Gemcitabine Plus Pemetrexed Disodium in Treating Patients With Unresectable or Metastatic Biliary Tract or Gallbladder Cancer

This study has been completed.
Information provided by:
National Cancer Institute (NCI) Identifier:
First received: May 6, 2003
Last updated: April 18, 2009
Last verified: July 2007

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 1
Phase 2

Study Type: Interventional
Study Design: Primary Purpose: 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

Resource links provided by NLM:

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:


  • 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.


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


  • 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



  • 18 and over

Performance status

  • ECOG 0-2

Life expectancy

  • At least 3 months


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


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


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


  • 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


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


  • 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


  • 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


  • Not specified


  • 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
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00059865

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

Additional Information:
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. Identifier: NCT00059865     History of Changes
Other Study ID Numbers: CDR0000298862, NCCTG-N9943
Study First Received: May 6, 2003
Last Updated: April 18, 2009
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

Additional relevant MeSH terms:
Bile Duct Neoplasms
Gallbladder Neoplasms
Liver Neoplasms
Bile Duct Diseases
Biliary Tract Diseases
Biliary Tract Neoplasms
Digestive System Diseases
Digestive System Neoplasms
Gallbladder Diseases
Liver Diseases
Neoplasms by Histologic Type
Neoplasms by Site
Neoplasms, Glandular and Epithelial
Anti-Infective Agents
Antimetabolites, Antineoplastic
Antineoplastic Agents
Antiviral Agents
Enzyme Inhibitors
Folic Acid Antagonists
Immunologic Factors
Immunosuppressive Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions processed this record on July 01, 2015