title: Phase I study of adjuvant chemotherapy with gemcitabine plus cisplatin in patients with biliary tract cancer undergoing curative resection without major hepatectomy (KHBO1004).
abstract: OBJECTIVE
  We conducted a phase I study to determine the maximum tolerated dose and recommended dose (RD) of this gemcitabine plus cisplatin (GC) combination in the adjuvant setting for biliary tract cancer (BTC). GC has become a standard chemotherapy regimen for patients with locally advanced or metastatic BTC; however, the benefit of adjuvant therapy for BTC is unclear.
  
  
  METHODS
  Patients with BTC were eligible if they met the following criteria: Stage IB or higher; and undergoing resection without major hepatectomy. The starting dose matched the standard dose of gemcitabine (1,000 mg/m(2)) and cisplatin (25 mg/m(2)) on days 1 and 8, every 3 weeks for up to 24 weeks. The dose limiting toxicities (DLTs) were determined during the first 6 weeks, and a 3+3 dose finding design with cohorts of 3-6 patients was used. Further cohort expansion took place.
  
  
  RESULTS
  One DLT, namely grade 4 neutropenia, was observed among six patients at the starting dosages. Then, we expanded the cohort with a total of eighteen patients to evaluate RD and no further DLTs were observed. During the entire study, the most common grade 3/4 adverse events were neutropenia (94 %) and leucopenia (56 %). Non-hematological toxicities were manageable.
  
  
  CONCLUSIONS
  We defined the standard dose of GC as the RD for adjuvant chemotherapy for BTC treated by curative resection without major hepatectomy. Further study is warranted to clarify the safety and efficacy of this regimen for all patients.
authors.affiliation: Department of Medical Oncology and Hematology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan, masanoritoyo@hotmail.co.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Toyoda
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ajiki
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano
authors.forename: Shogo
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sakai
authors.forename: Etsuro
authors.initials: E
authors.lastname: Hatano
authors.forename: Masashi
authors.initials: M
authors.lastname: Kanai
authors.forename: Shoji
authors.initials: S
authors.lastname: Nakamori
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miyamoto
authors.forename: Akihito
authors.initials: A
authors.lastname: Tsuji
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kaihara
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.forename: Hideyoshi
authors.initials: H
authors.lastname: Toyokawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Terajima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ioka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D001661:Biliary Tract Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine