Systemic therapy in elderly patients with advanced biliary tract cancer: Sub-analysis of ABC-02 and 10 other prospective studies.
Bibliographic record
Abstract
382 Background: Outcomes in elderly patients (pts), with advanced biliary tract cancer (ABTC) receiving palliative chemotherapy are unclear. The aim of this study was to assess the outcome of monotherapy vs combination therapy in elderly pts with ABTC in ABC-02, and 10 other prospective studies of systemic therapy. Methods: Multivariable analysis was employed to explore impact of therapy on progression-free (PFS) and overall survival (OS) in 2 age cohorts; non-elderly ( < 70 yrs) vs elderly ( ≥ 70 yrs). Results: Overall, 1163 pts were recruited from Jan 97-Dec 13. Median age of entire cohort was 63 yrs (range 23-85); 260 (22%) were ≥ 70 yrs, 18 (2%) were ≥ 80 yrs. In pts ≥ 70 yrs; 208 had ECOG PS 0-1, 129; male and 174; metastatic disease. Combination therapy was platinum-based in 9 studies. Among the 260 pts ≥ 70 yrs, 182 (70%) received combination therapy. Baseline characteristics/therapy received was balanced in both age cohorts. Median follow-up time for all pts was 42 months (95% CI 37-51). Median PFS for those < 70 yrs and ≥ 70 yrs was 6.0 (95% CI 5.5-6.4) and 5.0 months (95% CI 4.2-6.4) respectively. Median OS for pts < 70 yrs and ≥ 70 yrs was 10.2 (95% CI 9.6-11.1) and 8.8 months (95% CI 7.9-9.6) respectively. For the entire cohort, the PFS and OS were significantly better in those pts receiving combination therapy: HR 0.66, 95% CI 0.58-0.76, P < 0.0001 and HR 0.72, 95% CI 0.63-0.82, P < 0.0001 respectively, and in group ≥ 70 yrs: HR 0.54 (95% CI 0.38-0.77, P = 0.001) and HR 0.6 (95% CI 0.43-0.85, P = 0.004) respectively. In pts < 70 yrs, stage (locally advanced vs metastatic) and ECOG PS were prognostic for PFS (P < 0.001 and P = 0.04 respectively) and OS (P < 0.001 and P = 0.001 respectively) and in pts ≥ 70 yrs, they were prognostic for OS (P = 0.03 and P = 0.02 respectively). There was no evidence of interaction between age ( < 70 yrs and ≥ 70 yrs) and treatment (monotherapy and combination therapy) for PFS (P = 0.66) or OS (P = 0.75). Conclusions: In ABTC, PFS and OS in elderly pts receiving palliative chemotherapy (monotherapy or combination therapy) are comparable with that of non-elderly pts, therefore age in isolation should not influence treatment decisions. Clinical trial participation among elderly pts with ABTC is appropriate.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".