Topics:
Gastrointestinal Cancers • Medical Oncology • Cholangiocarcinoma • Journal Club ft. NEJM publications
Can durvalumab incorporation to gem+cis for advanced BTCs allow for earlier discontinuation of cytotoxic chemotherapy in patients exhibiting response?
TOPAZ-1 trial allowed for up to 8 cycles of gem/cis. Were there differences in chemotherapy duration/# cycles between treatment groups? Does use of durvalumab permit shortening the cytotoxic therapy or do you still aim to deliver 8c?
Answer from: Medical Oncologist at Community Practice
The TOPAZ-1 study was double blinded, and there were no meaningful differences in gemcitabine/cisplatin treatment duration between the groups. I do not intend to give fewer cycles of gemcitabine/cisplatin now that durvalumab has been added to the armamentarium. In the past, I would usually discuss m...
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Answer from: Medical Oncologist at Community Practice
I think the opposite question is more relevant: should we extend chemo beyond just 8 cycles, or limit it to 8 as in the TOPAZ-1 trial? Would the trial still have been positive if chemo wasn't stopped at 8 cycles? Many patients can tolerate longer than this, especially gemcitabine. In fact, the KEYNO...
Answer from: Medical Oncologist at Academic Institution
The data right now does not support shortening chemo duration.
Answer from: Medical Oncologist at Academic Institution
We are never likely to have level 1 evidence to answer this question. Cholangioca is too rare. However we have done many trials on stop-and-go, maintenance therapy or treatment breaks in colon cancer showing these make little difference in OS. Personally, for patients with CPS > 10, I will be ver...