Nab-paclitaxel plus cisplatin versus gemcitabine plus cisplatin as first-line treatment in advanced biliary tract cancer: results of a multicentre, randomised, phase II trial.

Background: The efficacy and safety of conventional first-line chemotherapeutic regimens for the treatment of advanced biliary tract carcinomas (ABTCs) have been unsatisfactory.

Objectives: We aimed to explore alternative chemotherapeutic regimens capable of providing improved efficacy and fewer side-effects.

Design: Multicentre, randomised, phase II clinical trial.

Methods: Patients with unresectable advanced-stage tumors, or those who have developed recurrence or metastasis following initial radical surgery, between January 2021 and November 2022 were included. The participants were randomised to either a gemcitabine-cisplatin group (GC) or an albumin-paclitaxel-cisplatin group (NC). Progression-free survival (PFS) was the primary outcome, whereas overall survival (OS), and objective response rate (ORR) were the secondary outcomes.

Results: The trial enrolled 75 patients and had a median follow-up period of 11 months. The median PFS (mPFS) was 7.8 m (95% confidence interval [CI]: 5.4-14.0 m) in the NC group, and 7.0 m (95%CI: 3.9-10.1 m) in the GC group (p = 0.0034, hazard ratio [HR] = 0.5136, 95%CI: 0.3136-0.8411). Median OS for the NC group was 12.4 m (95%CI: 7.3-22.3 m) and for the GC group was 12.1 m (95%CI: 6.7-20.7 m), with no significant differences (p = 0.4592, HR = 0.811, 95%CI: 0.463-1.442). PFS rates at 6 and 8 months were 52.6% vs. 73.0% and 13.2% vs. 35.1% for the NC and the GC group, respectively (p < 0.05). As the secondary endpoint, ORR rates, there was no significant difference between the two groups. GC group had 13 (34.2%) patients achieved ORR, while NC group had 14 (37.8%). Regarding safety, In the context of thrombocytopenia, the incidence was significantly lower in the NC group compared to the GC group (27% vs 50%, P = 0.041). Conversely, with regard to sensory neuropathy, the NC group demonstrated a higher incidence (62.1% vs 36.8%, P = 0.028).

Conclusion: In this phase II non-inferiority trial, NC demonstrated comparable efficacy to GC in advanced BTC, with a trend toward improved PFS and a potentially favorable hematological toxicity profile. Further studies are warranted to confirm these findings in the context of a modern immunotherapy-based standard.

Trial Registration: Clinical Trials.gov identifiers: NCT04692051. Registered October 31, 2018.  https://www.chictr.org.cn/showproj.html?proj=38440 .