Based on the TOPAZ-1 study, do you now routinely include durvalumab in first line treatment of advanced bile duct cancer?

Topics: Gastrointestinal Cancers • Medical Oncology • Liver and Pancreas Tumors • Journal Club ft. NEJM publications

Is data sufficient to adopt this as the new standard of care?

Can you comment on the reported regional and race-based variations in outcomes? Should that data be utilized in determining treatment?

Answer from: Medical Oncologist at Academic Institution

YES! And it is a strong yes. TOPAZ-1 is a very elaborate study with statistically and clinically significant data outcomes. See Do et al., Journal of Clinical Oncology 2022. What is better than holding chemotherapy after 6 months and keeping patients on single agent durvalumab? And avoiding all...

Comments

Medical Oncologist at Mary Lanning Healthcare Morrison Cancer Center/University of Nebraska Medical Center Adjunct Faculty
NCCN Guidelines Version 1.2022 recommends Durvalum...

Answer from: Medical Oncologist at Community Practice

**I deleted the initial part of my answer to this question, as the TOPAZ-1 regimen has now been FDA-approved for treatment of metastatic biliary tract cancer.** It is notable also that much of the separation of survival curves in TOPAZ-1 happened after cessation of active therapy in the control...

Answer from: Medical Oncologist at Community Practice

The TOPAZ-1 study showed that the combination of durvalumab plus gemcitabine/cisplatin prolonged overall survival over gemcitabine/cisplatin alone in advanced biliary tract cancer, and was also well tolerated. Although the survival benefit of durvalumab in this setting is modest, I do think the data...

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