Adjuvant chemo of questionable value in resected gallbladder cancer

Last Updated: 2016-10-21

By David Douglas

NEW YORK (Reuters Health) - Patients who undergo surgery for gallbladder cancer don't appear to benefit from adjuvant chemotherapy, according to new research.

As Dr. Adam J. Olszewski told Reuters Health by email, "Our study, as disheartening as it may seem, contradicts prior retrospective (and unfortunately flawed) analyses that suggested survival benefits of adjuvant chemotherapy in resected gallbladder cancer."

Dr. Olszewski of the Alpert Medical School of Brown University, Providence, Rhode Island, and colleagues analyzed data from the National Cancer Data Base on more than 4,700 patients who underwent surgery for T2-3 or node-positive, nonmetastatic gallbladder cancer between 2004 and 2011.

The data, said Dr. Olszewski, indicate "that only a minority of patients in the U.S. undergo radical resections, which should alert clinicians about the need to standardize and optimize the surgical approach."

Adjuvant chemotherapy was given to 28.8% of patients and 13.5% received upfront chemoradiation, the researchers report in the Journal of the National Cancer Institute, online October 5.

Overall survival at three years was 39.9% and appeared unaffected by adjuvant therapy after adjusting for multiple confounders (hazard ratio, 1.01).

Patients with T3 or node-positive tumors treated with upfront adjuvant chemoradiation had a modest early survival advantage. The absolute difference was 6.8% at two years, but by five years the difference was lost.

"This result suggests that single-agent chemotherapy with gemcitabine or a fluoropyrimidine may not be sufficient to overcome the poor prognosis associated with this aggressive cancer, highlighting the need for further research incorporating recent advances in the management of metastatic disease and accumulating knowledge about molecular pathways," said Dr. Olszewski.

"Our results," he concluded, "further illustrate that hepatobiliary cancers are not all the same, and the widespread practice of data extrapolation between studies on cancers of the gallbladder, pancreas, or biliary ducts may lead to erroneous conclusions."

SOURCE: http://bit.ly/2dsLroi

J Natl Cancer Inst 2016.