Second-line chemotherapy in advanced biliary cancer: the present now will later be past.

We have read with great interest the recent paper by Lamarca et al. [1], in which the authors conducted a systematic review of the literature to evaluate the level of evidence behind the use of second-line chemotherapy for patients with advanced biliary tract cancer (aBTC). The authors collected data of 761 patients from 14 phase II trials and 9 retrospective analyses, reporting a mean overall survival (OS) of 7.2 months and a mean progression-free survival (PFS) of 3.2 months. Response rate and disease control rate (DCR) were 7.7% and 49.5%, respectively, suggesting that a cohort of aBTC patients may benefit from second-line chemotherapy. We really thank the authors for their efforts: due to the paucity of reliable data in this setting, the topic is of great interest.