{"id":26916,"date":"2021-03-30T22:45:15","date_gmt":"2021-03-30T22:45:15","guid":{"rendered":"https:\/\/scienceblog.cancerresearchuk.org\/?p=18408"},"modified":"2024-11-03T15:14:59","modified_gmt":"2024-11-03T15:14:59","slug":"a-significant-step-forwards-treating-patients-with-advanced-biliary-tract-cancers","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/a-significant-step-forwards-treating-patients-with-advanced-biliary-tract-cancers\/","title":{"rendered":"\u2018A significant step forwards\u2019 \u2013 treating patients with advanced biliary tract cancers"},"content":{"rendered":"
A graphic showing the location of the bile duct, gallbladder and pancreas. <\/p>

” data-medium-file=”https:\/\/scienceblog.cancerresearchuk.org\/wp-content\/uploads\/2021\/03\/FOLFOX_hero-300×168.jpg” data-large-file=”https:\/\/scienceblog.cancerresearchuk.org\/wp-content\/uploads\/2021\/03\/FOLFOX_hero.jpg”><\/p><\/div>

Medical research very rarely has a single end point. There is often no final answer, or silver bullet, the science just continues to evolve, and with it, there will always be more to do, understand and investigate.
But sometimes it reaches a tipping point, where the knowledge that\u2019s been built up actually alters medical practice.
10 years ago, a team of our investigators published the results of a clinical trial that changed the way biliary tract cancer is treated. The Advanced Biliary tract Cancer (ABC)-02 trial<\/a> was the biggest trial of its kind, showing an improvement in survival from a new combination of drugs \u2013 gemcitabine<\/span><\/span><\/a> and<\/span><\/span> cisplatin<\/span><\/span><\/a>,<\/span><\/span> compared to<\/span><\/span> gemcitabine on its own<\/span><\/span>.<\/span><\/span><\/p>\n

To this day, that same combination of chemotherapy is offered as an initial therapy option for people with biliary tract cancers worldwide. But over a decade on from the publication of the initial trial, a follow up study, ABC-06, is pushing the research even further, searching for chemotherapy options for people with advanced biliary tract cancer, who are no longer benefitting from this initial treatment.<\/p>\n

And once again, the results from the latest trial have led to a change in practice, providing a new, widely accepted standard of care for patients with advanced biliary tract cancer.<\/p>\n

We spoke to Dr Angela Lamarca and Prof Juan W Valle, lead authors on the latest paper, published in The Lancet Oncology<\/em> about the next steps for the community of researchers dedicated to biliary tract cancers, and its impact for patients.<\/p>\n

An option for advanced<\/span><\/span> biliary tract cancer<\/span><\/span>s<\/span><\/span><\/h2>\n

\u201cBiliary tract cancers are quite rare,\u201d says Lamarca, \u201cand the problem is that for many years,<\/span> since the publication of ABC<\/span>\u2013<\/span>02,<\/span> there has been a<\/span> general<\/span> lack of<\/span> new chemotherapy options changing practice<\/span>.<\/span>\u201d<\/span><\/p>\n

But that\u2019s changing.<\/span><\/p>\n

\n

What is biliary tract cancer?<\/span><\/h3>\n

Biliary tract cancer includes bile duct cancer<\/span> (cholangiocarcinoma)<\/span>, gallbladder cancer, and ampulla of Vater cancer.<\/span> These cancer types are extremely rare \u2013 there are around 1,100 new gallbladder cancer cases and around 1,200 new biliary tract cancer cases in the UK each year.<\/span><\/p>\n<\/p><\/div>\n

\u201cThere\u2019s quite a lot of research looking into biliary tract cancers right now, with a lot of it focusing on precision medicine and new targeted treatments.\u201d Lamarca explains that the focus on precision medicine is because researchers have identified a proportion of patients with specific mutations in their cancers that can be treated successfully with new therapies.<\/p>\n

It\u2019s an exciting avenue, but it\u2019s not for everyone, \u201cthe problem is that, in reality, precision medicine is only applicable to a small proportion of all patients diagnosed with biliary tract cancer\u201d.<\/p>\n

The UK-led Advanced Biliary Cancer working group team wanted to take a different approach and designed the ABC-06 clinical trial (led by Professor Juan W Valle), focusing on people whose cancer had progressed despite initial treatment with chemotherapy, where new treatment options are desperately needed.<\/p>\n

So Valle and the rest of the team set out to establish whether an existing chemotherapy, known as FOLFOX, could be an effective option for this group.<\/p>\n

\u201cFOLFOX is a very well-known type of combination chemotherapy, which has been used in oncology for many, many years,\u201d says Valle. \u201cWe just didn\u2019t really know whether it was effective in this setting.\u201d<\/p>\n

But thanks to the Cancer Research UK and Stand Up To Cancer-funded ABC-06 trial, now they do. Based on their findings, there\u2019s now evidence to suggest that second-line chemotherapy could be of value for this group of patients.<\/p>\n

What<\/span><\/span> did the<\/span><\/span> trial<\/span><\/span> entail?<\/span><\/span><\/h2>\n

To get the numbers needed for the trial, the team went nationwide, collecting data from 20 centres across the country. 162 people took part, all of whom had already been treated with gemcitabine and cisplatin, and whose cancer had grown despite that chemotherapy.<\/p>\n

\u201cWe recruited a total of 162 patients, 81 patients in each of the 2 groups,\u201d explains Lamarca. One group was treated with FOLFOX, and the other with the standard of care in the UK for someone who\u2019s already had treatment at the time when the study was running, something known as active symptom control (without chemotherapy).<\/p>\n

Lamarca says that although the active symptom control group didn\u2019t have chemotherapy, that doesn\u2019t mean they didn\u2019t receive any care. \u201cWe were doing monthly reviews and every patient, even if they were feeling well, would come into the clinic. In doing that, we were able to identify early some of the cancer-related complications and proactively manage them.\u201d<\/p>\n

People on both arms of the trial were followed for a total of 12 months. And after 5 years of recruitment, the results are in.<\/p>\n

Taking a closer look at the results<\/span><\/span><\/h2>\n

\u201cThe interpretation of the results is quite complex,\u201d Valle comments. \u201cBut the main finding to focus on is that overall survival was improved by the use of FOLFOX.\u201d<\/p>\n

The reason the results are difficult to analyse Valle explains, is that the average overall survival for people on active symptom control was 5.3 months, compared to 6.2 months in the group that also had FOLFOX.
But while that difference doesn\u2019t seem huge, the number of people alive one year after starting treatment doubled in the group taking FOLFOX.<\/p>\n

Over half (51%) of people taking FOLFOX were alive at the 6-month follow up, compared with 36% of those on active symptom control alone. And a year after follow-up, 26% of people taking FOLFOX were alive, compared with 11% of those in the control arm.<\/p>\n

Lamarca says it\u2019s an important reminder to not just focus on the median (average) overall survival, but to also look at overall survival rates over time.<\/p>\n

\u201cAnd they\u2019re telling you that a proportion of patients will benefit in the longer term and will still be alive at 6 months and 12 months in the (FOLFOX) chemotherapy arm, than in the in the active symptom control arm.\u201d<\/p>\n

For Lamarca and her team, their next challenge is to understand exactly why some patients respond so well to the chemotherapy, while others don\u2019t.<\/p>\n

A<\/span><\/span> significant<\/span><\/span> step<\/span><\/span> forwards<\/span><\/span><\/h2>\n

Lamarca is<\/span> optimistic about the results<\/span> and the real-life impact for patients with ABC.<\/span> \u201cFOLFOX has moved from being a<\/span> \u201c<\/span>possibility<\/span>\u201d<\/span> mentioned by some guidelines, but without really very strong evidence<\/span>,<\/span> to be<\/span>ing<\/span> a worldwide accepted standard of care<\/span> treatment<\/span> with high-level evidence provided by the ABC-06 study,<\/span> and<\/span> is now being<\/span> considered<\/span> as a definitive option of second line treatment.\u201d<\/span><\/p>\n

But w<\/span>hile the<\/span>re is lots to be hopeful for,<\/span> Valle<\/span> remains<\/span> cautious<\/span> that ther<\/span>e\u2019<\/span>s still more work to<\/span> do, \u201c<\/span>we<\/span> still need<\/span> to look for<\/span> better options of chemotherapy<\/span>\u201d<\/span>.<\/span><\/p>\n

Valle<\/span> adds that although th<\/span>e results<\/span> ha<\/span>ve<\/span> allowed<\/span> oncologists to have<\/span> a<\/span>n informed<\/span> conversation<\/span> with their patients<\/span>, with facts and figures that we previously didn\u2019t have, the decision to take FOLFOX as a second treatment is ultimately up to the patient.<\/span><\/p>\n

Lamarca<\/span> says, \u201cthere will<\/span> still<\/span> be patients who may still not want treatment, because<\/span> of the<\/span> toxicity<\/span> and<\/span> the<\/span> additional<\/span> number<\/span> of visits to hospital<\/span>; because of the limited<\/span> improvement in overall survival, they may they say that i<\/span>t\u2019<\/span>s not for them<\/span>.<\/span><\/p>\n

\u201c<\/span>B<\/span>ut at least now we have the information for us to<\/span> support our patients<\/span> mak<\/span>ing<\/span> that decision.\u201d<\/span><\/p>\n

The results from ABC-06 ha<\/span>ve<\/span> proved that although FOLFOX is not<\/span> the answer for all patients<\/span>,<\/span> i<\/span>t\u2019s<\/span> progress<\/span>.<\/span><\/p>\n

\u201c<\/span>I<\/span>t<\/span> may just be<\/span> a step forward<\/span>,\u201d Lamarca concludes<\/span>.<\/span> \u201c<\/span>A<\/span>nd<\/span> while<\/span> we<\/span> still<\/span> need to improve the benefit that the patients get from chemotherapy in this setting<\/span>,<\/span> it\u2019s still<\/span> a critical step in the right direction<\/span>.\u201d<\/span><\/p>\n

Lilly<\/em><\/p>\n

More on this topic<\/h3>\n<\/p>\n

Source<\/a><\/p>","protected":false},"excerpt":{"rendered":"Medical research very rarely has a single end point. There is often no final answer, or silver bullet, the science just continues to evolve, and with it, there will always be more to do, understand and investigate.But sometimes it reaches a tipping point, where the knowledge that\u2019s been built up actually alters medical practice.10 years [...]","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[5137],"tags":[],"class_list":["post-26916","post","type-post","status-publish","format-standard","hentry","category-world-news"],"_links":{"self":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26916","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/comments?post=26916"}],"version-history":[{"count":1,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26916\/revisions"}],"predecessor-version":[{"id":43884,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/26916\/revisions\/43884"}],"wp:attachment":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media?parent=26916"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/categories?post=26916"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/tags?post=26916"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}