@Snoeffelen läs gärna artikeln. 
Summan av uttalanden från S. Azad som var inbjuden att diskutera resultaten : positivt med förbättrad överlevnad. Dock ett par frågor:
Kontrollgruppen fick ingen fortsatt behandling efter 6 månader medans de i studiearmen fick fortsatt immunterapi fram till Progressiv disease.
Tror dock det är standard i studier med immunterapi som tillägg till chemo.
Bättre resultat på tillägg med immunterapi för Asiatiska patienter.
Bättre resultat på intrahepatic jämfört med extrahepatic. Står inga siffror men gynnsamt för fimaChem att den inte verkar bäst på eCCA.
Större delen i studien var intrahepatic (56%) där det dock är mindre procentandel av totalen av CCA
SAN FRANCISCO – Patients with untreated advanced biliary tract cancer (BTC) had modest but statistically significant improvement in overall survival (OS) with the addition of immunotherapy to chemotherapy, a randomized trial showed.
The trial is first positive study of first-line therapy for advanced BTC in a decade and could establish a new standard of care for unselected patients, said invited discussant Nilofer S. Azad, MD, of the Johns Hopkins Sidney Kimmel Cancer Center in Baltimore. However, the increasing benefit beyond 6 months in the durvalumab arm occurred as patients in the control arm received no therapy. All treatment in the placebo group stopped at 6 months.
Even so, the trial raised some questions for future investigation, said Azad. Asian patients, who comprised more than half of the study population, seemed to fare better with durvalumab-chemotherapy as compared with all others. Patients with intrahepatic cholangiocarcinoma also appeared to do better with the durvalumab regimen versus those with extrahepatic and gallbladder cancers, representing smaller subgroups in the trial. Finally, at a tumor area positivity ≥1% for PD-L1 expression, the durvalumab arm did not demonstrate statistical significance.
Analysis of OS by PD-L1 expression showed a statistically significant 20% reduction in the survival hazard with durvalumab for all patients (95% CI 0.64-0.97), but the effect was uneven across different levels of expression. By TAP assessment, the addition of the PD-L1 inhibitor had a significant impact only at TAP ≥5% (HR 0.70, 95% CI 0.50-0.99) but not at TAP ≥1% (1%-4% group) or TAP ≥10%. By tumor cell (TC) positivity, patients with TC ≥1% fared better with durvalumab (HR 0.70, 95% CI 0.49-0.99).
So we have some open questions about this positive study, but overall, we absolutely have a trial that could change the standard of care," Azad concluded.
