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Gemcitabine Plus Pemetrexed Disodium in Treating Patients With Unresectable or Metastatic Biliary Tract or Gallbladder Cancer
This study has been completed.
Sponsors and Collaborators: North Central Cancer Treatment Group
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00059865
  Purpose

RATIONALE: Drugs used in chemotherapy such as gemcitabine work in different ways to stop tumor cells from dividing so they stop growing or die. Pemetrexed disodium may stop the growth of tumor cells by blocking the enzymes necessary for tumor cell growth. Combining gemcitabine with pemetrexed disodium may kill more tumor cells.

PURPOSE: This phase I/II trial is studying the side effects and best dose of gemcitabine when given together with pemetrexed disodium to see how well it works in treating patients with unresectable or metastatic biliary tract or gallbladder cancer.


Condition Intervention Phase
Extrahepatic Bile Duct Cancer
Gallbladder Cancer
Liver Cancer
Drug: gemcitabine hydrochloride
Drug: pemetrexed disodium
Phase I
Phase II

MedlinePlus related topics: Cancer Gallbladder Cancer Liver Cancer
Drug Information available for: Gemcitabine hydrochloride Gemcitabine Pemetrexed disodium Pemetrexed
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment
Official Title: Phase I/II Trial Of Gemcitabine And ALIMTA In Patients With Measurable Or Evaluable, Unresectable Or Metastatic Biliary Tract Carcinoma (Intrahepatic, Extrahepatic, Ampulla Or Vater) And Gallbladder Carcinoma

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Survival after 6 months of treatment [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Response as assessed by RECIST criteria every 8-16 weeks [ Designated as safety issue: No ]
  • Toxicity as assessed by CTC v3 every 4 weeks [ Designated as safety issue: Yes ]

Estimated Enrollment: 85
Study Start Date: January 2004
Primary Completion Date: February 2008 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

  • Determine the maximum tolerated dose of gemcitabine when administered with pemetrexed disodium in patients with unresectable or metastatic biliary tract or gallbladder cancer. (Phase I closed to accrual as of Oct. 2005.)
  • Determine the 6-month survival rate of patients treated with this regimen.
  • Determine the best objective tumor response rate and duration of best objective tumor response in patients treated with this regimen.
  • Determine the time to progression and overall survival of patients treated with this regimen.
  • Determine the toxic effects of this regimen in these patients.
  • Determine the individual patient variation in toxicity of and/or response to this regimen due to genetic differences in proteins involved in drug response in these patients.

OUTLINE: This is a multicenter phase I dose-escalation study of gemcitabine followed by a phase II study.

  • Phase I: Patients receive pemetrexed disodium IV over 10 minutes and gemcitabine IV over 30 minutes on days 1 and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity (phase I closed to accrual as of October 2005).

Cohorts of 3-6 patients receive escalating doses of gemcitabine until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

  • Phase II: Patients receive pemetrexed disodium as in phase I and gemcitabine at the recommended phase II dose.

Patients are followed every 3 months for 1 year and then every 6 months for 4 years.

PROJECTED ACCRUAL: A total of 85 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • One of the following histologically or cytologically confirmed cancers not amenable to treatment with combined chemotherapy and radiotherapy:

    • Biliary tract (intrahepatic, extrahepatic, or ampulla of Vater) carcinoma
    • Gallbladder carcinoma
  • Unresectable or metastatic disease
  • No CNS metastases

    • Prior brain metastases treated with surgery or radiosurgery allowed provided treatment was completed at least 4 weeks ago and there is no evidence of CNS progression
  • No clinically significant pericardial or pleural effusion or ascites unless able to be drained before study entry

PATIENT CHARACTERISTICS:

Age

  • 18 and over

Performance status

  • ECOG 0-2

Life expectancy

  • At least 3 months

Hematopoietic

  • Absolute neutrophil count at least 1,500/mm^3
  • Platelet count at least 100,000/mm^3

Hepatic

  • Bilirubin no greater than 3 times upper limit of normal (ULN)
  • AST no greater than 5 times ULN

Renal

  • Creatinine no greater than 1.5 times ULN OR
  • Creatinine clearance at least 45 mL/min

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer
  • Able to tolerate folic acid, corticosteroids, or cyanocobalamin supplements

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • More than 4 weeks since prior biologic or immunologic therapy
  • No prior biologic or immunologic therapy for metastatic disease
  • No concurrent immunotherapy
  • No concurrent colony-stimulating factors during course 1

Chemotherapy

  • No prior chemotherapy for metastatic disease
  • No prior gemcitabine
  • Prior chemoembolization allowed provided the following are true:

    • At least 4 weeks since prior chemoembolization
    • Evidence of new tumor growth since therapy
  • At least 6 months since prior chemotherapy used as a radiosensitizer (in adjuvant setting or for locally advanced disease)
  • No other concurrent chemotherapy

Endocrine therapy

  • Not specified

Radiotherapy

  • Prior radiofrequency ablation allowed provided the following are true:

    • At least 4 weeks since prior radiofrequency ablation
    • Evidence of new tumor growth since therapy
  • No prior radiotherapy to 25% or more of the bone marrow
  • More than 4 weeks since prior radiotherapy
  • No concurrent radiotherapy

Surgery

  • Not specified

Other

  • Prior embolization allowed provided the following are true:

    • At least 4 weeks since prior embolization
    • Evidence of new tumor growth since therapy
  • No prior pemetrexed disodium
  • No aspirin or nonsteroidal anti-inflammatory drugs for at least 2 days (5 days for long-acting agents [e.g., piroxicam]) before, during, and for at least 2 days after administration of pemetrexed disodium
  • No concurrent cyclo-oxygenase-2 inhibitors
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00059865

  Show 41 Study Locations
Sponsors and Collaborators
North Central Cancer Treatment Group
Investigators
Study Chair: Steven R. Alberts, MD Mayo Clinic
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Publications of Results:
Alberts SR, Sande JR, Foster NR, Quevedo FJ, McWilliams RR, Kugler JW, Fitch TR, Jaslowski AJ. Pemetrexed and Gemcitabine for Biliary Tract and Gallbladder Carcinomas: a North Central Cancer Treatment Group (NCCTG) Phase I and II Trial, N9943. J Gastrointest Cancer. 2008 Nov 21; [Epub ahead of print]
Alberts SR, Foster NR, McWilliams RR, et al.: NCCTG phase I/II trial (N9943) of gemcitabine and pemetrexed in patients with unresectable or metastatic biliary tract carcinoma and gallbladder carcinoma: interim results. [Abstract] American Society of Clinical Oncology 2007 Gastrointestinal Cancers Symposium, 19 -21 January 2007, Orlando, Florida A-149, 2007.
McWilliams RR, Foster NR, Quevedo FJ, et al.: NCCTG phase I/II trial (N9943) of gemcitabine and pemetrexed in patients with biliary tract or gallbladder carcinoma: phase II results. [Abstract] J Clin Oncol 25 (Suppl 18): A-4578, 2007.

Study ID Numbers: CDR0000298862, NCCTG-N9943
Study First Received: May 6, 2003
Last Updated: November 25, 2008
ClinicalTrials.gov Identifier: NCT00059865  
Health Authority: United States: Federal Government

Keywords provided by National Cancer Institute (NCI):
advanced adult primary liver cancer
unresectable gallbladder cancer
unresectable extrahepatic bile duct cancer
adult primary cholangiocellular carcinoma

Study placed in the following topic categories:
Bile duct cancer, extrahepatic
Gallbladder Diseases
Cholangiocarcinoma
Liver Diseases
Biliary Tract Neoplasms
Digestive System Neoplasms
Liver neoplasms
Gall bladder cancer
Carcinoma
Folic Acid
Pemetrexed
Liver Neoplasms
Digestive System Diseases
Bile Duct Diseases
Biliary Tract Diseases
Gastrointestinal Neoplasms
Gallbladder Neoplasms
Bile Duct Neoplasms
Gemcitabine

Additional relevant MeSH terms:
Antimetabolites
Anti-Infective Agents
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Physiological Effects of Drugs
Enzyme Inhibitors
Folic Acid Antagonists
Antiviral Agents
Immunosuppressive Agents
Pharmacologic Actions
Neoplasms
Neoplasms by Site
Radiation-Sensitizing Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on January 16, 2009