Cisplatin plus Gemcitabine versus Gemcitabine for Biliary Tract Cancer

Volume 362:1273-1281 April 8, 2010 Number 14
Cisplatin plus Gemcitabine versus Gemcitabine for Biliary Tract Cancer

Juan Valle, M.D., Harpreet Wasan, M.D., Daniel H. Palmer, M.D., Ph.D., David Cunningham, M.D., Alan Anthoney, M.D., Anthony Maraveyas, M.D., Ph.D., Srinivasan Madhusudan, M.D., Ph.D., Tim Iveson, M.D., Sharon Hughes, B.Sc., Stephen P. Pereira, M.D., Ph.D., Michael Roughton, M.Sc., John Bridgewater, M.D., Ph.D., for the ABC-02 Trial Investigators


ABSTRACT

Background: There is no established standard chemotherapy for patients with locally advanced or metastatic biliary tract cancer. We initially conducted a randomized, phase 2 study involving 86 patients to compare cisplatin plus gemcitabine with gemcitabine alone. After we found an improvement in progression-free survival, the trial was extended to the phase 3 trial reported here.

Methods: We randomly assigned 410 patients with locally advanced or metastatic cholangiocarcinoma, gallbladder cancer, or ampullary cancer to receive either cisplatin (25 mg per square meter of body-surface area) followed by gemcitabine (1000 mg per square meter on days 1 and 8, every 3 weeks for eight cycles) or gemcitabine alone (1000 mg per square meter on days 1, 8, and 15, every 4 weeks for six cycles) for up to 24 weeks. The primary end point was overall survival.

Results: After a median follow-up of 8.2 months and 327 deaths, the median overall survival was 11.7 months among the 204 patients in the cisplatin–gemcitabine group and 8.1 months among the 206 patients in the gemcitabine group (hazard ratio, 0.64; 95% confidence interval, 0.52 to 0.80; P<0.001). The median progression-free survival was 8.0 months in the cisplatin–gemcitabine group and 5.0 months in the gemcitabine-only group (P<0.001). In addition, the rate of tumor control among patients in the cisplatin–gemcitabine group was significantly increased (81.4% vs. 71.8%, P=0.049). Adverse events were similar in the two groups, with the exception of more neutropenia in the cisplatin–gemcitabine group; the number of neutropenia-associated infections was similar in the two groups.

Conclusions: As compared with gemcitabine alone, cisplatin plus gemcitabine was associated with a significant survival advantage without the addition of substantial toxicity. Cisplatin plus gemcitabine is an appropriate option for the treatment of patients with advanced biliary cancer. (ClinicalTrials.gov number, NCT00262769 [ClinicalTrials.gov] .)



Source Information

From Christie Hospital, Manchester (J.V.); Hammersmith Hospital, Imperial College Health Care Trust (H.W.), Royal Marsden Hospital (D.C.), Cancer Research United Kingdom and University College London Cancer Trials Centre (S.H., M.R.), Institute of Hepatology, University College London (S.P.P.), and University College London Cancer Institute (J.B.) — all in London; University Hospital Birmingham, Birmingham (D.H.P.); St. James's Hospital, Leeds (A.A.); Castle Hill Hospital, Hull (A.M.); Nottingham University Hospitals, Nottingham (S.M.); and Southampton University Hospitals, Southampton (T.I.) — all in the United Kingdom.

Address reprint requests to Dr. Bridgewater at the University College London Cancer Institute, 72 Huntley St., London WC1E 6AA, United Kingdom, or at j.bridgewater@ucl.ac.uk.


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http://content.nejm.org/cgi/content/full/362/14/1273