For unresectable/metastatic cholangiocarcinoma, would you continue gemcitabine/cisplatin beyond 24 weeks if the patient continues to have a response to therapy?

I frequently continue beyond the 24 weeks used in the ABC-02 trial. Despite scarcity of good quality evidence, some form of maintenance chemotherapy is increasingly being used in advanced non-colorectal GI cancers such as biliary, pancreatic and esophagogastric cancers. More prolonged therapy has already been built into some of the ongoing clinical trials.

My approach is to continue after 24 weeks assuming there are minimal or manageable toxicities and the patient agrees. In cases of renal insufficiency or neuropathy, I may discontinue the cisplatin and continue the gemcitabine alone until progression. Of course, prior to making these decisions, the patients need to be appropriately counseled on the limitations of the evidence behind this decision.

I would be curious to hear the opinions of others, especially if backed by published/presented data supporting (or not supporting) this decision.