Second-line FOLFOX chemotherapy for advanced biliary tract cancer – Authors' reply

Tiffany Foo and colleagues, Giovanni Brandi and colleagues, and Raja Pramanik and colleagues suggested other stratification factors such as progression-free survival after first-line chemotherapy of at least 6 months, previous resection, pretreatment serum CA19.9, peritoneal carcinomatosis, primary...

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Published in:The lancet oncology 2021-07, Vol.22 (7), p.e288-e289
Main Authors: Lamarca, Angela, Palmer, Daniel H, Wasan, Harpreet Singh, Ross, Paul J, Ma, Yuk Ting, Arora, Arvind, Falk, Stephen, Gillmore, Roopinder, Wadsley, Jonathan, Patel, Kinnari, Anthoney, Alan, Maraveyas, Anthony, Iveson, Tim, Waters, Justin S, Hobbs, Claire, Barber, Safia, Ryder, W David, Ramage, John, Davies, Linda M, Bridgewater, John A, Valle, Juan W
Format: Article
Language:English
Subjects:
Biliary tract
Cancer
Cancer therapies
Chemotherapy
Cisplatin
Gastric cancer
Gemcitabine
Peritoneum
Survival
Tumors
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Summary:Tiffany Foo and colleagues, Giovanni Brandi and colleagues, and Raja Pramanik and colleagues suggested other stratification factors such as progression-free survival after first-line chemotherapy of at least 6 months, previous resection, pretreatment serum CA19.9, peritoneal carcinomatosis, primary tumour site, and molecular profiling results. Platinum sensitivity has never been defined for biliary tract cancer; rather than using an arbitrary cutoff of 6 months, we tailored our definition to this cancer—namely, progression more than 90 days after day 1 of the last cycle of first-line cisplatin and gemcitabine, derived from 9 months' progression-free survival with cisplatin–gemcitabine minus 6 months of chemotherapy.2 Use of tumour markers as stratification factors in advanced disease has the difficulty of selecting a priori a clinically meaningful cutoff for high versus low categories. [...]we advise against directly extrapolating the (modest) benefit identified from FOLFOX to other chemotherapy strategies, as suggested by Pramanik and colleagues; adequately designed and powered trials are necessary to test other regimens.
ISSN:1470-2045
1474-5488
DOI:10.1016/S1470-2045(21)00341-7