title: A phase II study of capecitabine and oxaliplatin combination chemotherapy in patients with inoperable adenocarcinoma of the gall bladder or biliary tract.
abstract: BACKGROUND
  Advanced biliary tract carcinomas are associated with a poor prognosis, and palliative chemotherapy has only modest benefit. This multi-centre phase II study was conducted to determine the efficacy of capecitabine in combination with oxaliplatin in patients with inoperable gall bladder or biliary tract cancer.
  
  
  METHODS
  This was a Phase II, non-randomised, two-stage Simon design, multi-centre study. Ethics approval was sought and obtained by the North West MREC, and then locally by the West Glasgow Hospitals Research Ethics Committee. Eligible patients with inoperable locally advanced or metastatic adenocarcinoma of the gall bladder or biliary tract and with adequate performance status, haematologic, renal, and hepatic function were treated with capecitabine (1000 mg/m(2) po, twice daily, days 1-14) and oxaliplatin (130 mg/m(2) i.v., day 1) every 3 weeks for up to six cycles. The primary objective of the study was to determine the objective tumour response rates (complete and partial). The secondary objectives included assessment of toxicity, progression-free survival, and overall survival.
  
  
  RESULTS
  Forty-three patients were recruited between July 2003 and December 2005. The regimen was well tolerated with no grade 3/4 neutropenia or thrombocytopenia. Grade 3/4 sensory neuropathy was observed in six patients. Two-thirds of patients received their chemotherapy without any dose delays. Overall response rate was 23.8% (95% CI 12.05-39.5%). Stable disease was observed in a further 13 patients (31%) and progressive disease observed in 12 (28.6%) of patients. The median progression-free survival was 4.6 months (95% CI 2.8-6.4 months; Fig. 1) and the median overall survival 7.9 months (95% CI 5.3-10.4 months; Fig. 2). Fig. 1 Progression-free survival Fig. 2 Overall survival
  
  
  CONCLUSIONS
  Capecitabine combined with oxaliplatin has a lower disease control and shorter overall survival than the combination of cisplatin with gemcitabine which has subsequently become the standard of care in this disease. However, capecitabine in combination with oxaliplatin does have modest activity in this disease, and can be considered as an alternative treatment option for patients in whom cisplatin and/or gemcitabine are contra-indicated.
authors.affiliation: Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 OYN, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Graham
authors.affiliation: Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 OYN, UK. boyka01@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Boyd
authors.affiliation: Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.
authors.forename: F Y
authors.initials: FY
authors.lastname: Coxon
authors.affiliation: Edinburgh Cancer Centre, Western General Hospital, Edinburgh, EH4 2XU, UK.
authors.forename: L R
authors.initials: LR
authors.lastname: Wall
authors.affiliation: Belfast Cancer Centre, Belfast City Hospital, Belfast, BT9 7AB, UK.
authors.forename: M M
authors.initials: MM
authors.lastname: Eatock
authors.affiliation: Velindre Hospital, Whitchurch, Cardiff, CF14 2TL, UK.
authors.forename: T S
authors.initials: TS
authors.lastname: Maughan
authors.affiliation: Ninewells Hospital, Dundee, DD1 9SY, UK.
authors.forename: M
authors.initials: M
authors.lastname: Highley
authors.affiliation: Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 OYN, UK.
authors.forename: E
authors.initials: E
authors.lastname: Soulis
authors.affiliation: Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 OYN, UK.
authors.forename: S
authors.initials: S
authors.lastname: Harden
authors.affiliation: Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 OYN, UK.
authors.forename: P
authors.initials: P
authors.lastname: Bützberger-Zimmerli
authors.affiliation: Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 OYN, UK.|Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1BD, UK.
authors.forename: T R J
authors.initials: TR
authors.lastname: Evans
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001661:Biliary Tract Neoplasms / Q000188:drug therapy* / Q000601:surgery; D000069287:Capecitabine / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005706:Gallbladder Neoplasms / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D000077150:Oxaliplatin; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000069287:Capecitabine
keywords: Biliary tract; Capecitabine; Gall bladder; Oxaliplatin