Real‐World Validation of the
MAGIC
‐D Index in Unresectable Biliary Tract Cancer Treated With Durvalumab Plus Chemotherapy
Tianao Zhan, Hongwei Huang, Juncheng Zhan, Feng Xia, Tianyin Shao, Xinkang Liu, Jun Shen, Xingbin Xu, Yawei Fan, Qi Cheng ABSTRACT
Background
The MAGIC‐D index was originally developed to predict outcomes in advanced biliary tract cancer (BTC) patients receiving durvalumab‐gemcitabine‐cisplatin (Durva‐Gem‐Cis). This study aimed to assess the efficacy and safety of various durvalumab‐chemotherapy regimens for unresectable BTC patients and the broader applicability of the MAGIC‐D index.
Methods
This study retrospectively recruited unresectable BTC patients receiving durvalumab‐chemotherapy from 2021 to 2024. Overall survival (OS) and progression‐free survival (PFS) were assessed, and patients were risk‐stratified using the MAGIC‐D index.
Results
A total of 89 patients were included in the analysis. Between the Durva‐Gem‐Cis group and the durvalumab plus other chemotherapy regimens (Durva‐Other Regimens) group, the median OS (12.9 vs. 13.9 months) and PFS (5.5 vs. 6.2 months) were comparable. Patients were risk‐stratified into three risk groups (median OS: 21.0, 12.9, 12.4 months for the low‐, intermediate‐, and high‐risk groups, respectively; p = 0.002) using the MAGIC‐D index, which achieved a concordance index (C‐index) of 0.637. The Cox regression analysis showed serum CA 19‐9 level, high Ki67 expression and the MAGIC‐D index were related to OS. An exploratory model named the modified MAGIC‐D index, incorporating Ki67 and CA 19‐9 into the MAGIC‐D index, showed promising discrimination of survival among risk groups (25.0 vs. 12.9 vs. 9.1 months, p < 0.001) with a C‐index of 0.709.
Conclusion
Durvalumab plus different chemotherapy regimens achieves comparable outcomes in the treatment of unresectable BTC. Incorporating Ki67 and CA 19‐9 into the MAGIC‐D index may enhance risk stratification, but external validation in larger independent cohorts is required before clinical application.