***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Combination chemotherapy has shown benefit in the treatment of biliary cancer and further improvements might be achieved by the addition of a biological agent . We report here the effect of chemotherapy with the monoclonal EGFR antibody panitumumab as therapy for KRAS wild-type biliary cancer . PATIENTS AND METHODS Patients with advanced biliary tract cancer were r and omised ( 2:1 ) to receive  cisplatin 25 mg/m2 and gemcitabine 1000 mg/m2 on day 1 and day 8/q3w with ( arm A ) or without panitumumab ( arm B ; 9 mg/kg BW , i.v q3w ) . The primary end-point was the evaluation of progression-free survival ( PFS ) at 6 months . Secondary end-points included objective response rate ( ORR ) , overall survival ( OS ) , and toxicity . In addition , a post hoc assessment of genetic alterations was performed . Finally , we performed a meta- analysis of trials with chemotherapy with and without EGFR antibodies . RESULTS Sixty-two patients were r and omised in arm A and 28 patients in arm B. Patients received 7 treatment cycles in median ( 1 - 35 ) with a median treatment duration of 4.7 months ( 141 days , 8 - 765 ) . PFS rate at 6 months was 54 % in patients treated with cisplatin/gemcitabine and panitumumab but was 73 % in patients treated with cisplatin/gemcitabine without antibody , respectively . Secondary end-points were an ORR of 45 % in treatment arm A compared with 39 % receiving treatment B and a median OS of 12.8 months ( arm A ) and of 20.1 months ( arm B ) , respectively . In contrast to the p53-status , genetic alterations in IDH1/2 were linked to a high response after chemotherapy and prolonged survival . In accordance with our results , the meta- analysis of 12 trials did not reveal a survival advantage for patients treated with EGFR antibodies compared with chemotherapy alone . CONCLUSIONS Panitumumab in combination with chemotherapy does not improve ORR , PFS and OS in patients with KRAS wild-type , advanced biliary cancer . Genetic profiling should be included in CCA trials to identify and vali date predictive and prognostic biomarkers . CLINICAL TRIALS NUMBER The trial was registered with NCT01320254 BACKGROUND Combination chemotherapy with gemcitabine and a platinum-based agent is regarded as a st and ard treatment for patients with advanced biliary-tract cancer . Results of phase 2 trials of single-agent erlotinib in biliary-tract cancer and of gemcitabine plus erlotinib in pancreatic cancer have shown modest benefits . Therefore , we aim ed to investigate the efficacy of gemcitabine and oxaliplatin plus erlotinib versus chemotherapy alone for advanced biliary-tract cancer . METHODS In this open label , r and omised , phase 3 trial , we r and omly assigned patients ( in a 1:1 ratio ) with metastatic biliary-tract cancer ( cholangiocarcinoma , gallbladder cancer , or ampulla of Vater cancer ) to receive either first-line treatment with  chemotherapy alone ( gemcitabine 1000 mg/m(2 ) on day 1 and oxaliplatin 100 mg/m(2 ) on day 2 ) or chemotherapy plus erlotinib ( 100 mg daily ) . Treatment was repeated every 2 weeks until disease progression or unacceptable toxic effects . R and omisation was done central ly ( stratified by participating centre and presence of measurable lesion ) . The primary endpoint was progression-free survival . Analyses were by intention-to-treat . This study is registered with Clinical Trials.gov , number NCT01149122 . FINDINGS 133 patients were r and omly assigned to the chemotherapy alone group and 135 to the chemotherapy plus erlotinib group . The groups were balanced except for a higher proportion of patients with cholangiocarcinoma in the group given erlotinib than in the chemotherapy alone group ( 96 [ 71 % ] patients vs 84 [ 63 % ] ) . Median progression-free survival was 4·2 months ( 95 % CI 2·7 - 5·7 ) in the chemotherapy alone group and 5·8 months ( 95 % CI 4·6 - 7·0 ) in the chemotherapy plus erlotinib group ( hazard ratio [ HR ] 0·80 , 95 % CI 0·61 - 1·03 ; p=0·087 ) . Significantly more patients had an objective response  in the chemotherapy plus erlotinib group than in the chemotherapy alone group ( 40 patients vs 21 patients ; p=0·005 ) , but median overall survival was the same in both groups ( 9·5 months [ 95 % CI 7·5 - 11·5 ] in the chemotherapy alone group and 9·5 months [ 7·6 - 11·4 ] in the chemotherapy plus erlotinib group ; HR 0·93 , 0·69 - 1·25 ; p=0·611 ) . All-cause deaths within 30 days of r and om assignment occurred in one ( 1 % ) of the patients in the chemotherapy alone group and in four ( 3 % ) of those in the chemotherapy plus erlotinib group . The most common grade 3 - 4 adverse event was febrile neutropenia ( eight [ 6 % ] patients in the chemotherapy alone group and six [ 4 % ] in the chemotherapy plus erlotinib group ) . No patient died of treatment-related causes during the study . Subgroup analyses by primary site of disease showed that for patients with cholangiocarcinoma , the addition of erlotinib to chemotherapy significantly prolonged median progression-free survival ( 5·9 months [ 95 % CI 4·7 - 7·1 ] for chemotherapy plus erlotinib vs 3·0 months [ 1·1 - 4·9 ] for chemotherapy alone ; HR 0·73 , 95 % CI 0·53 - 1·00 ; p=0·049 ) . INTERPRETATION Although no significant difference in progression-free survival was noted between groups , the addition of erlotinib to gemcitabine and oxaliplatin showed antitumour activity and might be a treatment option for patients with cholangiocarcinoma . FUNDING None Background A st and ard treatment for unresectable advanced-stage intrahepatic cholangiocarcinoma ( IHCC ) has not yet been established . Although neoadjuvant concurrent chemoradiotherapy ( CCRT ) and liver transplantation are associated with long-term survival in select patients , the outcomes of CCRT for advanced-stage unresectable IHCC remain unclear . The aim of our study was to evaluate the outcomes of CCRT in patients with unresectable advanced-stage IHCC . Methods We retrospectively review ed the records of all patients with unresectable advanced stage ( stage IVa or IVb ) IHCC who were pathologically diagnosed and treated at National Cancer Center , Korea , from June 2001 to March 2012 . Of the total of 92 patients , 25 ( 27.1 % ) received capecitabine plus cisplatin ( XP ) chemotherapy with external radiotherapy ( RT ) ( XP-CCRT group ) and 67 ( 72.8 % ) received XP chemotherapy alone ( XP group ) . The clinical characteristics and outcomes of the 2 groups were compared . Results The 92 patients comprised 72 male and 20 female patients , with a median age of 58 years ( range 26–78 years ) . The baseline clinical characteristics of the 2 groups were similar . Patients in the XP-CCRT group received a mean 44.7 Gy of RT and a mean 5.6 cycles of XP chemotherapy , whereas patients in the XP group received a mean 4.0 cycles . The disease control rate was higher in the XP-CCRT group than in the XP group , but the difference was not statistically significant ( 56.0 % vs. 41.5 % , p = 0.217 ) . Although neutropenia was significantly more frequent in the XP-CCRT than in the XP group ( 48 % vs. 9 % , p < 0.001 ) , the rates of other toxicities and > grade 3 toxicities did not differ . At a median follow-up of 5.3 months , PFS ( 4.3 vs. 1.9 months , p = 0.001 ) and OS ( 9.3 vs. 6.2 months , p = 0.048 ) were significantly longer in the XP-CCRT than in the XP group . Conclusions XP-CCRT was well tolerated and was associated with longer PFS and OS than XP chemotherapy alone in patients with unresectable advanced IHCC . Controlled r and omized trials are required to determine whether XP-CCRT is a primary treatment option for patients with unresectable advanced IHCC BACKGROUND / AIM Few clinical trials are available for advanced biliary tract carcinoma ( BTC ) . We conducted this r and omized phase II clinical trial to explore efficacy and safety of 5-fluorouracil/leucovorin ( 5-FU/LV - de Gramont ) or the same regimen plus oxaliplatin ( Folfox 4 ) as first-line treatment of advanced BTC . PATIENTS AND METHODS Primary endpoint was overall survival ( OS ) ; secondary endpoints were progression-free survival ( PFS ) , response and toxicity . RESULTS A total of 48 patients were enrolled , 23 in de Gramont arm and 25 in the Folfox arm . Disease control rate was 56.5 % for de Gramont vs. 72 % for Folfox . RR was 21.7 % for de Gramont arm and 28 % for Folfox arm ( p=0.12 ) . PFS was in favor of Folfox ( 5.2 vs. 2.8 months ; p=0.031 ) . OS was 7.5 and 13.0 months for de Gramont and Folfox arm respectively ( p=0.0010 ) . Toxicity was generally mild in both arms . CONCLUSION Folfox 4 could be considered a valid option as first-line treatment of BTC due to its efficacy and tolerability Background : A British r and omised study of gemcitabine plus cisplatin ( GC ) combination showed promising results in biliary tract cancer ( BTC ) patients . In our study , we evaluated the efficacy and safety of this combination compared with gemcitabine alone ( G ) in Japanese BTC patients . Methods : Overall , 84 advanced BTC patients were r and omised to either cisplatin 25 mg m−2 plus gemcitabine 1000 mg m−2 on days 1 , 8 of a 21-day cycle ( GC-arm ) , or single-agent gemcitabine 1000 mg m−2 on days 1 , 8 and 15 of a 28-day cycle ( G-arm ) . Treatments were repeated for at least 12 weeks until disease progression or unacceptable toxicity occurred , up to a maximum of 48 weeks . Results : A total of 83 patients were included in the analysis . For the GC and G-arms , respectively , the 1-year survival rate was 39.0 vs 31.0 % , median survival time 11.2 vs 7.7 months , median progression-free survival time 5.8 vs 3.7 months and overall response rate 19.5 vs 11.9 % . The most common grade 3 or 4 toxicities ( GC-arm/G-arm ) were neutropenia ( 56.1%/38.1 % ) , thrombocytopenia ( 39.0%/7.1 % ) , leukopenia ( 29.3%/19.0 % ) , haemoglobin decrease ( 36.6%/16.7 % ) and γ-GTP increase ( 29.3%/35.7 % ) . Conclusions : Gemcitabine plus cisplatin combination therapy was found to be effective and well tolerated , suggesting that it could also be a st and ard regimen for Japanese patients PURPOSE This study aim ed to establish an effective prognostic nomogram for intrahepatic cholangiocarcinoma ( ICC ) after partial hepatectomy . PATIENTS AND METHODS The nomogram was based on a retrospectively study on 367 patients who underwent partial hepatectomy for ICC at the Eastern Hepatobiliary Surgery Hospital from 2002 to 2007 . The predictive accuracy and discriminative ability of the nomogram were determined by concordance index ( C-index ) and calibration curve and compared with five currently used staging systems on ICC . The results were vali date d using bootstrap resampling and a prospect i ve study on 82 patients operated on from 2007 to 2008 at the same institution . RESULTS On multivariate analysis of the primary cohort , independent factors for survival were serum carcinoembryonic antigen , CA 19 - 9 , tumor diameter and number , vascular invasion , lymph node metastasis , direct invasion , and local extrahepatic metastasis , which were all selected into the nomogram . The calibration curve for probability of survival showed good agreement between prediction by nomogram and actual observation . The C-index of the nomogram for predicting survival was 0.74 ( 95 % CI , 0.71 to 0.77 ) , which was statistically higher than the C-index values of the following systems : American Joint Committee on Cancer ( AJ 
    Output:
    
Conclusions : Folfox-4 regimen is likely to be the optimal chemotherapy for patients with advanced BTC and the predominant targeted therapy has n't achieved significant success currently .
XP and GS can be considered as alternatives for advanced BTC