supported by an independent educational grant from · 2019-09-19 · patients with advanced biliary...

Supported by an Independent Educational Grant from

MEETING SUMMARY

AASLD 2016, BOSTON USANOVEMBER 11TH TO 15TH 2016

DR. MOHAMED BOUATTOUR

HÔPITAL UNIVERSITAIRE BEAUJON, PARIS, FRANCE

NON-HCC HEPATIC MALIGNANCIES

T RA N S L AT I N G T H E A B C- 0 2 T R I A L I N TO DA I LY P RACT I C E : O U TCO M E O F PA L L I AT I V E T R E AT M E N T I N PAT I E N T S W I T H A DVA N C E D B I L I A RY T RACT CA N C E R

T R E AT E D W I T H G E M C I TA B I N E A N D C I S P L AT I N

MARCIA GASPERSZ ET AL

Centers: Rotterdam, Amsterdam, Zwolle, Breda, Hoorn, Den Bosch, Arnhem, Nijmegen, Hilversum,

Alkmaar, Apeldoorn (NETHERLANDS)

4* Valle J. et al. New Eng J Med 2010

AIMS

Gemcitabine and cisplatin is the standard of care in patients with advanced biliary tract cancer based on the ABC-02 trial*

To evaluate this chemotherapy regimen in clinical practice

5* PS: performance status, GFR: Glomerular filtration rate

METHODS

2010-2015

208 patients included

Inclusion criteria ABC-02 trial

PS: 0-2

Bilirubin ≤ 1.5 ULN

AST/ALT ≤ 5 ULN

Creatinin ≤ 1.5 ULN and GFR ≥ 45 ml/min

Group 1N = 71

Group 2N = 61

Group 3N = 65

• Patients received chemotherapy

• Met the criteria of the ABC-02 trial

• Patients received chemotherapy

• Did not meet the criteria of ABC-02 trial

Best supportive care without

chemotherapy

6

MAIN RESULTS

Overall survival Progression free survivalGroup 1 = 9.7 months (95%CI: 7.1 -12.3 ) Group 2 = 9.4 months (95%CI: 7.2 - 11.6 ) Group 3 = 7.6 months (95%CI: 5.0 -10.2 ) p = 0.729 (group 1 versus 2) p = 0.011 (group 1 and 2 versus 3 )

Group 1 = 6.0 months (95%CI: 4.6- 7.4) Group 2 = 4.6 months (95%CI: 3.3- 5.9) (p=0.789)

Toxicities were similar between Groups 1 and 2

7

CONCLUSION

First line treatment with gemcitabin and cisplatin appearssafe and efficient in routine use for patients with advancedbiliary tract cancer

SURVEILLANCE FOR HEPATOBILIARY CANCER IN PRIMARY SCLEROSING

CHOLANGITIS

NAVINE NASSER-GHODSI ET AL

Centers: Phoenix Amarillo, Rochester, Sacramento, Philadelphia, UNITED STATES

9

AIM

The utility of surveillance program by imaging in patients with Primary Sclerosing Cholangitis (PSC) to detect biliary tract cancer and its impact on the outcome

10

METHODS

1992-2012

Surveillance program: annual imaging (US, CT, or MR)

serum CA 19-9

Diagnosis of biliary tract cancer histopathologically confirmed

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MAIN RESULTS

Biliary tract cancer (n=31)

Surveillance program group

(n=9)

No surveillance program group

(n=22)

Surveillance group No surveillance group p

5-year survival rate 65% 51% 0.5

Cancer-related deaths 33% 41% 0.5

Liver transplantation 67% 55% 0.42

Patients with PSC (n=763)

12

CONCLUSION

Surveillance program in PSC patients seems to have a positive impact on outcome of patients

Larger studies are needed to confirm these results

A COMPARISON OF PROGNOSTIC SCHEMES FOR PERIHILARCHOLANGIOCARCINOMA

STEFAN BUETTNER ET AL

Centers: Rotterdam, NETHERLANDS – Baltimore, Atlanta, Stanford, Nashville, Missouri, Madison, Louisville Winston-Salem, Columbus, New York,

UNITED STATES - Verona, ITALY

14* American Joint Committee on Cancer: AJCC

AIMS

Limitation of the AJCC* staging system for perihilarcholangiocarcinoma (PHC)

Validation of a proposed nomogram

15

METHODS

1998-2014

407 patients resected for PHC

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MAIN RESULTS (1)

Nomogram based on: age, lymphovascular invasion, perineural invasion and lymph node metastases

42.2

55.6

45.9

57.963.1

70.8

45.7

57.1

0

10

20

30

40

50

60

70

80

3 year mortality 5 year mortality

Stage I Stage II Stage III Stage IV

Proposed nomogram Overall survival by AJCC stage

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MAIN RESULTS (2)

Nomogram based on: age, lymphovascular invasion, perineural invasion and lymph node metastases

18.824.8

51

65.763.7

77.676.5

83.4

0

10

20

30

40

50

60

70

80

90

3 year mortality 5 year mortality

Stage I Stage II Stage III Stage IV

Proposed nomogram Overall survival by proposed nomogram stage

C-Index AJCC 0.570Proposed nomogram 0.682

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CONCLUSION

This nomogram seems to better predict survival than the AJCC staging system in patients with PHC

It might be a more useful tool for clinical decision-making and prognostic stratification

Dr. Antoine Lacombe Pharm D, MBAPhone: +41 79 529 42 79antoine.lacombe@cor2ed.com

HCC CONNECTBodenackerstrasse 174103 Bottmingen SWITZERLAND

Dr. Froukje SosefMDPhone: +31 6 2324 3636froukje.sosef@cor2ed.com