Rapid Fire Best of the Best Oral 2025 Joint Meeting of the COSA ASM and IPOS Congress

Changing patterns of care in incurable biliary tract cancers in South Western Sydney, Australia (126435)

Zhen Howe Hong 1 2 , Weng Ng 3 4 5 , Eunice Dai 3 4 5 , Annette Tognela 1 5 , Aflah Roohullah 1 3 4 5 , Stephanie Hui-Su Lim 1 4 5
  1. Department of Medical Oncology , Macarthur Cancer Therapy Centre , Campbelltown , NSW, Australia
  2. School of Clinical Medicine, UNSW Medicine and Health, Bankstown, NSW, Australia
  3. Department of Medical Oncology, Liverpool Hospital , Liverpool, NSW, Australia
  4. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
  5. School of Medicine, Western Sydney University, Campbelltown, NSW, Australia

Background: Biliary tract cancers (BTC) were primarily treated with cisplatin and gemcitabine (CG) prior to introduction of durvalumab. Our study examines the changing treatment landscape in incurable BTC in two culturally diverse metropolitan cancer centres in Australia. 

 

Methods: Clinicopathological variables, molecular profiling data, treatment information and survival outcomes were obtained from 72 patients with incurable BTC diagnosed between January 2019 and December 2024.  

 

Results: Of 72 patients, 60% were female and 40% male; 61% Caucasian, 18% Asian, 11% Middle eastern, 10% other. Median age was 64 years. 42% had intrahepatic cholangiocarcinoma (CCA), 28% gallbladder carcinomas, 8% extrahepatic CCA and 6% periampullary carcinomas.  75% had de novo metastatic disease, 19% metastatic recurrence and 6% unresectable disease.  40% had molecular profiling with next-generation sequencing, increasing over time. 3 patients with intrahepatic CCA had actionable mutations (two with FGFR2 and one ARID1A-MSI), 2 progressed to clinical trials in third-line. 81% patients were treated with CG and durvalumab as first-line therapy since July 2022, when durvalumab became available in Australia. Of these, 20% had upfront dose reductions in CG due to age (4), thrombocytopaenia (1) and hearing impairment (1). Median cycles administered was 6. Median progression-free survival was 8.4 months compared to 4.9 months with CG. Grade 3 immune-related adverse events were encephalitis (1) and hepatitis (1). 30% proceeded to second-line therapy on progression with majority prescribed 5-fluorouracil-based therapy.

 

Conclusions: CG and durvalumab has been adopted as the standard of care for incurable BTC since late 2022, with comparable survival outcomes to trial data, but higher rates of dose adjustments and lower treatment durations as expected from a real-world population.  A third of patients received second-line therapy, highlighting the importance of molecular testing which is increasing with time. 1 in 10 patients tested had an actionable molecular alteration. Survival and subgroup analyses are ongoing.