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Gemcitabine, capecitabine and oxaliplatin in advanced biliary tract carcinoma

Biliary tract carcinoma includes gallbladder cancer and cholangiocarcinoma. Cholangiocarcinoma can be subdivided into intrahepatic, perihilar (Klatskin) and extrahepatic carcinoma. Biliary tract carcinoma is a relative rare cancer which account for less than 1% of new cancer cases. Only resection is a curative treatment, but unfortunately resection is only possible in approximately 10%, leaving most patients with advanced disease. For patients with advanced disease only palliative treatment is possible. The most active drugs in phase II trials are gemcitabine [1,2], fl ourpyrimidine/capecitabine [3,4] and cisplatin/oxaliplatin [5 – 9]. Support for gemcitabine as an anchor drug for the treatment of advanced biliary tract carcinoma comes from a pooled analysis of 104 trials that showed that the subgroup receiving a combination of gemcitabine and platinium-based agent had the greatest benefi t [10]. In 2010 Valle published a study with 410 patients where cisplatin and gemcitabine were compared to gemcitabine alone [11]. The patients receiving cisplatin and gemcitabine had a better and impressive median overall survival (OS) of 11.7 months. Cisplatin and gemcitabine were therefore suggested as standard treatment to patients with advanced biliary tract carcinoma. Several phase two trials have replaced cisplatin with oxaliplatin and the combination with gemcitabine and oxaliplatin show similar median OS of approximately 12 months [12,13]. One smaller trial tested the triplet of gemcitabine, oxaliplatin and capecitabine and found it well tolerated with similar median OS [14]. Furthermore, the study showed that the addition of capecitabine allowed a lower oxaliplatin dose than the usual 100 mg/m 2 every second week and subsequently reducing especially neutropenia and neurotoxicity. In the present study we wanted to investigate the effi ciency of the triplet gemcitabine, capecitabine and oxaliplatin in daily clinic and compare the results with other similar studies.