Gemcitabine, Oxaliplatin in Combination With Bevacizumab in Biliary Tract and Gallbladder Cancer

• The chemotherapy drugs are given twice every 28 days. This 28 day period is called a cycle of study treatment.
• Bevacizumab will be administered by IV over 90 minutes on day 1 and day 15. Gemcitabine will be administered by IV over 1 hour and 40 minutes on days 1 and 15 of each cycle. Oxaliplatin will be administered by IV for 2 hours on days 1 and 15 of each cycle.
• The following tests and procedures will be performed on day 1 and day 15 or each cycle: physical examination; medical history; blood work; and urine test. A PET scan will be repeated at the end of cycle 2 and CT scans will be repeated once every 8 weeks.
• Participants will continue to receive cycles of study treatment as long as their disease does not progress and they are not experiencing any serious side effects.

Inclusion criteria

• Histologically confirmed, locally unresectable or metastatic biliary tract or gallbladder adenocarcinoma. Patients must have at least one measurable lesion outside prior radiation field.
• Zero to one prior chemotherapy for biliary tract or gallbladder cancer
• Age > 18 years
• ECOG performance status 0-2
• Life expectancy > 12 weeks
• Adequate organ and bone marrow function

Exclusion criteria

• Chemotherapy within past 3 weeks of initiation of therapy
• Pregnant or lactating women
• Clinically apparent central nervous system metastases or carcinomatous meningitis
• Biliary obstruction with inadequate drainage and total bilirubin > 2.5 mg/dL
• Concurrent malignancy of any site, except limited basal cell carcinoma or squamous cell carcinoma of the skin or carcinoma in situ of the cervix
• Uncontrolled serious medical or psychiatric illness
• Pre-existing peripheral neuropathy of grade 2 or greater severity according to the Common Terminology Criteria of the NCI (version 3.0)
• Current, recent (within 4 weeks of the first infusion of this study), or planned participation in an experimental drug study
• Blood pressure of > 150/100 mmHg
• Unstable angina
• NYHA Grade II or greater congestive heart failure
• History of myocardial infarction or stroke within 6 months
• Clinically significant peripheral vascular disease
• Evidence of bleeding diathesis or coagulopathy
• Major surgical procedure, open biopsy, or significant traumatic injury with 28 days prior to Day 1, anticipation of need for major surgical procedure during the course of the study
• History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to day 1
• Serious, non-healing wound, ulcer, or bone fracture