Randomized Phase II Trial of Combination Chemotherapy With Panitumumab or Bevacizumab for Patients With Inoperable Cholangiocarcinoma Without KRAS Mutations
Inclusion Criteria:
- Histologically verified adenocarcinoma arisen from gall bladder, extra- or
intrahepatic bile ducts or malignant cells consistent with the above and simultaneous
radiologic findings consistent with cholangiocarcinoma
- Minimum 18 years of age
- Curative treatment currently not an option (operation, stereotactic radiation
treatment or similar)
- KRAS analyzed and found wild-type (wt)
- Performance status 0-2
- Evaluable disease according to RECIST, i.e. the disease need not be measurable
- Hematology: ANC ≥1.5x10^9/l. Thrombocytes ≥ 100x10^9/l
- Biochemistry: Bilirubinemia ≤ 3 x upper normal level. ALAT ≤ 5 x upper normal level.
- Creatinine ≤ upper normal level. At raised creatinine level the measured or
calculated GFR must be at least 50% of the lower normal level
- Fertile women must present a negative pregnancy test and use secure birth control
during and 6 months after treatment. Men with fertile partners must also take care of
secure birth control.
- Written and orally informed consent
Exclusion Criteria:
- Previous cytostatic treatment of inoperable cholangiocarcinoma
- Adjuvant or neoadjuvant chemotherapy, radiation therapy or immunotherapy within 4
weeks prior to treatment start
- Other concomitant experimental treatment
- Severe medical disease such as considerable heart disease, serious active infection
or other disease making the patient unfit for study participation as assessed by
investigator
- Other malignant disease within 5 years prior to enrolment except from non-melanotic
skin cancer and carcinoma in situ cervicis uteri
- Interstitial pneumonitis or subsequent pulmonary fibrosis
- Pregnant or breastfeeding women
- Large-scale surgical intervention, excision biopsy or significant traumatic lesions
within 28 days prior to treatment start or presumption that large-scale surgery will
become necessary during study treatment.
- Significant non-healing wound or ulcers
- Active hemorrhage or increased risk of hemorrhage (e.g. tumor invasion in large
vessels or known esophagus varices)
- Known hypersensitivity to panitumumab, bevacizumab or any of the auxiliary agents
- Grade IV fistulas
- Uncontrolled hypertension, i.e. symptomatic hypertension or non-medically stabilized
hypertension >160/100
- Haemoptysis > 2.5 ml within 2 weeks prior to enrolment
- Previous serious and unexpected reactions or know hypersensitivity to two or more of
the applied cytostatics