UCL Cancer Institute,</institution></institution-wrap>London, WCIE 6BT UK</aff><aff id="Aff3"><label>3</label><institution-wrap><institution-id institution-id-type="GRID">grid.11485.39</institution-id><institution></institution><institution>Cancer Research UK & UCL Cancer Trials Centre,</institution></institution-wrap>London, WCIE 6BT UK</aff><aff id="Aff4"><label>4</label>Imperial Healthcare, London, WI2 ONN UK</aff><aff id="Aff5"><label>5</label><institution-wrap><institution-id institution-id-type="GRID">grid.14925.3b</institution-id><institution></institution><institution>Institute Gustave Roussy,</institution></institution-wrap>94805 Villejuif, France</aff><aff id="Aff6"><label>6</label><institution-wrap><institution-id institution-id-type="GRID">grid.417271.6</institution-id><institution></institution><institution>Vejle Hospital,</institution></institution-wrap>7100 Vejle, Denmark</aff><aff id="Aff7"><label>7</label><institution-wrap><institution-id institution-id-type="GRID">grid.272242.3</institution-id><institution></institution><institution>National Cancer Center Hospital,</institution></institution-wrap>Tokyo, 104-0045 Japan</aff><aff id="Aff8"><label>8</label><institution-wrap><institution-id institution-id-type="GRID">grid.415224.4</institution-id><institution></institution><institution>Princess Margaret Cancer Centre,</institution></institution-wrap>Toronto, M5G 2M9 Canada</aff><aff id="Aff9"><label>9</label><institution-wrap><institution-id institution-id-type="GRID">grid.8515.9</institution-id><institution></institution><institution>Centre Hospitalier Universitaire Vaudois,</institution></institution-wrap>CH-1011 Lausanne, Switzerland</aff><aff id="Aff10"><label>10</label><institution-wrap><institution-id institution-id-type="GRID">grid.424926.f</institution-id><institution></institution><institution>Royal Marsden Hospital,</institution></institution-wrap>London, UK</aff><aff id="Aff11"><label>11</label><institution-wrap><institution-id institution-id-type="GRID">grid.1013.3</institution-id><institution></institution><institution>University of Sydney,</institution></institution-wrap>Sydney, NSW 2006 Australia</aff><aff id="Aff12"><label>12</label><institution-wrap><institution-id institution-id-type="GRID">grid.1005.4</institution-id><institution>Prince of Wales Clinical School,</institution><institution>University of New South Wales,</institution></institution-wrap>Sydney, NSW 2052 Australia</aff><aff id="Aff13"><label>13</label><institution-wrap><institution-id institution-id-type="GRID">grid.410607.4</institution-id><institution></institution><institution>Universitätsmedizin Mainz,</institution></institution-wrap>55122 Mainz, Germany</aff><aff id="Aff14"><label>14</label><institution-wrap><institution-id institution-id-type="GRID">grid.417468.8</institution-id><institution></institution><institution>Mayo Clinic,</institution></institution-wrap>Phoenix, AZ 85054 USA</aff></contrib-group><pub-date pub-type="epub"><day>12</day><month>4</month><year>2017</year></pub-date><pub-date pub-type="pmc-release"><day>12</day><month>4</month><year>2017</year></pub-date><pub-date pub-type="collection"><year>2017</year></pub-date><volume>17</volume><elocation-id>262</elocation-id><history><date date-type="received"><day>23</day><month>12</month><year>2016</year></date><date date-type="accepted"><day>5</day><month>4</month><year>2017</year></date></history><permissions><copyright-statement>© The Author(s). 2017</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>Outcomes in younger (<40 years) and elderly (≥70 years) patients with advanced biliary cancer (ABC) receiving palliative chemotherapy are unclear. This study assessed outcomes in those receiving monotherapy or combination therapy in thirteen prospective systemic-therapy trials.</p></sec><sec><title>Methods</title><p>Multivariable analysis explored the impact of therapy on progression-free (PFS) and overall survival (OS) in two separate age cohort groups: <70 years and ≥70 years, and <40 years and ≥40 years.</p></sec><sec><title>Results</title><p>Overall, 1163 patients were recruited (Jan 1997-Dec 2013). Median age of entire cohort: 63 years (range 23–85); 36 (3%) were <40, 260 (22%); ≥70. Combination therapy was platinum-based in nine studies. Among patients <40 and ≥70 years, 23 (64%) and 182 (70%) received combination therapy, respectively. Median follow-up was 42 months (95%-CI 37–51). Median PFS for patients <40 and ≥40 years was 3.5 and 5.9 months (<italic>P</italic> = 0.12), and OS was 10.8 and 9.7 months, respectively (<italic>P</italic> = 0.55). Median PFS for those <70 and ≥70 years was 6.0 and 5.0 months (<italic>P</italic> = 0.53), and OS was 10.2 and 8.8 months, respectively (<italic>P</italic> = 0.08). For the entire cohort, PFS and OS were significantly better in those receiving combination therapy: Hazard Ratio [HR]-0.66, 95%-CI 0.58–0.76, <italic>P</italic> < 0.0001 and HR-0.72, 95%-CI 0.63–0.82, <italic>P</italic> < 0.0001, respectively; and in patients ≥70 years: HR-0.54 (95%-CI 0.38–0.77, <italic>P</italic> = 0.001) and HR-0.60 (95%-CI 0.43–0.85, <italic>P</italic> = 0.004), respectively. There was no evidence of interaction between age and treatment for PFS (<italic>P</italic> = 0.58, <italic>P</italic> = 0.66) or OS (<italic>P</italic> = 0.18, <italic>P</italic> = 0.75).</p></sec><sec><title>Conclusions</title><p>In ABC, younger patients are rare, and survival in elderly patients in receipt of systemic therapy for advanced disease, whether monotherapy or combination therapy, is similar to that of non-elderly patients, therefore age alone should not influence decisions regarding treatment.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Biliary cancer</kwd><kwd>Younger patients</kwd><kwd>Elderly</kwd><kwd>Systemic therapy</kwd><kwd>Prospective trials</kwd></kwd-group><funding-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/501100000289</institution-id><institution>Cancer Research UK</institution></institution-wrap></funding-source><award-id>C1813/A4853</award-id><award-id>C444/A15953</award-id><principal-award-recipient><name><surname>Lopes</surname><given-names>Andre</given-names></name><name><surname>Valle</surname><given-names>Juan W.</given-names></name></principal-award-recipient></award-group></funding-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2017</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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