ArticleCancer management and research2026
Gemcitabine-Based versus Fluoropyrimidine-Based Chemotherapy and Role of Platinum Combination for First-Line Palliative Systemic Treatment in Advanced Ampullary Adenocarcinoma.
Article in Cancer management and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Ampullary adenocarcinoma is a rare malignancy with limited evidence on the efficacy of systemic chemotherapy for advanced disease. This study aimed to evaluate the treatment outcomes of gemcitabine- and fluoropyrimidine-based regimens and the benefits of platinum combination therapy. Patients and Methods: This retrospective study reviewed the data of patients with advanced ampullary adenocarcinoma treated at a university hospital in Southern Thailand between 2005 and 2024. Results: Among the 97 patients, 71 (73.2%) received palliative chemotherapy, including 43 (60.6%) receiving gemcitabine-based regimens and 28 (39.4%) receiving fluoropyrimidine-based regimens. Median overall survival (OS) and progression-free survival (PFS) for gemcitabine-based vs. fluoropyrimidine-based regimens were 14.4 vs. 11.5 months (adjusted hazard ratio [HR] 0.85; 95% CI 0.34-2.13; P = 0.725) and 8.67 vs. 7.18 months (adjusted HR 0.60; 95% CI 0.26-1.36; P = 0.219), respectively. No significant difference in OS or PFS was observed between platinum combination and single-agent chemotherapy. The objective response rate (ORR) was 9.3% for gemcitabine-based therapy, 14.3% for fluoropyrimidine-based therapy, and 26.9% for platinum combination therapy, compared to 2.2% for monotherapy. Conclusion: Gemcitabine- and fluoropyrimidine-based regimens demonstrated comparable survival outcomes. Platinum-combination chemotherapy was associated with a higher ORR, but no significant OS or PFS benefit was observed. Therefore, platinum-combination regimens may be considered in selected patients requiring tumor shrinkage, and these findings should be interpreted as hypothesis-generating real-world evidence.
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