The role of systemic chemotherapy in advanced biliary tract cancer (BTC) is known to be very limited although various single-agent or combination therapies had been tested. However, there is a possibility that palliative chemotherapy induce prolong survival and improve quality of life in advanced BTC based on several studies. A GERCOR study showed the promising result of gemcitabine in combination with oxaliplatin as first line chemotherapy in advanced BTC. Therefore, this phase II trial was planned to investigate efficacy and toxicity of combination chemotherapy with gemcitabine and dose adjusted oxaliplatin in patients with inoperable BTC in Korea.

Treatment scheme

:Gemcitabine 1000 mg/m2/d IV D1 as a 10mg/m2/min Oxaliplatin 85 mg/m2/d IV D2 as a 2 hours infusion

Each cycle is repeated every 2 weeks.

Repeated cycles of treatment will be given for this study unless there is confirmed disease progression or unacceptable toxicity. Subjects will be treated for at least 4 cycles unless there is documented disease progression, unacceptable adverse events or withdrawal of consent.

Inclusion Criteria:

1. Patients with histologically or cytologically confirmed biliary tract adenocarcinoma

2. Inoperable disease as defined by:

   • Localized disease in a portion of the liver that does not allow the possibility of complete surgical removal of the tumor with a clear resection margin.

     • Presence of metastatic lesion

       • Unresectable recurrent tumor after curative resection

         • anatomically resectable but inoperable associated with medical condition

3. Biliary obstruction controlled

4. Minimum life expectancy of 12 weeks.

5. At least one measurable lesion according to the Response Evaluation Criteria in Solid Tumors (RECIST) or evaluable lesion present by imaging study

6. Age over 18 years

7. ECOG performance status of * 2.

8. Adequate organ function as evidenced by the following; Absolute neutrophil count > 1.5 x 109/L; platelets > 100 x 109/L; total bilirubin ≤3xUNL; AST and/or ALT < 5x UNL; Creatinine< 1.5mg/dl or creatinine clearance >50 ml/mins

9. Consent form signed and dated prior to study specific procedures.

10. Subject able to comply with the scheduled follow-up and with the management of toxicities.

Exclusion Criteria:

1. Decompensated Cirrhosis or stage C (Index > 10) according to the Child-Pugh Classification
2. Prior systemic chemotherapy
3. Subject with reproductive potential (M/F) not using adequate contraceptive measures.
4. Pregnancy and breast-feeding.
5. Other serious illness or medical condition, notably heart or lung failure, active uncontrolled infection (infection requiring antibiotics).
6. Past or concurrent history of other neoplasm, except curatively treated basal cell skin cancer or adequately treated in-situ carcinoma of the cervix.
7. Symptomatic or uncontrolled brain metastasis
8. Other concomitant anticancer agent, including Tamoxifen and Interferon.
9. Subjects who cannot be regularly followed up for psychological, social, familial or geographic reasons.
10. Participation in another clinical study or within 30 days before inclusion.
11. History of severe hypersensitivity reactions to gemcitabine or oxaliplatin