title: Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer.
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.)
authors.affiliation: Christie Hospital, Manchester, United Kingdom.
authors.forename: Juan
authors.initials: J
authors.lastname: Valle
authors.forename: Harpreet
authors.initials: H
authors.lastname: Wasan
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Palmer
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.forename: Alan
authors.initials: A
authors.lastname: Anthoney
authors.forename: Anthony
authors.initials: A
authors.lastname: Maraveyas
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Madhusudan
authors.forename: Tim
authors.initials: T
authors.lastname: Iveson
authors.forename: Sharon
authors.initials: S
authors.lastname: Hughes
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Pereira
authors.forename: Michael
authors.initials: M
authors.lastname: Roughton
authors.forename: John
authors.initials: J
authors.lastname: Bridgewater
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001661:Biliary Tract Neoplasms / Q000188:drug therapy* / Q000401:mortality; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D010349:Patient Compliance / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine