A phase II FOLFOX-4 regimen as second-line treatment in advanced biliary tract cancer refractory to gemcitabine/cisplatin

Abstract

Objective:

We aimed to evaluate the efficacy and safety of oxaliplatin, 5-fluorouracil (5-FU), and leucovorin (LV) (FOLFOX-4) as second-line treatment in patients with advanced biliary tract cancer (BTC) failing gemcitabine/cisplatin first-line chemotherapy.

Methods:

Thirty-seven patients with advanced BTC refractory to gemcitabine/cisplatin chemotherapy were included in the study. FOLFOX-4 regimen consisted of oxaliplatin (85 mg/m²) as a 2-hour infusion on day 1 and 2-hour infusion of LV (200 mg/m²/day) followed by a 5-FU bolus (400 mg/m²/day) and 22-hour infusion of 5-FU (600 mg/m²/day) for two consecutive days every 2 weeks. The primary end point was the time to progression (TTP).

Results:

Between January 2009 and January 2012, a total of 37 patients were enrolled. The median age was 57 years (range 32–70) and male to female ratio was 21:16. Median TTP was 3·1 months (95% CI 2·3–3·6). The objective response rate was 21·6% (eight partial responses), and disease control rate was 62·2% (15 stable disease). Grade 3–4 toxicities were observed in 37·8% of the patients with neutropenia and fatigue being the most frequent (21·6%).

Conclusions:

FOLFOX-4 regimen is a feasible and moderately efficacious second-line chemotherapy for advanced BTC.

Keywords:

• Biliary tract cancer
• FOLFOX-4
• Gemcitabine
• Cisplatin
• Second line

Acknowledgments

This project was supported by the Shanghai ‘outstanding young medicine clinical personnel’ training plan, China (ZYSNXD011-RC-XLXX-20110027). The authors would like to express their heartfelt gratitude to Dr Koung Fang Pei (M.D. Anderson Cancer Center) who had modified the language of the manuscript.