Patient case: 50-year-old male with cholangiocarcinoma; genetic feature: IDH1

Clinical trial: Gemcitabine and Capecitabine in Treating Patients With Advanced and/or Inoperable Cholangiocarcinoma or Carcinoma of the Gallbladder

Summary: RATIONALE: Drugs used in chemotherapy, such as gemcitabine and capecitabine, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one chemotherapy drug may kill more tumor cells.
  PURPOSE: Phase II trial to study the effectiveness of combining gemcitabine with capecitabine in treating patients who have advanced and/or inoperable cholangiocarcinoma or carcinoma (cancer) of the gallbladder.

Detailed description: OBJECTIVES:
  Primary
  -  Determine the response rate in patients with advanced and/or inoperable cholangiocarcinoma or carcinoma of the gallbladder treated with gemcitabine and capecitabine.
  Secondary
  -  Determine time to disease progression and overall survival of patients treated with this regimen.
  -  Determine quality of life of patients treated with this regimen.
  OUTLINE: This is an open-label study.
  Patients receive gemcitabine IV over 30 minutes on days 1 and 8 and oral capecitabine twice daily on days 1-14. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
  Quality of life is assessed at baseline and at weeks 3, 6, 9, and 12.
  Patients are followed monthly.
  PROJECTED ACCRUAL: A total of 9-17 patients will be accrued for this study within 1.5 years.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically or cytologically confirmed cholangiocarcinoma or carcinoma of the gallbladder
  -  Advanced and/or inoperable disease
  -  Measurable disease
  -  At least 1 unidimensionally measurable lesion ≥ 20 mm by conventional techniques OR ≥ 10 mm by spiral CT scan
  -  No known brain metastases
  PATIENT CHARACTERISTICS:
  Age
  -  18 and over
  Performance status
  -  ECOG 0-2 OR
  -  Karnofsky 60-100%
  Life expectancy
  -  More than 2 months
  Hematopoietic
  -  WBC ≥ 3,000/mm^3
  -  Absolute neutrophil count ≥ 1,500/mm^3
  -  Platelet count ≥ 100,000/mm^3
  Hepatic
  -  Bilirubin < 3 mg/dL
  Renal
  -  Creatinine ≤ 1.6 mg/dL
  Cardiovascular
  -  No symptomatic congestive heart failure
  -  No unstable angina pectoris
  -  No cardiac arrhythmia
  Other
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective contraception
  -  No prior allergic reaction attributed to compounds of similar chemical or biological composition to study drugs
  -  No ongoing or active infection
  -  No psychiatric illness or social situation that would preclude study compliance
  -  No other concurrent uncontrolled illness
  PRIOR CONCURRENT THERAPY:
  Biologic therapy
  -  Not specified
  Chemotherapy
  -  More than 4 weeks since prior chemotherapy and recovered
  -  No more than 1 prior chemoembolization OR chemoradiotherapy regimen for locally advanced biliary tract cancer
  -  No other prior chemotherapy (except adjuvant therapy)
  Endocrine therapy
  -  Not specified
  Radiotherapy
  -  See Chemotherapy
  -  More than 4 weeks since prior radiotherapy and recovered
  Surgery
  -  Not specified
  Other
  -  No other concurrent investigational agents
  -  No other concurrent anticancer agents or therapies

Relevance to patient case: not relevant