SynthesisInternational journal of surgery (London, England)2026
Comparison of second-line chemotherapy regimens in advanced biliary tract cancer: a systematic review, meta-analysis, and population-based cohort study.
Synthesis in International journal of surgery (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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9 authors.
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Abstract
backgroundBiliary 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.
methodsWe 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.
resultsIn our cohort, median PFS and OS were 2 · 7 and 8 · 9 months, respectively. ORR was 12 · 5%, and DCR was 52 · 1%, with 4 · 2% achieving complete response. Meta-analysis revealed pooled PFS and OS for FOLFIRINOX at 4 · 15 and 8 · 91 months, respectively, suggesting a potential benefit over FOLFIRI and FOLFOX. Grade 3-5 neutropenia occurred in 40 · 7% of patients, leading to dose reductions in 29.6% but low discontinuation rates (3 · 7%).
conclusionFOLFIRINOX 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.
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