Lenvatinib combined with PD-1 inhibitor plus Gemox chemotherapy versus plus HAIC for advanced biliary tract cancer

Objective: To compare the treatment efficacy and safety of lenvatinib and programmed cell death 1 (PD-1) inhibitor combined with oxaliplatin plus gemcitabine (Gemox) chemotherapy or hepatic arterial infusion chemotherapy (HAIC) for patients with advanced biliary tract cancer (BTC). Method: This study involved 86 patients with advanced BTC receiving PD-1 inhibitor and lenvatinib combined with HAIC (P -L-H group) or Gemox chemothrapy (P -L-G group). Propensity score matching (PSM) (1:1) analysis was used to balance potential bias. The primary endpoints were overall survival (OS) and progression -free survival (PFS), whereas the secondary endpoints were objective response rate (ORR), disease control rate (DCR), and safety. Result: After PSM, a total of 60 patients were enrolled with 30 in the P -L-G group and 30 in the P -L-H group. The median PFS was significantly longer with P -L-G group (13.7 versus 6.0 months, p < 0.0001) than with the P -L-H group. The median OS was 23.8 months in the P -L-G group versus 11.6 months in the P -L-H group (p < 0.0001). Patients in the P -L-G group exhibited a better ORR (73.3 % vs 30 %, p = 0.002) compared to the P -L-H group. The DCR was the same in both groups, 96.7 %, respectively. The P -L-G group had a higher incidence of grade 3-4 AEs than the P -L-H group. However, there was no significant difference in the any grade or grade 3-4 of AEs between the two groups. Conclusion: PD-1 inhibitor plus lenvatinib and Gemox are promising first-line regimens for the treatment of advanced BTC in the multicenter retrospective real-world study.