1 (edited by PCL1029 Mon, 05 Mar 2012 11:14:17)

Topic: Compare 5FU-Based and Gemcitabine-based Chemo w/wo Cisplatin

Hi, everyone,
If it is of interest to you,please read.

Current available literature from uptodate.com indicated:
1. 5FU alone and older 5FU- based combination therapies- the objective response rates(OR ) is between 0-34%. Higher responses rate(OR=32%) are reported when using either infusional 5FU or 5FU with leucovorin(ie:using continuous infusion pump for 48 hrs);For unclear reasons,capecitabine as a single agent is LESS effective against CCA than for gallbladder(GB) cancer;(thus ,in my opinion and not from any other sources, Xeloda is more effective in extrahepatic CCA than intrahepatic CCA due to the physiological location of the extrahepatic bile ducts are closer to the GB than the intrahepatic bile ducts that originated from the inside of the liver for the intrahepatic CCA..

2.Gemcitabine ALONE-The Objective responses rate is around 7-27%; for Gemzar+cisplatin combination ,a pooled analysis of 104 trails of  a variety of chemotherapy regimens in advanced biliary cancer (dose not included the  famous ABC trial which  total pt. pop=410,CCA pt=242;gallbladder=148;ampullary=20 that means this famous ABC02 trials is not exclusively for CCA either) concluded that  the GEM/CIS regimen offered the highest rates of objective response and tumor control compared to either gemcitabine-free or cisplatin-free regimens.,however,this did not translate into significant benefit in terms of either time to progression(ie:the time from the last scan that shows no tumor growth or stable to  the time the  new scan  shows tumor is growing or new lesion is discovered) ; median overall survival (ie; is the middle number in months of all the patients who survived.eg. if have 100 patient in a study,and the MEDIAN overall survival is 20 months;that means 50 patients will survive less than 20 months and the other 50 patients will be live longer than 20 months); therefore  the Gem/Cis regimen in their view(the uptodate literature review panel) should be considered a standard option,but NOT the definitive REFERENCE standard for treatment of advanced CCA.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Compare 5FU-Based and Gemcitabine-based Chemo w/wo Cisplatin

while you're on the search for info re. use of 5FU-based protocols for treatment of CCA -

am i looking in the wrong place for any studies describing the use of FOLFIRINOX/FOLFOX/FOLFIRI for CCA?  can't find anything other than pancreatic CA studies.

3 (edited by eli Mon, 27 Feb 2012 20:01:54)

Re: Compare 5FU-Based and Gemcitabine-based Chemo w/wo Cisplatin

mydadrocks,

I did a quick search using Google Scholar:

http://scholar.google.com/scholar?q=cho … oma+FOLFOX

Found two studies on Page 1 that seem relevant:

[2010] Preliminary phase II results of oxaliplatin, 5-FU, and leucovorin in advanced biliary tract cancer.
http://meeting.ascopubs.org/cgi/content … ppl/e14507

[2002] Oxaliplatin, fluorouracil and leucovorin for advanced biliary system adenocarcinomas: a prospective phase II trial
http://www.nature.com/bjc/journal/v87/n … 0543a.html

I haven't reviewed google search results beyond page 1.

Searching PubMed for the same terms doesn't return anything. Odd!!

EDIT:

The second study is available on PubMed:
http://www.ncbi.nlm.nih.gov/pubmed/12232749

Re: Compare 5FU-Based and Gemcitabine-based Chemo w/wo Cisplatin

Hi,
Thanks ,Eli.

mydadrocks, try to look under colon cancer for FOLFOX or FOLFINOX and the like and you will find some answers.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Compare 5FU-Based and Gemcitabine-based Chemo w/wo Cisplatin

Just waned to chime in.  Cholangiocarcinoma clinical trials should be conducted exclusively however, due to lack of accrual (in this country) we often see gallbladder included.  It is however, a completely different cancer with completely different cell structure.
Hugs and love
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER