Establishing a standard of care for advanced biliary tract cancer
12 December 2014
Before 2010, there was no accepted standard treatment for patients with advanced biliary tract cancer. The ABC02 trial showed that the combination of two drugs significantly improves survival, with acceptable side effects. Consequently, national and international guidelines have been revised to recommend this regimen as a standard of care.
About 1,200 people are diagnosed with biliary tract cancer each year in the UK and 12,000 in the US. For the majority of patients, it is an incurable cancer and before 2010 there was no established standard of care; some patients had best supportive care, others single agent drugs (and on average they lived for 8 months). Therefore, there was an urgent need to find more effective treatments.
This is a major positive step forwards in treating a difficult type of cancer, for which many patients have poor survival. Research is now building upon this effective drug combination, by adding other drugs that can further improve outcomes. - Professor Allan Hackshaw This is a major positive step forwards in treating a difficult type of cancer, for which many patients have poor survival. Research is now building upon this effective drug combination, by adding other drugs that can further improve outcomes. - Professor Allan Hackshaw
A Phase II study (the UK ABC01 trial) conducted jointly by UCL and the Christie Hospital in Manchester compared the combination of two chemotherapy drugs (gemcitabine and cisplatin) with gemcitabine alone and showed very promising results for the combination. As a result, a large phase III trial was funded by Cancer Research UK.
The ABC02 trial began in 2002 (with Dr John Bridgewater, UCL Cancer Institute, as chief investigator), and was one of the first large-scale national studies in biliary tract cancer in the UK. It showed that the combination of gemcitabine and cisplatin significantly improves survival, with an extra 3.5 months of life on average. It also showed that more patients were alive at two years if they had both drugs than gemcitabine alone. The side effects were similar to the single drug, and the treatment was shown to be cost effective.
As a result of this trial, international guidelines on treating biliary tract cancer were updated in 2011 to recommend the combination therapy, and this has now become the standard therapy. Several hundred patients have already benefited from the new treatment over the last three years.