Treatment Patterns and Survival in Locally Advanced or Metastatic Biliary Tract Cancer Using SEER Medicare Data

Open AccessPublished:January 20, 2023DOI:
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      Background & Aims

      Biliary tract cancer (BTC) is a rare, lethal, heterogeneous group of cancers often diagnosed at an advanced stage. While gemcitabine plus cisplatin is the standard of care (SoC) for first-line treatment of locally advanced or metastatic BTC, no globally accepted SoC currently exists for second-line treatment of BTC following chemotherapy. However, the treatment landscape is evolving with approvals for therapies targeting actionable mutations. This study aimed to characterize treatment patterns and survival in patients with locally advanced or metastatic BTC.


      Patients with advanced or metastatic BTC in the Surveillance, Epidemiology, and End Results Medicare database between 2010 and 2015 (N=2,063) were included; patients with non-primary BTC were excluded. Patient and clinical characteristics, line and type of therapy, and overall survival (OS) of patients were analyzed.


      Only 45.5% (n=938) of patients initiated systemic therapy within 90 days of diagnosis. The most common event following diagnosis was initiation of first-line therapy, and the most common event following first-line treatment was death. Median survival ranged from 5.0 months for patients receiving second-line fluoropyrimidine , to 9.7 months for patients receiving second-line gemcitabine. Duration of therapy ranged from 0.7 months for patients receiving second-line fluoropyrimidine, to 3.7 months for patients receiving first-line gemcitabine plus cisplatin therapy.


      OS from diagnosis was poor and influenced by age, sex, stage, mobility limitations, comorbidity burden, poverty, and previous cancer. Treatment patterns varied for patients who progressed following first-line therapy, as there was no consensus second-line treatment for locally advanced or metastatic BTC without clinically targetable mutations.



      BTC (biliary tract cancer), FDA (US Food and Drug Administration), FOLFOX (leucovorin, fluorouracil, and oxaliplatin), ORR (objective response rate), NCI (National Cancer Institute), SEER (Survival, Epidemiology, and End Results Program)