Prospective Randomized Controlled Trial Comparing Adjuvant Chemotherapy vs. No Chemotherapy for Patients with Carcinoma of Gallbladder Undergoing Curative Resection

• Published in: Journal of gastrointestinal surgery 2022-02, Vol.26 (2), p.398-407
• Main Authors: Saluja, Sundeep Singh, Nekarakanti, Phani Kumar, Mishra, Pramod Kumar, Srivastava, Anurita, Singh, Kishore
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bile ducts; Bladder cancer; Cancer therapies; Carcinoma - drug therapy; Carcinoma - surgery; Chemotherapy; Chemotherapy, Adjuvant; Clinical trials; Gallbladder; Gallbladder cancer; Gallbladder Neoplasms - drug therapy; Gallbladder Neoplasms - pathology; Gallbladder Neoplasms - surgery; Gastroenterology; Gastrointestinal surgery; Humans; Medical prognosis; Medicine; Medicine & Public Health; Metastasis; Original Article; Surgery; Tumors
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-021-05143-6

Background Gallbladder carcinoma (GBC) has a dismal prognosis even after curative resection. The objective of the study was to evaluate the effect of adjuvant chemotherapy in patients with GBC undergoing curative resection in a randomized control trial (RCT). Methods A single-center open-labeled prospective RCT was done from January 2012 to June 2018. R0 curative resected GBC patients were randomized in 1:1 to either surveillance alone (control group) or adjuvant chemotherapy (gemcitabine and cisplatin (GemCis group)) for 6 cycles. The primary outcome was disease-free survival (DFS), and the secondary outcomes were overall survival (OS) and toxicity profile. Results On the evaluation of 362 patients with GBC, 50 patients were enrolled in each control or GemCis group. Per protocol (PP), it comprised 96 patients. The demographic and clinical profile was similar between the two groups except in the lower nodal stage where patients were higher in the control group ( p  = 0.01). Recurrences were similar between groups (control 44% vs GemCis 56%; p  = 0.23). On the intention to treat (ITT), analyses of median DFS (not reached vs. 24 months, p  = 0.14) and OS (not reached vs. 31 months, p  = 0.10) were similar between groups. On PP, analyses of median DFS (not reached vs. 24 months, p  = 0.16) and OS (not reached vs. 31 months, p  = 0.09) were similar between groups. The common toxicity profile was hematological followed by gastrointestinal symptoms. Conclusions Adjuvant GemCis therapy for 6 cycles does not improve DFS or OS than R0 surgery alone patients with GBC. Trial Registration NCT02778308 ( https://www.clinicaltrials.gov )