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. 2025 Jul;45(7):e70181.
doi: 10.1111/liv.70181.

A Prognostic Index for Advanced Biliary Tract Cancer Treated With Cisplatin, Gemcitabine and Durvalumab: The MAGIC-D Index

Mara Persano  1   2 , Margherita Rimini  1 , Francesca Salani  3   4 , Federica Lo Prinzi  5 , Federico Nichetti  6 , Anna Saborowski  7 , Lorenzo Antonuzzo  8   9 , Laura Passeri  1 , Tomoyuki Satake  10 , Frederik Peeters  11 , Caterina Vivaldi  3   4 , Tiziana Pressiani  12 , Jessica Lucchetti  5 , Jin Won Kim  13 , Oluseyi Abidoye  14 , Salvatore Corallo  15   16 , Ilario Giovanni Rapposelli  17 , Stefano Tamberi  18   19 , Fabian Finkelmeier  20 , Guido Giordano  21   22 , Chiara Pircher  23 , Hong Jae Chon  24 , Chiara Braconi  25 , Aitzaz Qaisar  25 , Chiara Pirrone  26 , Florian Castet  27 , Emiliano Tamburini  28 , Changhoon Yoo  29 , Alessandro Parisi  30 , Anna Diana  31 , Mario Scartozzi  32 , Gerald W Prager  33 , Antonio Avallone  34 , Marta Schirripa  35 , Il Hwan Kim  36 , Lukas Perkhofer  37   38 , Ester Oneda  39 , Monica Verrico  40 , Nuno Couto  41 , Jorge Adeva  42 , Stephen L Chan  43 , Gian Paolo Spinelli  44 , Nicola Personeni  45 , Ingrid Garajova  46 , Maria Grazia Rodriquenz  47 , Silvana Leo  48 , Cecilia Melo Alvim  49 , Ricardo Roque  50 , Giovanni Farinea  51 , Lorenzo Fornaro  3 , Antonio De Rosa  6   52 , Irene Lanzetta  15 , Rita Balsano  12   53 , Daniele Lavacchi  8 , Silvia Camera  1 , Masafumi Ikeda  10 , Jeroen Dekervel  11 , Monica Niger  23 , Giulia Tesini  25   53 , Giuseppe Tonini  54 , Minsu Kang  13 , Tanios Bekaii-Saab  14 , Luca Esposito  17 , Alessandra Boccaccino  18 , Michele Ferrara  1 , Vera Himmelsbach  20 , Matteo Landriscina  21   22 , Selma Ahcene Djaballah  5 , Gianluca Masi  3   4 , Arndt Vogel  7   55 , Sara Lonardi  6 , Lorenza Rimassa  12   53 , Andrea Casadei-Gardini  1
Affiliations

A Prognostic Index for Advanced Biliary Tract Cancer Treated With Cisplatin, Gemcitabine and Durvalumab: The MAGIC-D Index

Mara Persano et al. Liver Int. 2025 Jul.

Abstract

Background: Over the years, prognostic indexes have been developed to help clinicians stratify patients with biliary tract cancers (BTC) into risk groups. This study aims to identify a new prognostic index for patients with BTC treated with cisplatin, gemcitabine and durvalumab (CGD) in the first-line setting.

Patients and methods: The study population consisted of patients with BTC from 11 Eastern and Western Countries. Using multivariate analysis for overall survival (OS), we identified 5 baseline statistically significant variables: stage, carcinoembryonic antigen (CEA) levels, albumin levels, gamma glutamyl transferase (GGT) levels, neutrophil-to-lymphocyte ratio (NLR). Metastatic disease is a prognostic factor with a superior weight considering the HR of 3.62, while all the others can be considered prognostic factors with equivalent weight as the HRs are quite similar (HRs between 1.55 and 1.92). Based on these reasons, we developed a prognostic model called the MAGIC-D index by assigning a score of 2 for metastatic disease, and a score of 1 for CEA increased levels, albumin decreased levels, GGT increased levels, NLR ≥ 3. Patients were stratified into three risk groups as follows: low-risk group (Score from 0 to 2), intermediate-risk group (Score from 3 to 4) and high-risk group (Score from 5 to 6). At the first data cutoff (April 2024), these data were available for 319 patients that composed the training cohort used for the analysis. At the second data cutoff (May 2025), 79 patients were further enrolled and composed the validation cohort.

Results: Median progression-free survival was 11.7 months in low-risk group (20.7%), 8.7 months in intermediate-risk group (46.4%) and 5.4 months in high-risk group (32.9%) [low-risk hazard ratio (HR): 0.27, intermediate-risk HR: 0.55, high-risk HR: 1, p < 0.0001]. Median OS was 18.4 months in low-risk group,15.9 months in intermediate-risk group and 7.8 months in high-risk group (low-risk HR: 0.17, intermediate-risk HR: 0.43, high-risk HR: 1, p < 0.0001). There was no difference in overall response rate (low-risk: 31.8%, intermediate-risk: 36.5% and high-risk: 25.7%; p = 0.0718), while disease control rate was significantly different across the three risk groups (low-risk: 83.3%, intermediate-risk: 70.9% and high-risk: 60.9%; p < 0.0001) as well as the rate of patients receiving a second-line therapy (low-risk: 54.5%, intermediate-risk: 48.6% and high-risk: 25.7%; p = 0.0061). Finally, the prognostic role in terms of OS and PFS of the MAGIC-D index was confirmed in a validation cohort of 79 patients.

Conclusion: The MAGIC-D index is an easy-to-use tool able to stratify patients with BTC with different prognoses undergoing first-line therapy with CGD.

Keywords: biliary tract cancer; durvalumab; prognostic index.

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