Oncologist Dr. Milind Javel provides an overview of first- and subsequent-line treatments for patients with cholangiocarcinoma.
Milind Javle, MD: For patients who do not have actionable mutations, the first-line chemotherapy is still based on the ABC-02 trial, which is gemcitabine and cisplatin. While this is the standard of care, it’s relatively suboptimal. The response rate is in the 20% to 30% range, progression-free survival of 6 to 8 months, and overall survival of 11 months. Therefore, although it is a standard, this is a standard that we hope we can change with therapy. There have been many promising trials, including one recently conducted in the United States with gemcitabine, cisplatin, and Abraxane [paclitaxel] that we hope will change this paradigm.
In the second-line setting, the ABC-06 trial investigated the use of FOLFOX [folinic acid, fluorouracil, oxaliplatin], which is the standard chemotherapy used in colon cancer, and also used in cholangiocarcinoma. Again, it is very modest in terms of how effective it is, with a 5% response rate, progression-free survival of 4 months, and overall survival of only 6 months. Clearly, this is an area that needs further investigation, and cholangiocarcinoma represents an area of great unmet need.
Going back to our patient, she received appropriate first-line treatment, gemcitabine and cisplatin. She had a good ECOG [The Eastern Cooperative Oncology Group] performance status of 1. She handled the treatment, however not surprisingly, she experienced disease progression and the tumor stopped responding after a few months of therapy.
Transcript edited for clarity.
Case: A 61-Year-Old Woman with Metastatic Cholangiocarcinoma