The cisplatin, epirubicin, 5‐fluorouracil, gemcitabine (PEFG) regimen in advanced biliary tract adenocarcinoma

Abstract

BACKGROUND: Biliary tract adenocarcinoma (BTA) is an uncommon tumor with a poor prognosis and no standard, systemic chemotherapy. The combined cisplatin, epirubicin, 5-fluorouracil, and gemcitabine (PEFG) regimen is an effective, upfront treatment for advanced pancreatic cancer. In this study, the authors assessed the activity and safety of this combination regimen in patients with advanced BTA. METHODS: PEFG (cisplatin 40 mg/m 2 and epirubicin 40 mg/m 2 on Day 1; gemcitabine 600 mg/m 2 on Days 1 and 8; and 5-fluorouracil [FU] 200 mg/m 2 daily as a continuous infusion) was administered to chemotherapy-naive patients who had a cytologic or histologic diagnosis of locally advanced or metastatic BTA, aged 75 years, and a performance status (PS) >60 either until they had evidence progressive disease or for a maximum of 6 months. Tumor size was assessed every 2 months during treatment. RESULTS: Between May 1999 and December 2005, 37 patients (62% metastatic) who had a median age of 62 years and a median PS of 90 received the PEFG regimen at the authors' institution. Primary tumor sites were the intrahepatic bile duct in 10 patients (27%), the extrahepatic bile duct in 8 patients (22%), the gallbladder in 12 patients (32%), and the ampulla of Vater in 7 patients (19%). A partial response was observed in 16 patients (43%), and stable disease was observed in 12 patients (32%). The median overall survival (OS) was 12.1 months, and the 1-year OS rate was 52%. The median progression-free survival (PFS) was 7.9 months, and the 6-month PFS rate was 67%. The main grade 3/4 toxicity was neutropenia in 18% of cycles followed by thrombocytopenia in 9% of cycles, nausea/vomiting in 5% of cycles, and febrile neutropenia, fatigue, anemia, and stomatitis in 2% of cycles. CONCLUSIONS: The current results demonstrated that PEFG was an active regimen with a manageable toxicity profile for patients with advanced BTA.

Better Outcome of XELOX Chemotherapy in Patients with Advanced Intestinal-Type Adenocarcinoma of the Ampulla of Vater

“…Overall, 5-FU derivative, platinum, and gemcitabine have been the cornerstone of combination chemotherapy of AAC, all of which have showed an ORR of nearly 30% (range, 18 to 50) and median OS of approximately 12 months (range, 8.0 to 20.4) (Andre et al 2004;Gibson et al 2005;Rao et al 2005;Overman et al 2009;Cereda et al 2010;Kim et al 2010;Valle et al 2010;Lee et al 2012). Though no superior regimen exists that has been confirmed by randomized controlled study, XELOX is the most evaluated regimen to date in AAC and could be the preferred regimen, owing to the comparable efficacy and tolerance in a phase II and in our study (Overman et al 2009).…”

Berberine Inhibits Growth and Induces G1 Arrest and Apoptosis in Human Cholangiocarcinoma QBC939 Cells

“…The incidence of cholangiocarcinoma is rising over the past decades (1,2). However, the prognosis for cholangiocarcinoma is quite poor because of difficulties in early diagnosis, and relative resistance of the tumors to chemotherapy (3,4), and no standard chemotherapy has been established (5,6). Surgical resection, considered as palliative rather than curative, has been the mainstay of curative treatment for cholangiocarcinoma.…”

Preclinical evaluation of sorafenib-eluting stent for suppression of human cholangiocarcinoma cells

“…Furthermore, sorafenib-released media was used to test whether sorafenib maintained its biological activity during the stent-coating process and drug-release experiment. At 1,5,10,15,20, and 30 days of the drug-release experiment, the collected media were used to test anticancer activity.…”

“…1 reported with combinations of anticancer drugs. [4][5][6][7][8][9] Among them, clinical trials with a combination of gemcitabine plus cisplatin were reported to have significant survival advantage compared to gemcitabine alone. [7][8][9] However, systemic chemotherapy and radiation therapy for cholangiocarcinoma is not sufficiently effective.…”