Topic: Adjuvant therapy - Gemcitabine or Capecitabine?

Hello, I meant to post an introduction but am having difficulty (my problem). I have a question please -

Does anyone know if there is any updated information about outcomes from the BILCAP trial? Or is there any other information suggesting whether Gemcitabine or Capecitabine is more likely to be effective as adjuvant therapy?

My husband is due to start chemotherapy in a couple of weeks' time after his second resection (last month) for intrahepatic CC. He has clean margins again and is doing well - back at work part-time and riding his bike. His tumour was said to be ductular on the path report the first time and while there have been several recent papers regarding possible differences between intrahepatic CC arising from ductules vs ducts, I don't think there is much about what that might mean for therapy. Like many who get this disease, he had no obvious risk factors. He didn't have chemo after the first resection (October '11). The second tumour was probably there after the first operation but too small to be seen on the post-op scan.

We thought he would be offered Gemcitabine this time but the oncologist has given us the choice of Gemcitabine or Capecitabine. We've said Gemcitabine but thought I'd ask if anyone knows more.

Thanks to the moderators and everyone involved with this board.

Regards,

Genevieve

Re: Adjuvant therapy - Gemcitabine or Capecitabine?

Genevie....welcome to our site.  I will try to answer your question as best as possible. 
At present we don't have any data re: the efficacy of adjuvant therapy for CC.  There are numerous clinical trials in process however; all are in various stages of accrual and none have been completed as of yet. 
Having said that many patients prefer to receive some type of adjuvant therapy simply because they feel it might possibly assure for this cancer not to return.  Also the majority of physicians I have spoken with recommend some type of adjuvant therapy.
I will try to find out some information in re: to the BILCAP
trial and if given permission, I will post it here.

http://www.asco.org/ASCOv2/Meetings/Abs … ctID=84552
I am not a doctor therefore, you would want to confirm with your physician everything mentioned. 
I would also like to attach some previous postings re: adjuvant therapy.
http://www.cholangiocarcinoma.org/punbb … hp?id=8369
http://www.cholangiocarcinoma.org/punbb … hp?id=4647
http://www.cholangiocarcinoma.org/punbb … hp?id=8440
http://www.cholangiocarcinoma.org/punbb … 30&p=2
http://www.cholangiocarcinoma.org/punbb … 30&p=2
I hope for others to chime in also to share their thoughts with us.
Best of luck,
Hugs,
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

3 (edited by eli Wed, 22 Aug 2012 16:40:06)

Re: Adjuvant therapy - Gemcitabine or Capecitabine?

Hi Genevieve,

Here are my thoughts.

1. Did your oncologist explain why you have to make the choice between Gemcitabine and Capecitabine? Why not do both at the same time?

Take a look at this link:

Biliary Tract Cancer Treatment Protocols
http://emedicine.medscape.com/article/2003836-overview

Gem/Cap protocol is an acceptable regimen for good performance status patients.

Also take a look at NCCN Treatment Guidelines, the current standard of care in the US. You might need to register to open the PDF:

http://www.nccn.org/professionals/physi … iliary.pdf

Page 22 (INTRA-2), footnote i. Gem/Cap is listed as one of the protocols that can be used in the adjuvant setting.

2. Have you discussed Gemcitabine/Cisplatin protocol with your oncologist? Gem/Cis improves survival in the unresected/metastatic cases, compared to Gem alone. As you probably know, this was proven in a large randomized Phase 3 trial done in the UK (ABC-02 trial). It's reasonable to extrapolate these results to the adjuvant setting.

3. BILCAP trial results are not out yet. In any case, I don't see how BILCAP trial can help you to make the choice between Gemcitabine and Capecitabine.

BILCAP trial tests Capecitabine vs. no treatment at all. The trial might help to establish Capecitabine as the standard of care in the resected cases. However, it's not going to tell us anything about relative merits of Gemcitabine vs. Capecitabine. They chose to test Capecitabine because it's an oral chemo. Patients take it at home. This is much easier on the patients after surgery... no need to travel to the hospital to receive IV. But, it's still possible that Gemcitabine is better overall.

Hope this helps and good luck!

Eli

Re: Adjuvant therapy - Gemcitabine or Capecitabine?

Thank you Marion, for asking about BILCAP. And thank you also for the links re adjuvant therapy; that was interesting reading.

Best wishes,
Genevieve

Re: Adjuvant therapy - Gemcitabine or Capecitabine?

Here's another previous discussion that might be worth a look.

Adjuvant treatment in biliary tract cancer: To treat or not to treat?
http://www.cholangiocarcinoma.org/punbb … hp?id=8426

Re: Adjuvant therapy - Gemcitabine or Capecitabine?

Genevieve.....to answer your question re: the BilCap study:  it is still recruiting patients and is expected to close to accrual in the next 6 months. We don't expect to hear the results of this UK study anytime before 2014.
Hugs,
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

Re: Adjuvant therapy - Gemcitabine or Capecitabine?

Hi Eli,

Thank you so much for all the information. It's been put to us as a trade off between possible benefit and toxicity, because of the lack of evidence regarding effectiveness, particularly for intrahepatic CC (and my husband's appears to be a less common type). We've spoken to two oncologists and that's why they are not suggesting gem/cis or any other combination.

Marion, thank you very much for finding out.

Thanks again to you both,

Gen

8 (edited by magic Fri, 24 Aug 2012 03:28:05)

Re: Adjuvant therapy - Gemcitabine or Capecitabine?

Hi there ,also the capecitabine is available in tablet form and that is another consideration.In these situations there is so much to weigh up,you know ,just enjoying life as much as you can as well as the health /disease benefits  because there is no predicting the outcome
                                                 Janet