Comparison of second-line chemotherapy regimens in advanced biliary tract cancer: a systematic review, meta-analysis, and population-based cohort study

Abstract

Background:Biliary tract cancers (BTCs) are aggressive malignancies with limited treatment options, especially after first-line chemotherapy failure. FOLFIRINOX, though established for pancreatic cancer, has shown promise in advanced BTC, yet its role as a second-line treatment remains unclear. To address this gap, we conducted a retrospective cohort study to evaluate the efficacy and safety of FOLFIRINOX and performed a systematic review with meta-analysis to compare its outcomes with currently recommended regimens, including FOLFIRI, FOLFOX, and nal-IRI/FL.Methods:We retrospectively analyzed 54 patients with BTC treated with FOLFIRINOX as second-line therapy after progression on first-line chemotherapy at a single tertiary hospital between 2011 and 2022. A systematic review and meta-analysis, registered with PROSPERO, incorporated 21 studies comparing second-line regimens for BTC, assessing progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and safety.Results:In our cohort, median PFS and OS were 2 <middle dot> 7 and 8 <middle dot> 9 months, respectively. ORR was 12 <middle dot> 5%, and DCR was 52 <middle dot> 1%, with 4 <middle dot> 2% achieving complete response. Meta-analysis revealed pooled PFS and OS for FOLFIRINOX at 4 <middle dot> 15 and 8 <middle dot> 91 months, respectively, suggesting a potential benefit over FOLFIRI and FOLFOX. Grade 3-5 neutropenia occurred in 40 <middle dot> 7% of patients, leading to dose reductions in 29.6% but low discontinuation rates (3 <middle dot> 7%).Conclusion:FOLFIRINOX demonstrates numerically favorable outcomes compared to current second-line regimens for advanced BTC, with manageable toxicities. These findings suggest FOLFIRINOX as a potential second-line option, warranting further prospective validation and patient selection refinement.