Multidisciplinary effect of adding docetaxel and mitomycin-C to low-dose multidrug therapy for cholangiocarcinoma.

Abstract

e14546 Background: Multidrug chemotherapy improves rates and quality of response in cholangiocarcinoma.It also delays progression and appears to improve survival for the, unresectable and recurrent, high-risk patients (ICACT Bruckner, H et al Paris 2004). This is analogous to experience with treatment for pancreatic cancer (Bruckner, H. et. al ASCO 2008). Methods: Chemotherapy with gemcitabine, 5-flourouracil, irinotecan, leucovorin, oxaliplatin (GFLIOx) and GFLIOx+ docetaxel, mitomycin-C (GFLIO-TXT±MMC) was used sequentially for 50 patients in order to produce opportunities for resection, debulking surgery, TACE and Yittrium 90. Analysis excluded ideal patients with either less than 5cm or well differentiated primary tumors. Prior oversight, safety, eligibility and consent procedures were employed in these ongoing retrospective analysis. Results: GFLIOx produced a 50% rate of benefit for six 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 6 months or more in duration and a median survival of 10 months from time of first addition. Chemotherapy sometimes eradicated bulky lymph node disease of bile duct and gallbladder origin and produced opportunities for multi-modality care. There were no hospitalizations for febrile nutropenia or bleeding due to thrombocytopenia. Treatment was well tolerated up to age 80 years. Final review of additional patients, patient characteristics, and impact on surgery will be available in April 2011. Conclusions: These findings satisfy our criteria for continued use, including median survival greater than one year and high quality, sometimes rapid, second-line responses. Findings also support testing these low dose combinations in both neoadjuvant and classic adjuvant settings. It is feasible to produce multidisciplinary 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.