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Real‐World Validation of the MAGIC ‐D Index in Unresectable Biliary Tract Cancer Treated With Durvalumab Plus Chemotherapy

Year: 2026

Type: article

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.

Source: Cancer Medicine

DOI: 10.1002/cam4.72254