Second-line FOLFOX chemotherapy for patients with advanced biliary tract cancers pretreated with cisplatin/gemcitabine: a systematic review and meta-analysis
Bibliographic record
Abstract
Background: Biliary cancers are aggressive carcinomas frequently diagnosed at an advanced stage. Palliative combination systemic therapy provides survival benefits in the first-line setting of advanced and metastatic disease. FOLFOX chemotherapy is one of the few options in the second-line therapy. Materials and methods: The medical literature was searched through the Medline/PubMed and Embase databases to acquire clinical reports or trials of FOLFOX treatment for biliary cancers in the second-line metastatic setting after first-line cisplatin/gemcitabine chemotherapy. Eligible prospective and retrospective studies were reviewed and included in a meta-analysis with overall response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) as outcomes of interest. Results: Six clinical studies were eligible and included in the meta-analysis. The ORR with second-line FOLFOX chemotherapy in this population was 10.42% [95% confidence interval (CI) 4.55% to 16.3%]. Two-fifths of the patients had stable disease for a DCR of 50.65% (95% CI 38.4% to 62.9%). The median PFS was 3.03 months (95% CI 1.38-4.09 months) and the median OS was 6.43 months (95% CI 5.43-7.43 months). The main grade 3/4 adverse effects observed in >10% of patients were neutropenia (21.2%) and asthenia/fatigue (10.3%). Conclusions: The meta-analysis observed a moderate efficacy of the FOLFOX combination in this setting. These results may be used as a benchmark to compare gains obtained in this setting with novel treatments, including recently introduced targeted therapies in appropriately selected patients.
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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 | 0.006 | 0.012 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.029 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".