Chemotherapy with Gemcitabine in Advanced Biliary Tract Carcinoma

Serrano, A.; Gerson, Raquel

doi:10.2174/157488708783330512

Cited by 6 publications

(7 citation statements)

References 50 publications

(93 reference statements)

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“…The results presented here suggest that Gem-based combination chemotherapy induced more toxicity compared with Gem alone or non-Gem-based chemotherapy. However, all severe hematological toxicities (grade 3 or 4) are infrequent and reversible, and these results are consistent with a previous study [24] . Several limitations of our meta-analysis should be mentioned.…”

Section: Discussionsupporting

confidence: 93%

“…However, the analysis involved studies that evaluated Gem plus platinum chemotherapy; thus, new treatments, such as Gem plus S-1, were not included. A review published by Serrano et al [24] also suggested that Gem alone or in combination with other agents showed a better response rate that correlated with the time to progression. Additionally, regimens that contained two drugs induced higher response rates compared with single agent treatments.…”

Section: Discussionmentioning

confidence: 97%

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Efficacy and safety of gemcitabine-based chemotherapies in biliary tract cancer: A meta-analysis

Liu¹,

Zhang²,

Li³

et al. 2014

WJG

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AIM:To investigate the efficacy and safety of gemcitabine (Gem)-based combination chemotherapies for the treatment of advanced biliary tract cancer. METHODS:Clinical trials were identified by searching scientific literature databases (PubMed, EMBASE and the Cochrane Library) for studies published between 1975 and 2013. Two reviewers independently evaluated the relevant studies and manually searched references from these reports to locate additional eligible studies. The disease response and control rates, progressionfree and overall survivals, and the grade 3-4 toxicities were evaluated by a meta-analysis. Odds-ratios (ORs) of the disease response and control rates and grade 3-4 toxicities, and the mean difference (MD) of both progression-free and overall survivals were calculated and used for statistical analysis. RESULTS:Seven randomized trials with a total of 858 patients were selected and included in the final analysis. The studies were divided into subgroups based on the chemotherapy regimens, including Gem-based and non-Gem-based chemotherapies. The overall analyses revealed that the patients treated with Gem-based combination chemotherapy had significantly higher disease response rates [OR = 1.69, 95% confidence interval (CI): 1.17-2.43; P = 0.01], a longer progressionfree survival (MD = 1.95, 95%CI: 0.90-3.00; P = 0.00) and a longer overall survival (MD = 1.85, 95%CI: 0.26-3.44; P = 0.02). A higher incidence of grade 3-4 hematological toxicities, including leukopenia (OR = 2.98, 95%CI: 1.44-6.20; P = 0.00), anemia (OR = 2.96, 95%CI: 1.79-4.92; P = 0.00) and neutropenia (OR = 2.80, 95%CI: 1.39-5.64; P = 0.00) was found in the Gem-based combination chemotherapy group compared with the Gem monotherapy and non-Gem-based chemotherapy groups. CONCLUSION:Gem-based combination chemotherapy is a potential first-line treatment for advanced biliary tract cancer as a result of improved survival, though with additional toxicity.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Biliary tract cancer; Combination chemotherapy; Gemcitabine; Meta-analysis; Randomized trial Core tip: To investigate the efficacy and safety of gemcitabine (Gem)-based combination chemotherapy for the treatment of advanced biliary tract cancer, the authors analyzed the potential impact of Gem-based combination chemotherapy and other regimens on the outcomes and toxicities of the patients using metaanalysis methodologies. Meta-analysis showed that compared with Gem monotherapy and non-Gem-based chemotherapy, Gem-based combination chemotherapy provided a modest improvement in survival but was associated with more toxicity. META-ANALYSIS

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 97%

Efficacy and safety of gemcitabine-based chemotherapies in biliary tract cancer: A meta-analysis

Liu¹,

Zhang²,

Li³

et al. 2014

WJG

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“…GEM is the standard chemotherapeutic regimen for advanced pancreatic cancer and advanced biliary tract cancer 18,19 . GEM (2′, 2′‐difluorodeoxycytidine) is a nucleoside analog that is phosphorylated to produce the active metabolites difluorodeoxycytidine diphosphate and triphosphate 20 . These metabolites exert their cytotoxic effects primarily by inhibiting DNA synthesis and inducing apoptosis 21 .…”

Section: Introductionmentioning

confidence: 99%

“…These metabolites exert their cytotoxic effects primarily by inhibiting DNA synthesis and inducing apoptosis 21 . Severe hematological or non‐hematological toxicities associated with GEM are reported to be infrequent and reversible 20 . Based on its promising anti‐tumor effect and safety profile, we selected GEM as the basis for a DES for malignant biliary obstruction in pancreaticobiliary cancer.…”

Section: Introductionmentioning

confidence: 99%

Safety evaluation of self‐expanding metallic biliary stents eluting gemcitabine in a porcine model

Chung

Kim

et al. 2012

J of Gastro and Hepatol

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“…4 In single-agent therapy, GEM demonstrated moderate efficacy (17.5% partial response rate) with manageable toxicity in patients with BTC. 5 Recently, results from randomized phase III studies (ABC-02, have demonstrated that patients receiving a GEM-cisplatin combination had a significantly longer progression-free survival and overall survival (11.7 compared with 8.1 months; HR 0.64 [95% CI 0.52 to 0.80]; log rank p < 0.001) 6 than GEM single agent with an acceptable toxicity. 6,7 Despite 1 these findings, the effect of chemotherapy on survival or ORR is still not sufficient, and the development of additional regimens is required.…”

Section: Introductionmentioning

confidence: 99%

Synergistic Effect Between Juzen-taiho-to, a Japanese Traditional Herbal Medicine, and Gemcitabine Single-Agent Chemotherapy for Advanced Biliary Tract Cancer

Nishiuchi

Okutani²,

Yamagishi³

et al. 2013

The Journal of Alternative and Complementary Medicine

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This is the first report of the successful treatment of advanced biliary tract cancer with gemcitabine single-agent chemotherapy in combination with Juzen-taiho-to (JTT), a Japanese traditional herbal medicine. An 84-year-old woman was referred to our hospital with general fatigue and appetite loss; she was diagnosed with advanced biliary tract cancer and accompanying colonic invasion and hepatic metastasis. The patient's response to combination chemotherapy was extremely good, and her tumors disappeared. Recent studies have confirmed the occurrence of spontaneous and induced antitumor immune responses, carried out by tumor-infiltrating lymphocytes in the tumor microenvironment. The availability, antigen presentation, and proliferation of these immune cells are increased by cytokines such as granulocyte macrophage colony-stimulating factor (GM-CSF) and interleukin (IL)-2. Recently, JTT has gained recognition as a biological response modifier that has stimulatory effects on systemic immune responses such as enhancement of cytokine expression (GM-CSF, IL-2, etc.). In addition, some chemotherapy agents, such as anthracyclines and gemcitabine, are effective boosters of the immune response through tumor-specific antigen overexpression after apoptotic tumor cell destruction. These findings suggest that JTT enhances the antitumor effects of gemcitabine, in particular its tumor-specific effects on immune response, and these drugs are a good combination for advanced biliary tract cancer therapy.

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Chemotherapy with Gemcitabine in Advanced Biliary Tract Carcinoma

Abstract: Gemcitabine is an effective drug in advanced biliary tract carcinoma with a low toxicity profile. It should be considered as the standard treatment for unresectable or metastatic disease while awaiting phase III results.

Cited by 6 publications

References 50 publications

Efficacy and safety of gemcitabine-based chemotherapies in biliary tract cancer: A meta-analysis

Efficacy and safety of gemcitabine-based chemotherapies in biliary tract cancer: A meta-analysis

Safety evaluation of self‐expanding metallic biliary stents eluting gemcitabine in a porcine model

Synergistic Effect Between Juzen-taiho-to, a Japanese Traditional Herbal Medicine, and Gemcitabine Single-Agent Chemotherapy for Advanced Biliary Tract Cancer

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