{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:02:16Z","timestamp":1790827336883,"version":"4.1.0"},"reference-count":33,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,6,3]],"date-time":"2023-06-03T00:00:00Z","timestamp":1685750400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union\u2019s Horizon 2020 Research and Innovation Programme","award":["825510"],"award-info":[{"award-number":["825510"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Phase 3 trials have established standard first-line (1L) and 2L systemic therapy options for patients with advanced biliary cancer (ABC). However, a standard 3L treatment remains undefined. Clinical practice and outcomes for 3L systemic therapy in patients with ABC were therefore evaluated from three academic centres. Included patients were identified using institutional registries; demographics, staging, treatment history, and clinical outcomes were collected. Kaplan\u2013Meier methods were used to assess progression-free survival (PFS) and overall survival (OS). Ninety-seven patients, treated between 2006 and 2022, were included; 61.9% had intrahepatic cholangiocarcinoma. At the time of analysis, there had been 91 deaths. Median PFS from initiating 3L palliative systemic therapy (mPFS3) was 3.1 months (95%CI 2.0\u20134.1), while mOS3 was 6.4 months (95%CI 5.5\u20137.3); mOS1 was 26.9 months (95%CI 23.6\u201330.2). Among patients with a therapy-targeted molecular aberration (10.3%; n = 10; all received in 3L), mOS3 was significantly improved versus all other included patients (12.5 vs. 5.9 months; p = 0.02). No differences in OS1 were demonstrated between anatomical subtypes. Fourth-line systemic therapy was received by 19.6% of patients (n = 19). This international multicentre analysis documents systemic therapy use in this select patient group, and provides a benchmark of outcomes for future trial design.<\/jats:p>","DOI":"10.3390\/cancers15113047","type":"journal-article","created":{"date-parts":[[2023,6,5]],"date-time":"2023-06-05T02:18:29Z","timestamp":1685931509000},"page":"3047","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Third-Line Palliative Systemic Therapy for Advanced Biliary Tract Cancer: Multicentre Review of Patterns of Care and Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8396-3328","authenticated-orcid":false,"given":"Simon","family":"Gray","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Rd., Manchester M20 4BX, UK"},{"name":"Department of Molecular and Clinical Cancer Medicine, Faculty of Health and Life Sciences, University of Liverpool, Ashton St., Liverpool L69 3GB, UK"},{"name":"Department of Medical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Pembroke Pl, Liverpool L7 8YA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0683-739X","authenticated-orcid":false,"given":"Octave","family":"Letissier","sequence":"additional","affiliation":[{"name":"Centre Eug\u00e8ne Marquis, Av. De la Bataille Flandres Dunkerque-CS 44229, CEDEX, 35042 Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance","family":"d\u2019Abrigeon","sequence":"additional","affiliation":[{"name":"Centre Eug\u00e8ne Marquis, Av. De la Bataille Flandres Dunkerque-CS 44229, CEDEX, 35042 Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinakshi","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Rd., Manchester M20 4BX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Wardell","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Rd., Manchester M20 4BX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olusola","family":"Faluyi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Pembroke Pl, Liverpool L7 8YA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Lamarca","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Rd., Manchester M20 4BX, UK"},{"name":"Department of Oncology, Oncohealth Institute, Jim\u00e9mez D\u00edaz University Hospital, Av. de los Reyes Catolicos 2, 28040 Madrid, Spain"},{"name":"Division of Cancer Sciences, University of Manchester, Oxford Rd., Manchester M13 9PL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Hubner","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Rd., Manchester M20 4BX, UK"},{"name":"Division of Cancer Sciences, University of Manchester, Oxford Rd., Manchester M13 9PL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8289-7741","authenticated-orcid":false,"given":"Julien","family":"Edeline","sequence":"additional","affiliation":[{"name":"Centre Eug\u00e8ne Marquis, Av. De la Bataille Flandres Dunkerque-CS 44229, CEDEX, 35042 Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1999-0863","authenticated-orcid":false,"given":"Juan W.","family":"Valle","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Rd., Manchester M20 4BX, UK"},{"name":"Division of Cancer Sciences, University of Manchester, Oxford Rd., Manchester M13 9PL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2272-3678","authenticated-orcid":false,"given":"Mair\u00e9ad G.","family":"McNamara","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Rd., Manchester M20 4BX, UK"},{"name":"Division of Cancer Sciences, University of Manchester, Oxford Rd., Manchester M13 9PL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1038\/s41575-020-0310-z","article-title":"Cholangiocarcinoma 2020: The next horizon in mechanisms and management","volume":"17","author":"Banales","year":"2020","journal-title":"Nat. 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