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.
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.
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.
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.)
2010 Massachusetts Medical Society