Neoadjuvant Chemotherapy With Gemcitabine/Cisplatin/S‐1 for Resectable Biliary Tract Cancer With FDG ‐ PET ‐Positive Lymph Node Metastasis ( KHBO1201 ): A Multicenter Phase II Trial

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PURPOSE: To evaluate the safety and efficacy of neoadjuvant gemcitabine, cisplatin, and S-1 (GCS) chemotherapy for resectable biliary tract cancer (BTC) and FDG-PET-positive lymph nodes in a multicenter phase II study (KHBO1201). METHODS: Patients with resectable BTC (intrahepatic/extrahepatic bile duct, gallbladder, or ampullary cancers) and FDG-PET-positive lymph nodes received GCS chemotherapy: gemcitabine/cisplatin on Day 1 and oral S-1 for 7 days, repeated every 2 weeks for 3-6 cycles. Surgery was planned 4-8 weeks later if the tumor was deemed resectable. The primary endpoint was the curative resection rate. Secondary endpoints were the completion rate, radiological response, radiological/pathological complete response (CR) of FDG-PET-positive lymph nodes, and 1-year survival (UMIN000009831). RESULTS: Twenty-five patients were enrolled. Twenty-three (92%) completed GCS without treatment-related deaths; grade 3 biliary infection occurred in 8.0%. Curative resection was achieved in 60% with a morbidity rate of 40%. The radiological response rate was 13%, and the radiological and pathological CR rates of FDG-PET-positive lymph nodes were 24% and 28%, respectively. The 1-year survival rate was 75%. CONCLUSIONS: Neoadjuvant GCS chemotherapy is safe, feasible, and potentially effective for resectable BTC with FDG-PET-positive lymph nodes. A randomized phase III trial (JCOG1920) is underway to compare neoadjuvant GCS chemotherapy with upfront surgery (jRCTs031200388).