Multi-institutional retrospective analysis of FOLFIRI in patients with advanced biliary tract cancers

Jonathan D Mizrahi; Valerie Gunchick; Kabir Mody; Lianchun Xiao; Phanikeerthi Surapaneni; Rachna T Shroff; Vaibhav Sahai

doi:10.4251/wjgo.v12.i1.83

Multi-institutional retrospective analysis of FOLFIRI in patients with advanced biliary tract cancers

World J Gastrointest Oncol. 2020 Jan 15;12(1):83-91. doi: 10.4251/wjgo.v12.i1.83.

Authors

Jonathan D Mizrahi¹, Valerie Gunchick², Kabir Mody³, Lianchun Xiao⁴, Phanikeerthi Surapaneni³, Rachna T Shroff⁵, Vaibhav Sahai²

Affiliations

¹ Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77005, United States. jdmizrahi@mdanderson.org.
² Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States.
³ Division of Medical Oncology, Mayo Clinic Cancer Center, Jacksonville, FL 32224, United States.
⁴ Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77005, United States.
⁵ University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, United States.

Abstract

Background: Gemcitabine plus platinum is the standard of care first-line treatment for advanced biliary tract cancers (BTC). There is no established second-line therapy, and retrospective reviews report median progression-free survival (PFS) less than 3 mo on second-line therapy. 5-Fluorouracil plus irinotecan (FOLFIRI) is a commonly used regimen in patients with BTC who have progressed on gemcitabine plus platinum, though there is a paucity of data regarding its efficacy in this population.

Aim: To assess the efficacy of FOLFIRI in patients with biliary tract cancers.

Methods: We retrospectively identified patients with advanced BTC who were treated with FOLFIRI at MD Anderson, University of Michigan and Mayo Clinic in Jacksonville. Data were collected on patient demographics, BTC subtype, response per RECIST v1.1, progression and survival.

Results: Ninety-eight patients were included of which 74 (75%) had metastatic and 24 (25%) had locally advanced disease at the time of treatment with FOLFIRI. The median age was 60 (range, 22-86) years. The number of patients with extrahepatic cholangiocarcinoma, gall bladder cancer and intrahepatic cholangiocarcinoma were 10, 17 and 71, respectively. FOLFIRI was used as 1^st, 2^nd, 3^rd or 4^th - N^th lines in 8, 50, 36 and 4 patients, respectively. Median duration on FOLFIRI in the entire cohort was 2.2 (range, 0.5-8.4) mo. The median PFS and overall survival were 2.4 (95% confidence interval (CI): 1.7-3.1) and 6.6 (95%CI: 4.7-8.4) mo, respectively. Median PFS for patients treated with FOLFIRI in 1^st, 2^nd, 3^rd or 4^th - N^th lines were 3.1, 2.5, 2.3 and 1.5 mo, respectively. Eighteen patients received concurrent bevacizumab (n = 13) or EGFR-targeted therapy (n = 5) with FOLFIRI, with a median PFS of 2.7 mo (95%CI: 1.7-5.1).

Conclusion: In this largest multi-institution retrospective review of 98 patients with BTC treated with FOLFIRI, efficacy appears to be modest with outcomes similar to other cytotoxic chemotherapy regimens.

Keywords: Biliary tract neoplasms; Cholangiocarcinoma; Fluorouracil; Irinotecan; Retrospective studies.

Abstract

Grants and funding