title: The efficacy of frontline platinum-based combination chemotherapy in advanced adenocarcinoma of the ampulla of Vater.
abstract: Adenocarcinoma arising from the ampulla of Vater is a rare neoplasm that accounts for only 0.2% of all gastrointestinal tract malignancies and has limited data regarding its frontline therapy. We investigated the treatment outcomes in patients with advanced adenocarcinoma of the ampulla of Vater receiving frontline cisplatin-based combination chemotherapy. We analyzed 29 patients with advanced adenocarcinoma of the ampulla of Vater who had been treated by frontline cisplatin-based combination chemotherapy between June 2003 and April 2008. The chemotherapeutic agent added to cisplatin was gemcitabine in 9 patients and fluorouracil (FU) in 20 patients (11; intravenous 5-FU and 9; oral 5-FU (capecitabine)). The median age of patients was 56 years (range, 36-78), and the median ECOG performance status was 1 (0-1). The confirmed overall response rate was 27.5%, and the disease control rate was 72.4%. In all patients, no complete responses and 8 partial responses were observed (overall response rate, 27.5%). Stable disease was observed in 13 patients (44.8%), and progressive disease in 5 patients (17.2%). The median time to progression (TTP) was 4.9 months (95% CI, 3.4-6.4), and the median overall survival (OS) was 12.5 months (95% CI, 10.6-14.4). There were no significant differences for TTP and OS according to the different chemotherapeutic agents added to cisplatin. Grade 3 or 4 hematologic toxicities included leukopenia in seven patients and thrombocytopenia in one patient. There were no grade 3 or 4 nonhematologic toxicities or treatment-related deaths. The cisplatin-based combination chemotherapy showed moderate activity and a favorable toxicity profile as a frontline treatment for patients with advanced adenocarcinoma of the ampulla of Vater.
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, South Korea. seungtai.kim@samsung.com
authors.forename: Seung Tae
authors.initials: ST
authors.lastname: Kim
authors.forename: Jeeyun
authors.initials: J
authors.lastname: Lee
authors.forename: Kyu Taek
authors.initials: KT
authors.lastname: Lee
authors.forename: Jong Kyun
authors.initials: JK
authors.lastname: Lee
authors.forename: Kwang Hyuk
authors.initials: KH
authors.lastname: Lee
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Jin-Seok
authors.initials: JS
authors.lastname: Heo
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Choi
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Park
authors.forename: Joon Oh
authors.initials: JO
authors.lastname: Park
authors.forename: Ho Yeong
authors.initials: HY
authors.lastname: Lim
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Park
authors.forename: Won Ki
authors.initials: WK
authors.lastname: Kang
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000187:drug effects* / Q000473:pathology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069287:Capecitabine; D002945:Cisplatin / Q000008:administration & dosage; D003138:Common Bile Duct Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000556:secondary; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary; D015996:Survival Rate; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D000069287:Capecitabine; D002945:Cisplatin; D005472:Fluorouracil; D000093542:Gemcitabine