Patient case: 64-year-old male with cholangiocarcinoma; genetic feature: BRAF (V600E)

Clinical trial: Yttrium Y 90 Glass Microspheres and Capecitabine in Treating Patients With Liver Cholangiocarcinoma or Liver Metastases

Summary: RATIONALE: Radiation therapy uses high-energy x-rays and other types of radiation to kill tumor cells. Specialized radiation therapy, such as yttrium Y 90 glass microspheres that deliver a high dose of radiation directly to the tumor, may kill more tumor cells and cause less damage to normal tissue. Drugs used in chemotherapy, such as capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Capecitabine may also make tumor cells more sensitive to radiation therapy.
  PURPOSE: This phase I trial is studying the side effects and best dose of yttrium Y 90 glass microspheres when given together with capecitabine in treating patients with liver cholangiocarcinoma or liver metastases.

Detailed description: OBJECTIVES:
  -  Establish the maximally tolerated dose of yttrium Y 90 glass microspheres in combination with capecitabine in patients with intrahepatic cholangiocarcinoma or liver metastases.
  -  Characterize the toxicity of this regimen in these patients.
  -  Determine the time to tumor progression in these patients.
  OUTLINE: This is a dose escalation study of yttrium Y 90.
  Patients receive oral capecitabine twice daily on days 1-14. Treatment repeats every 21 days for 3 courses in the absence of disease progression or unacceptable toxicity. Patients also receive yttrium Y 90 glass microspheres by intra-arterial hepatic infusion on days 1-7 of course 2.
  After completion of study therapy, patients are followed every 3 months for 2 years.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed diagnosis of 1 of the following:
  -  Intrahepatic cholangiocarcinoma
  -  Metastatic cancer confined to the liver
  -  Measurable disease, defined as ≥ 1 lesion that can be accurately measured in ≥ 1 dimension as ≥ 20 mm by conventional techniques or as ≥ 10 mm by spiral CT scan
  -  Must have tumor volume ≤ 50% of total liver volume based on visual estimation
  PATIENT CHARACTERISTICS:
  -  ECOG performance status 0-2
  -  ANC ≥ 1,500/mm^3
  -  Platelet count ≥ 75,000/mm^3
  -  Serum creatinine ≤ 2.0 mg/dL
  -  Serum bilirubin ≤ 1.5 times upper limit of normal
  -  Albumin ≥ 2.0 g/dL
  -  No baseline symptoms or laboratory values > grade 2 in severity by NCI CTCAE v 3.0 criteria
  -  Not pregnant or nursing
  -  Fertile patients must use effective contraception
  -  No malabsorption syndrome
  -  No severe liver dysfunction or pulmonary insufficiency
  -  No complete occlusion of the main portal vein
  -  No contraindication to iodine-based contrast agents
  -  No contraindication to hepatic artery catheterization (e.g., vascular abnormalities or bleeding diathesis)
  -  No prior unanticipated severe reaction to fluoropyrimidine therapy, known hypersensitivity to fluorouracil, or known dihydropyrimidine dehydrogenase deficiency
  PRIOR CONCURRENT THERAPY:
  -  No prior radiotherapy to the liver
  -  No more than 2 prior therapies for metastatic disease to the liver
  -  No prior intervention to or compromise of the Ampulla of Vater
  -  At least 4 weeks since prior and no concurrent sorivudine or brivudine
  -  No concurrent cimetidine

Relevance to patient case: not relevant