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Abstract

Background:

Gallbladder cancer (GBC) represents a rare but aggressive malignancy, often diagnosed at an advanced stage. Although immune checkpoint inhibitors have improved outcomes in biliary tract cancers, GBC-specific evidence remains limited due to underrepresentation in pivotal clinical trials.

Objectives:

To evaluate the real-world effectiveness and safety of durvalumab combined with gemcitabine and cisplatin (Durva + gemcitabine and cisplatin (GemCis)) compared to GemCis alone in patients with advanced GBC.

Design:

Retrospective, multi-institutional cohort study.

Methods:

Data were collected from the TriNetX Global Collaborative Network. Adults diagnosed with advanced GBC between January 2020 and January 2025 who received Durva + GemCis or GemCis as first-line therapy were included. Propensity score matching (1:1) was performed based on age, sex, race, metastatic sites, and tumor marker levels. The primary outcome was overall survival (OS), whereas secondary outcomes included adverse events (AEs).

Results:

Among 2458 patients with advanced GBC, 130 received Durva + GemCis and 201 received GemCis. After matching, 111 patients per group were analyzed. Median OS was significantly longer in the Durva + GemCis group compared to the GemCis group (13.1 vs 8.5 months; log-rank p = 0.028). Most AEs were comparable between groups; however, malaise and fatigue were more frequently reported in the Durva group (28.8% vs 16.2%; hazard ratio: 1.98, 95% confidence interval: 1.11–3.53).

Conclusion:

In this real-world study, the addition of durvalumab to GemCis was associated with improved OS in patients with advanced GBC, with a manageable safety profile. These exploratory findings should be interpreted with caution, underscoring the need for dedicated GBC-specific prospective trials.

Keywords

durvalumab gallbladder cancer gemcitabine and cisplatin immune checkpoint inhibitors real-world study

Introduction

Gallbladder cancer (GBC) represents a relatively rare but highly lethal malignancy. According to the 2022 Global Cancer Observatory (GLOBOCAN) estimates, GBC ranks as the 22nd most commonly diagnosed cancer and the 20th leading cause of cancer-related death worldwide.¹ The incidence of GBC varies markedly across regions, with high-burden areas identified in South America, northern India, and East Asia.² Due to the absence of specific symptoms during early disease stages, most patients receive a diagnosis at an advanced stage, and only 20% of cases are detected before the onset of metastasis. In the United States, the overall 5-year survival rate for GBC stands at approximately 18%, falling to less than 2% in cases involving distant metastatic spread.³

Systemic therapy remains the cornerstone of treatment for advanced GBC. Historically, GBC has been categorized under biliary tract cancers (BTCs), and most clinical trials have grouped patients with intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, and GBC. The landmark ABC-02 trial demonstrated that gemcitabine plus cisplatin (GemCis) significantly improved survival compared to gemcitabine alone in patients with advanced BTC, establishing GemCis as the standard first-line regimen.⁴ However, clinical outcomes for advanced GBC remain suboptimal, with median overall survival (OS) typically falling below 12 months despite systemic therapy.

The advent of immune checkpoint inhibitors (ICIs) has reshaped the treatment landscape of several gastrointestinal cancers.⁵ In the phase III TOPAZ-1 trial, the addition of durvalumab, a programmed death-ligand 1 (PD-L1) inhibitor, to GemCis significantly improved survival in patients with advanced BTC, resulting in its adoption as a new standard first-line option.⁶ However, subgroup analysis revealed that only 25% of enrolled patients had GBC, and the survival benefit associated with durvalumab in this subgroup did not reach statistical significance. Although GBC is frequently treated alongside other BTC subtypes in clinical settings, increasing evidence highlights its distinct tumor biology and genomic profile, which differ markedly from those of intrahepatic and extrahepatic cholangiocarcinomas.^2,7 Given these differences and the underrepresentation of GBC in prospective trials, further investigation is warranted to clarify the real-world effectiveness of durvalumab-based regimens in this population.

This study aimed to address this gap by conducting a retrospective, real-world analysis using the TriNetX Global Collaborative Network to compare survival outcomes and adverse events (AEs) in patients with advanced GBC treated with durvalumab plus GemCis (Durva + GemCis) versus those treated with GemCis alone.

Patients and methods

Study design and data source

This retrospective, multi-institutional study utilized de-identified data from the TriNetX Global Collaborative Network (Cambridge, MA, USA), a federated health research platform that provides access to electronic medical records from more than 140 large healthcare organizations worldwide. The TriNetX platform complies with the Health Insurance Portability and Accountability Act and operates under a waiver from the Western Institutional Review Board (IRB), as all data are de-identified and reported in aggregate. The study adhered to the principles outlined in the Declaration of Helsinki. This study was approved by the IRB of Taichung Veterans General Hospital (IRB No. CE25367C). The reporting of this study conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.⁸

Data collection and study population

Data extraction was performed on May 31, 2025. Eligibility criteria included adult patients (⩾18 years) diagnosed with GBC (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code: C23) between January 1, 2020, and January 31, 2025. The start date was selected because early clinical evidence for Durva + GemCis became available in 2020, with wider adoption after the phase III TOPAZ-1 trial and U.S. Food and Drug Administration (FDA) approval in 2022.^6,9 The end date was set to allow at least 4 months of follow-up before data extraction on May 31, 2025. Patients with primary intrahepatic or extrahepatic bile duct carcinomas were excluded to prevent diagnostic misclassification. Advanced GBC was defined by the presence of lymph node or distant organ metastases, as determined by relevant International Classification of Diseases (ICD) codes. Due to the lack of uniform tumor–node–metastasis (TNM) staging data, metastatic disease was inferred based on diagnostic codes indicating metastatic involvement. Administration of systemic therapies (durvalumab, gemcitabine, and cisplatin) was confirmed through RxNorm and Healthcare Common Procedure Coding System procedure codes. Patients were categorized into treatment groups according to the use of Durva + GemCis or GemCis alone. Detailed codes used for diagnoses, medications, and procedures are listed in Table S1.

Treatment and outcomes

Patients received either GemCis or Durva + GemCis. The index event was defined as the initiation date of the complete treatment regimen: the first date on which all three drugs were administered in the Durva + GemCis group, or both agents in the GemCis group. The primary outcome was OS, defined as the time from the index event to death from any cause. Secondary outcomes included the incidence of AEs, such as hematologic events, sepsis, acute kidney injury, constipation, diarrhea, malaise and fatigue, nausea and vomiting, and possible immune-related AEs (irAEs). The irAEs evaluated included hypothyroidism, hyperthyroidism, adrenal insufficiency, skin rash or dermatitis, pneumonitis, hepatitis, hypopituitarism, and myositis. AEs were identified using ICD and Logical Observation Identifiers Names and Codes (LOINC), as specified in Table S1.

Statistical analysis

Baseline characteristics were compared using chi-square tests for categorical variables and t tests for continuous variables. Propensity score matching (1:1) was applied to control for potential confounders, including age, sex, race, metastatic sites, and tumor marker levels (e.g., carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA)). Matched group comparisons were conducted using McNemar’s test for categorical variables and paired t tests for continuous variables. Kaplan–Meier methods were used to analyze OS, with comparisons made using stratified log-rank tests. Hazard ratios (HRs) were estimated via conditional Cox proportional hazards models. A two-sided p-value <0.05 was considered statistically significant.

Results

Study population

From the TriNetX Global Collaborative Network, 161,638,037 patients were available for query. Of these, 29,310 were identified as having GBC (ICD-10-CM: C23). After restricting the analysis to adults diagnosed between January 1, 2020, and January 31, 2025, 23,073 patients remained. Patients with intrahepatic or extrahepatic bile duct cancer were excluded. Among the remaining cohort, 2458 had documented lymph node or distant metastases. Of these, 130 patients received Durva + GemCis and 201 received GemCis. Following 1:1 propensity score matching based on age, sex, race, metastatic sites, and tumor marker levels, 111 patients were retained in each treatment group for comparative analysis (Figure 1).

Figure 1.

Patient selection flow. Flow diagram showing patient identification, eligibility criteria, and 1:1 propensity score matching, resulting in 111 patients per group for analysis.

Baseline characteristics

Table 1 summarizes the baseline characteristics. In the unmatched cohort, patients in the Durva + GemCis group were slightly younger (mean age: 65.6 vs 67.0 years) and more likely to be under 65 years (40.8% vs 31.8%). The GemCis group included a higher proportion of female patients (68.7% vs 57.7%, p = 0.042). Racial distribution was generally comparable, although more patients in the GemCis group had unknown race (24.4% vs 14.6%). Lymph node metastases were more frequent in the Durva + GemCis group (33.1% vs 17.4%, p = 0.001). No significant differences were observed in liver, lung, or peritoneal metastases, or in CA 19-9 and CEA levels.

Table 1.

Baseline characteristics of the patients in the Durva + GemCis and GemCis groups, overall cohort, and propensity-matched cohort.

	Overall cohort				Propensity-matched cohort
	Durva + GemCis(n = 130)	GemCis(n = 201)	p-Value	SMD	Durva + GemCis(n = 111)	GemCis(n = 111)	p-Value	SMD
Age at index, mean ± SD	65.6 ± 10.5	67.0 ± 9.5	0.204	0.142	66.0 ± 10.7	65.7 ± 9.8	0.825	0.030
<65, n (%)	53 (40.8)	64 (31.8)	0.097	0.187	41 (36.9)	48 (43.2)	0.338	0.129
⩾65, n (%)	77 (59.2)	137 (68.2)	0.097	0.187	70 (63.1)	63 (56.8)	0.338	0.129
Sex, n (%)
Female	75 (57.7)	138 (68.7)	0.042	0.229	68 (61.3)	67 (60.4)	0.891	0.019
Male	50 (48.5)	56 (27.9)	0.044	0.227	39 (35.1)	42 (37.8)	0.676	0.056
Unknown gender	⩽10	⩽10			⩽10	⩽10
Race, n (%)
White	71 (54.6)	98 (48.8)	0.298	0.118	63 (56.8)	63 (56.8)	1	<0.001
Black or African American	16 (12.3)	30 (14.9)	0.501	0.076	15 (13.5)	14 (12.6)	0.842	0.027
Asian	17 (13.1)	16 (8.0)	0.129	0.167	10 (9.0)	13 (11.7)	0.509	0.089
Unknown race	19 (14.6)	49 (24.4)	0.032	0.248	18 (16.2)	17 (13.5)	0.854	0.025
Other race	⩽10	⩽10			⩽10	⩽10
Site of metastasis, n (%)
Liver	42 (32.3)	67 (33.3)	0.846	0.022	34 (30.6)	32 (38.8)	0.769	0.039
Lymph nodes	43 (33.1)	35 (17.4)	0.001	0.367	26 (23.4)	26 (23.4)	1	<0.001
Lung	10 (7.7)	10 (5.0)	0.311	0.112	10 (9.0)	10 (9.0)	1	<0.001
Peritoneum or retroperitoneum	22 (17.0)	39 (19.4)	0.570	0.064	20 (18.0)	19 (17.1)	0.860	0.024
CEA level, n (%)
Normal	31 (23.8)	37 (18.4)	0.232	0.134	22 (19.8)	20 (18.2)	0.732	0.046
Elevated (⩾5 U/ml)	33 (25.4)	59 (29.4)	0.431	0.089	32 (28.8)	34 (30.6)	0.769	0.039
CA 19-9 level, n (%)
Normal	23 (17.7)	25 (12.4)	0.185	0.147	16 (14.4)	15 (13.5)	0.847	0.026
Elevated (⩾37 U/ml)	32 (24.6)	69 (34.3)	0.061	0.214	32 (28.8)	36 (32.4)	0.560	0.078

CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; Durva, Durvalumab; GemCis, gemcitabine and cisplatin; SD, standard deviation; SMD, standardized mean differences.

After propensity score matching, the two groups were well balanced across key variables. The mean ages were nearly identical (66.0 vs 65.7 years), and the proportions of female patients (61.3% vs 60.4%), racial distributions, metastatic sites, and elevated tumor markers were also similar. Standardized mean differences were below 0.1 for nearly all variables, indicating adequate balance.

Survival analysis and AEs

Following propensity score matching, the median OS was significantly longer in the Durva + GemCis group compared to the GemCis group (13.1 vs 8.5 months; log-rank p = 0.028; Figure 2). The median follow-up durations were 6.8 months in the Durva + GemCis group and 7.0 months in the GemCis group.

Figure 2.

Overall survival in matched cohorts. Kaplan–Meier curves comparing OS between the Durva + GemCis and GemCis groups. Median OS was 13.1 versus 8.5 months, respectively (log-rank p = 0.028).

As shown in Figure 3, AEs were common among patients receiving Durva + GemCis. The most frequent AEs were anemia (84.7%), constipation (40.5%), nausea and vomiting (40.5%), malaise or fatigue (28.8%), diarrhea (17.1%), neutropenia (19.8%), thrombocytopenia (12.6%), sepsis (18.9%), acute kidney injury (24.3%), and possible irAEs (21.6%).

Figure 3.

Adverse events in matched cohorts. Forest plot of adverse events. Most were similar between groups, except malaise and fatigue, which were more frequent with Durva + GemCis (HR 1.98, 95% CI: 1.11–3.53).

Most AE rates were comparable between groups, except for malaise and fatigue, which were significantly more frequent in the Durva + GemCis group (28.8% vs 16.2%; HR: 1.98, 95% confidence interval (CI): 1.11–3.53).

Discussion

This retrospective real-world study found that adding durvalumab to GemCis was associated with improved OS in patients with advanced GBC. After propensity score matching, the median OS was 13.1 months in the Durva + GemCis group versus 8.5 months in the GemCis group. AEs were comparable between groups, with malaise and fatigue being the only events significantly more frequent in the Durva + GemCis group. These findings suggest that durvalumab-based therapy may offer clinical benefit in this rare and understudied population.

BTC carries a poor prognosis, and even in the resectable setting, 60%–70% of patients experience recurrence. Based on the landmark phase III BILCAP study, the ASCO guideline recommends 6 months of adjuvant capecitabine.^10,11 In this trial, adjuvant capecitabine demonstrated improvements in relapse-free survival and OS in the per-protocol analysis; however, it failed to meet its primary endpoint in the intention-to-treat population. Reviewing BILCAP and other adjuvant trials highlights the persistent challenge of heterogeneity across anatomical subgroups of BTC, which complicates trial design and interpretation.¹²

In advanced BTC, gemcitabine-based chemotherapy remains the backbone of first-line treatment. Several attempts to enhance efficacy by adding targeted agents have been unsuccessful.¹³ A systematic review and meta-analysis by Rizzo et al.¹⁴ found that the addition of epidermal growth factor receptor monoclonal antibodies (cetuximab or panitumumab) to gemcitabine-based chemotherapy did not significantly improve OS, progression-free survival (PFS), or objective response rate, while increasing grade 3–4 hematologic and cutaneous toxicities. These findings underscore the challenges of developing effective targeted combinations in BTC and highlight the need for novel therapeutic strategies such as immunotherapy.

The pivotal phase III TOPAZ-1 trial established the clinical benefit of adding durvalumab to GemCis, demonstrating a median OS of 12.8 versus 11.5 months with chemotherapy alone; thereby, redefining first-line treatment in advanced BTC.¹⁵ Similarly, the KEYNOTE-966 trial demonstrated that pembrolizumab combined with GemCis improved OS to 12.7 months compared to 10.9 months in the chemotherapy arm.¹⁶ However, subgroup analyses from both trials failed to demonstrate a statistically significant OS benefit in patients with GBC, with reported HRs of 0.94 (95% CI: 0.65–1.37) in TOPAZ-1 and 0.96 (95% CI: 0.73–1.26) in KEYNOTE-966. A likely explanation for these null results is the limited number of GBC cases—fewer than 25% of the study populations—reducing statistical power to detect treatment differences within this subgroup.

Following the approval of durvalumab in clinical practice, several real-world studies have evaluated the effectiveness of the Durva + GemCis regimen. Reported median OS in these cohorts ranges from 12.9 to 15.8 months, and median PFS varies between 5.6 and 8.9 months—findings largely consistent with the outcomes observed in the TOPAZ-1 trial.^17–21 For example, a multicenter retrospective study by Rimini et al.¹⁹ involving 666 patients with advanced BTC across 39 sites in 11 countries reported a median OS of 15.1 months and a median PFS of 8.2 months. In that study, patients with GBC comprised 20.3% of the cohort. Although similar real-world studies have included GBC as a minority subgroup (typically 15%–30%), few have reported outcomes specific to this population, leaving an evidence gap regarding the effectiveness of Durva + GemCis in GBC.

This study specifically focused on GBC. The observed median OS of 13.1 months in the Durva + GemCis group aligns with survival outcomes reported in both the TOPAZ-1 trial and recent real-world studies. This regimen demonstrated a survival benefit over GemCis alone (median OS: 8.5 months). Although the OS in our GemCis group was lower than that in the TOPAZ-1 trial (11.5 months) and the KEYNOTE-966 trial (10.9 months), both trials included only a limited number of patients with GBC. Focusing specifically on GBC, a prospective phase III trial exclusively enrolled patients with this disease reported a median OS of 9.0 months with gemcitabine plus oxaliplatin and 8.3 months with GemCis among 243 evaluable patients.²² In addition, a systematic review and meta-analysis by Azizi et al.,²³ which included 58 studies of chemotherapy for advanced GBC, reported a pooled median OS of 8.3 months. These findings support the validity of our GemCis group’s survival outcome and underscore the potential benefit of incorporating durvalumab in this patient population.

In recent years, genomic studies have increasingly characterized the molecular landscape of BTC, revealing several potentially actionable alterations. Consequently, comprehensive genomic profiling is gaining importance in clinical practice. For example, in patients harboring fibroblast growth factor receptor 2 (FGFR2) rearrangements or fusions who progressed after chemotherapy, FGFR2 inhibitors have achieved response rates of approximately 37%–42%.^24–26 On this basis, both pemigatinib and futibatinib have received FDA approval for the treatment of previously treated BTC with FGFR2 alterations. GBC, however, exhibits distinct genomic and immunologic features that differentiate it from intrahepatic and extrahepatic cholangiocarcinomas. Molecular profiling studies have identified frequent mutations in TP53, ERBB2, and PIK3CA, as well as a relatively higher rate of HER2 amplification in GBC. By contrast, alterations commonly seen in intrahepatic cholangiocarcinoma, such as IDH1/2 mutations and FGFR2 fusions, rarely occur in GBC, underscoring the need for subtype-specific therapeutic strategies.^27,28 Immunologically, GBC tends to show lower baseline PD-L1 expression and reduced tumor-infiltrating lymphocytes, which may partly explain the modest efficacy of ICIs as monotherapy.^2,7,29 Nonetheless, chemotherapy may enhance tumor immunogenicity by promoting antigen presentation, CD8⁺ T-cell infiltration, and PD-L1 upregulation in the tumor microenvironment. In particular, PD-L1 expression in immune cells has been reported to increase more frequently following chemo-immunotherapy than chemotherapy alone, suggesting a synergistic interaction.³⁰ Consistent with these observations, a recent single-center real-world study by Liu et al.³¹ reported that patients with unresectable or recurrent GBC who received a combination of chemotherapy and programmed death-1 (PD-1) inhibitors experienced improved OS and PFS, as well as higher response rates, compared to those receiving chemotherapy alone, with an acceptable safety profile. These findings further support the rationale for integrating immunotherapy into the treatment strategy for advanced GBC.

For BTC patients receiving immunotherapy, current evidence suggests that PD-L1 status has limited predictive value for durvalumab plus chemotherapy.⁶ By contrast, recent studies highlight the prognostic potential of systemic inflammation- and nutrition-related indices. A meta-analysis demonstrated that an elevated neutrophil-to-eosinophil ratio (NER) was associated with inferior survival outcomes across solid tumors, including patients receiving ICIs, supporting its role as a simple, noninvasive prognostic marker.³² Similarly, the cachexia index (CXI), which integrates skeletal muscle mass, albumin, and the neutrophil-to-lymphocyte ratio, has emerged as a robust prognostic indicator. A comprehensive meta-analysis of more than 5000 patients confirmed that low CXI consistently predicted poor OS and PFS across multiple cancer types and treatment settings.³³ Future studies should investigate whether integrating indices such as NER and CXI can refine patient selection for chemo-immunotherapy in BTC, particularly in GBC.

Hematological AEs, including anemia, neutropenia, and thrombocytopenia, were identified using LOINC laboratory codes reflecting post-treatment hemoglobin, neutrophil, and platelet levels. The incidence of any-grade anemia in the Durva + GemCis group was notably high (84.7%) compared to 48.2% in the TOPAZ-1 trial, and the proportion of grade 3 anemia was also higher. This discrepancy may reflect the greater clinical fragility of patients in real-world settings. By contrast, the rates of neutropenia and thrombocytopenia were comparable to those reported in TOPAZ-1, and no statistically significant differences in hematologic toxicity emerged between the two treatment groups. Non-hematologic AEs were identified using ICD-10 diagnostic codes. Most events—such as sepsis, acute kidney injury, constipation, diarrhea, and nausea or vomiting—occurred at similar rates across groups. However, malaise and fatigue were significantly more common in the Durva + GemCis group (28.8% vs 16.2%; HR: 1.98, 95% CI: 1.11–3.53). This finding aligns with prior reports: fatigue was observed in 26.9% of patients receiving Durva + GemCis in TOPAZ-1 and up to 55% in a large real-world study by Rimini et al.,¹⁹ supporting the consistency of this observation. Assessment of irAEs using electronic medical records remains challenging. Due to privacy restrictions in TriNetX, events with fewer than 10 cases could not be reported individually. Consequently, potentially irAEs—including hypothyroidism, hyperthyroidism, adrenal insufficiency, skin rash or dermatitis, pneumonitis, hepatitis, hypopituitarism, and myositis—were grouped into a composite “possible irAEs” outcome. The rate in the Durva + GemCis group reached 21.6%, higher than the 12.7% reported in TOPAZ-1 and similar to the approximately 20% rate observed in real-world cohorts. A comparable rate was also noted in the GemCis group, which may reflect the limitations of claims-based data. Diagnoses such as skin rash or liver enzyme elevation (e.g., alanine aminotransferase elevation) cannot be definitively attributed to immunotherapy in this setting. Therefore, interpretation of irAEs in both groups should be approached with caution, as misclassification and overestimation may occur in real-world database studies.

This study had several limitations that warrant consideration. First, as a retrospective analysis, the study was inherently subject to selection bias and residual confounding. Second, although the dataset was derived from a large, multinational electronic medical record network, the number of patients with advanced GBC remained relatively limited due to the rarity of the disease. Third, despite the use of propensity score matching to balance key variables—including age, sex, race, metastatic sites, and tumor marker levels—important clinical parameters such as Eastern Cooperative Oncology Group performance status were not available in the database. Fourthly, the absence of baseline histopathologic data and detailed TNM staging represented a notable limitation in the oncologic context. Fifth, objective response rates, PFS, and dose intensity were not captured, restricting outcome evaluation to OS alone. Sixth, the median follow-up time was relatively short, reflecting the poor prognosis of GBC and the inherent constraints of real-world databases, thereby limiting the assessment of long-term outcomes. Seventh, patient-reported outcomes, including quality of life, were unavailable. Eighth, non-hematologic AEs were identified using ICD-10 codes, which lacked information on event severity (grade) and did not reliably differentiate immune-related from non-immune-related etiologies. Finally, limitations specific to the TriNetX platform—such as missing entries for race and sex and privacy restrictions that precluded reporting of outcomes with fewer than 10 events—may have obscured rare but clinically relevant toxicities.

Pivotal trials established durvalumab plus GemCis as a first-line option in BTC, although no significant benefit was demonstrated in the GBC subgroup. The FDA nevertheless approved the regimen across all BTC subtypes, leaving an evidence gap. Our study sought to address this gap using a large, multinational electronic medical record database; however, GBC remains a rare malignancy with poor prognosis, and the number of patients able to receive standard treatment is inherently limited, resulting in a modest sample size. Given these limitations, the observed survival benefit should be considered exploratory and hypothesis-generating, underscoring the need for dedicated prospective trials in this underrepresented subgroup.

Conclusion

This real-world, retrospective study suggests that the addition of durvalumab to GemCis may improve OS in patients with advanced GBC, with a comparable safety profile except for increased fatigue. However, these findings are exploratory and should be interpreted with caution due to the study’s methodological constraints. Prospective, GBC-specific clinical trials are warranted to validate these observations and better define the role of chemo-immunotherapy in this rare malignancy.

Supplemental Material

sj-docx-1-tam-10.1177_17588359251393064 – Supplemental material for Real-world effectiveness of durvalumab plus gemcitabine and cisplatin versus gemcitabine and cisplatin in advanced gallbladder cancer: a study using the TriNetX global network

Supplemental material, sj-docx-1-tam-10.1177_17588359251393064 for Real-world effectiveness of durvalumab plus gemcitabine and cisplatin versus gemcitabine and cisplatin in advanced gallbladder cancer: a study using the TriNetX global network by Hsin-Chen Lin, Kuan-Yu Tseng and Yu-Hsuan Shih in Therapeutic Advances in Medical Oncology

Footnotes

Acknowledgements

We would like to thank Editage () for English language editing.

Declarations

ORCID iDs

Hsin-Chen Lin

Kuan-Yu Tseng

Yu-Hsuan Shih

Supplemental material

Supplemental material for this article is available online.

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