Systemic therapy in younger and elderly patients with advanced biliary cancer: Sub-analysis of ABC-02 and twelve other prospective trials

Mairéad Geraldine McNamara, John Bridgewater, Andre Lopes, Harpreet Wasan, David Malka, Lars Henrik Jensen, Takuji Okusaka, Jennifer J. Knox, Dorothea Wagner, David Cunningham, Jenny Shannon, David Goldstein, Markus Moehler, Tanios Bekaii-Saab, Juan W. Valle

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9 Scopus citations


Background: Outcomes in younger (<40years) and elderly (≥70years) 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. Methods: Multivariable analysis explored the impact of therapy on progression-free (PFS) and overall survival (OS) in two separate age cohort groups: <70years and ≥70years, and <40years and ≥40years. Results: Overall, 1163 patients were recruited (Jan 1997-Dec 2013). Median age of entire cohort: 63years (range 23-85); 36 (3%) were <40, 260 (22%); ≥70. Combination therapy was platinum-based in nine studies. Among patients <40 and ≥70years, 23 (64%) and 182 (70%) received combination therapy, respectively. Median follow-up was 42months (95%-CI 37-51). Median PFS for patients <40 and ≥40years was 3.5 and 5.9months (P=0.12), and OS was 10.8 and 9.7months, respectively (P=0.55). Median PFS for those <70 and ≥70years was 6.0 and 5.0months (P=0.53), and OS was 10.2 and 8.8months, respectively (P=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, P<0.0001 and HR-0.72, 95%-CI 0.63-0.82, P<0.0001, respectively; and in patients ≥70years: HR-0.54 (95%-CI 0.38-0.77, P=0.001) and HR-0.60 (95%-CI 0.43-0.85, P=0.004), respectively. There was no evidence of interaction between age and treatment for PFS (P=0.58, P=0.66) or OS (P=0.18, P=0.75). Conclusions: 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.

Original languageEnglish (US)
Article number262
JournalBMC cancer
Issue number1
StatePublished - Apr 12 2017


  • Biliary cancer
  • Elderly
  • Prospective trials
  • Systemic therapy
  • Younger patients

ASJC Scopus subject areas

  • Oncology
  • Genetics
  • Cancer Research


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