Bits and Pieces About Chemo Therapy Abstracts & Other-from ASCO 6/2011

1. BILCAP is currently the only treatment protocol for UK patients after curative resection for CC under phase III trial with adjuvant therapy capecitabline.#4125

2.A meta-analysis of abstracts from 1960-Nov. 2010 showed a trend to improved survival with any adjuvant chemo(AT) compared to surgery alone .This analysis provided for support AT for CC,esp. in patients with high risk(ie:node or margin + after resection.Most if not all in the study were high risk patients and thus a non -treatment arm in a randomized study of low risk patients is still justified.#4050

#3 A study reviewed the outcome of CC patients after resections from 2005-2009 and received AT.(median age=61,ICC=19;ECC=32;other=65% had T3 or T4 tumors;42%nodes+;37% tumor grade=3-4;vascular invasion=19%).Only 39% of pts received gemcitabline or 5FU,capecitabine.All the above were important factors significantly correlated with disease-free-survival(DFS)=29 month when compared with surgery alone (17.5mo).AT seems effective to prolong DFS in CC pts.#e14614

#4 In a phase II study done between May 2009-October 2010,41 (73.2%) were CC patients ,median age=55yrs,who failed the first-line chemo therapy;using sunitinib as 2nd line treatment in advanced CC,It demonstrated this was a feasible mono therapy for CC patients who have failed to previous chemotherapy.Howerever the toxicity were high(Grade3-4=42.2% with 17.9% neutropenia)The objective rate was only 8.9% and the DFS was 50%. #e14653.

#5 In a phase III,multicenter,randomized trials of GEMOX with or without erlotinib(GEMOX/T) in unresectable metastatic CC as 1st-line treatment from Feb2009-August 2010.Total patient population=268;median age 61 ;67.2% were CC ptients.Median Progress free survival was 3.0 vs 5.9 mo.)#LBA4032

#6 This is of special interest to patients who is now under or consider treatment under Dr. Bruckner,oncologist who practices in down town New York using “chemo cocktails” to treat CC patients.
In his “multidisciplinary effect of adding docetaxel and mitomycin C to low dose multidrug therapy for cholangiocarcinoma”He states he uses gemcitabine, 5FU irinotecan,leucovorin,oxaliplatin(GFLIOx) and GFLIOx+docetaxel,mitomycin C (GFLIOx-TXT+/-MMC) to treat high risk CC patients who are unresectable and recurrent. Analysis excluded ideal patients with either tumor<5cm or well differentiated primary tumors.GFLIOx produced a 50% rate of benefit for 6 months or more and 19.5 months median overall survival. In sequence,on progression addition of both TXT and MMC produced a 90% rate of benefit,all for six mohths or more and a median survival of 10 months from time of first addition. All this benefits provide opportunities for resection,debulking surgery,TACE and Yittium 90. The findings support testing these low dose combinations in both neoadjuvant and classic adjuvant settings.It is feasible to produce opportunities and multi-year,treatment-free survivors with "palliative" low dose treatments for recurrent and unresectable disease.Secondary benefits include reduced cost and adverse events,compared to high dose standard therapy.Final review will presented in J.Clinical Oncology in 2011. #e14546.