Treatment patterns and survival in older adults with unresected nonmetastatic biliary tract cancers

Ali Belkouz; Elise de Savornin Lohman; Jyothi R Thumma; Bas Groot Koerkamp; Philip R de Reuver; Martijn G H van Oijen; Cornelis J A Punt; Hari Nathan; Heinz-Josef Klümpen

doi:10.1016/j.jgo.2023.101447

Treatment patterns and survival in older adults with unresected nonmetastatic biliary tract cancers

J Geriatr Oncol. 2023 Apr;14(3):101447. doi: 10.1016/j.jgo.2023.101447. Epub 2023 Feb 26.

Authors

Ali Belkouz¹, Elise de Savornin Lohman², Jyothi R Thumma³, Bas Groot Koerkamp⁴, Philip R de Reuver², Martijn G H van Oijen⁵, Cornelis J A Punt⁶, Hari Nathan³, Heinz-Josef Klümpen⁷

Affiliations

¹ Amsterdam UMC, Dept. of Medical Oncology, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
² Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
³ Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
⁴ Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
⁵ Amsterdam UMC, Dept. of Medical Oncology, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
⁶ Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
⁷ Amsterdam UMC, Dept. of Medical Oncology, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands. Electronic address: h.klumpen@amsterdamumc.nl.

PMID: 36848749
DOI: 10.1016/j.jgo.2023.101447

Abstract

Introduction: The optimal treatment for unresected nonmetastatic biliary tract cancer (uBTC) is not well-established. The objective of this study was to analyze the treatment patterns and compare the differences in overall survival (OS) between different treatment strategies amongst older adults with uBTC.

Materials and methods: We identified patients aged ≥65 years with uBTC using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2004-2015). Treatments were classified into chemotherapy, chemoradiotherapy, and radiotherapy. The primary outcome was OS. The differences in OS were analyzed using Kaplan-Meier curves and multivariable Cox proportional hazard regression.

Results: A total of 4352 patients with uBTC were included. The median age was 80 years and median OS was 4.1 months. Most patients (67.3%, n = 2931) received no treatment, 19.1% chemotherapy (n = 833), 8.1% chemoradiotherapy (n = 354), and 5.4% radiotherapy alone (n = 234). Patients receiving no treatment were older and had more comorbidities. Chemotherapy was associated with significantly longer OS than no treatment in uBTC (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.79-0.95), but no difference was found in the subgroups of intrahepatic cholangiocarcinoma (iCCA; HR 0.87, 95% CI 0.75-1.00) and gallbladder carcinoma (GBC; HR 1.09, 95% CI 0.86-1.39). In the sensitivity analyses, capecitabine-based chemoradiotherapy showed significantly longer OS in uBTC compared to chemotherapy (adjusted HR 0.71, 95% CI 0.53-0.95).

Discussion: A minority of older patients with uBTC receive systemic treatments. Chemotherapy was associated with longer OS compared to no treatment in uBTC, but not in the subgroups of iCCA and GBC. The efficacy of chemoradiotherapy, especially in perihilar cholangiocarcinoma using capecitabine-based chemoradiotherapy, may be further evaluated in prospective clinical trials.

Keywords: Biliary tract neoplasms; Chemoradiotherapy; Chemotherapy; Cholangiocarcinoma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Biliary Tract Neoplasms* / drug therapy
Capecitabine
Chemoradiotherapy
Humans
Medicare*
Prospective Studies
Treatment Outcome
United States

Substances

Capecitabine