A trial looking at whether stereotactic radiotherapy together with chemotherapy is a useful treatment for people with locally advanced bile duct cancer (ABC-07)

ISRCTN ISRCTN10639376
DOI https://doi.org/10.1186/ISRCTN10639376
Clinical Trials Information System (CTIS) 2014-003656-31
Protocol serial number 19234
Sponsor University College London
Funder Cancer Research UK
Submission date
14/10/2015
Registration date
14/10/2015
Last edited
17/08/2026
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Cancer
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

http://www.cancerresearchuk.org/a-trial-looking-chemotherapy-stereotactic-radiotherapy-people-locally-advanced-bile-duct-cancer-abc-07

Contact information

Mrs Shumona Shelly
Public

Cancer Research UK & UCL Cancer Trials Centre
Maple House, 149 Tottenham Court Road
London
W1T 7NF
United Kingdom

Phone +44 (0)20 7679 9518
Email ctc.abc07@ucl.ac.uk

Study information

Primary study designInterventional
Study designRandomized; Interventional; Design type: Treatment
Secondary study designRandomised controlled trial
Scientific titleAddition of stereotactic body radiotherapy to systemic chemotherapy in locally advanced biliary tract cancers
Study acronymABC-07
Study objectives 1. The overall aim of the feasibility component of the trial is to determine if it is feasible to deliver SBRT in a multi-centre trial setting in a rare disease
2. The overall aim of the phase II trial is to evaluate the efficacy of 8 cycles of CisGem chemotherapy compared to 6 of cycles of CisGem chemotherapy followed by SBRT
Ethics approval(s)

Approved 04/08/2015, London - Hampstead Research Ethics Committee (2 Redman Place, Stratford, London, E20 1JQ, United Kingdom; +44 (0)20 7104 8284; hampstead.rec@hra.nhs.uk), ref: 15/LO/1077

Health condition(s) or problem(s) studiedBiliary tract cancer
InterventionCurrent interventions as of 19/07/2017:
All patients will be registered to receive 6 cycles of chemotherapy consisting of cisplatin 25 mg/m2 plus gemcitabine 1000 mg/m2 on days 1 and 8 of a 21-day cycle. Treatment takes about 2 hours each time.
Patients will then be randomised to one of two groups.

Investigational arm: Participants receive 5 or 15 fractions of SBRT over 5-21 days approximately 6 weeks after the start of cycle 6. (Number of fractions and duration of treatment depends on size of tumour on end of cycle 4 imaging).

Standard arm: Participants receive 2 further cycles of CisGem (8 cycles in total)

All patients will be followed up every 3 months for up to 2 years from date of registration.

Previous interventions:
All patients will be registered to receive 6 cycles of chemotherapy consisting of cisplatin 25 mg/m2 plus gemcitabine 1000 mg/m2 on days 1 and 8 of a 21-day cycle. Treatment takes about 2 hours each time.
Patients will then be randomised to one of two groups.

Investigational arm: Participants receive 5 fractions of SBRT over 5-15 days approximately 6 weeks after the start of cycle 6.

Standard arm: Participants 2 further cycles of CisGem (8 cycles in total)

All patients will be followed up every 3 months for up to 2 years from date of registration.
Intervention typeOther
Primary outcome measure(s)

Current primary outcome as of 17/08/2026:
The efficacy of 6 cycles of CisGem followed by SBRT versus 8 cycles of CisGem, measured using progression-free survival (PFS), assessed from randomisation to disease progression (RECIST v1.1 on CT/MRI) or death from any cause.

Previous primary outcome:
Average monthly rate of recruitment is determined over the 18-month trial period

Key secondary outcome measure(s)

Added 17/08/2026:
1. Progression-free survival (PFS) measured using CT and/or MRI imaging assessments (RECIST v1.1) and death from any cause, at 9 months from randomisation
2. The frequency and severity of toxicities measured using CTCAE v4.03 at registration, all treatment visits, completion of treatment, and all follow up visits.
3. Best overall response will be assessed according to RECIST v1.1. Confirmation of a complete or partial response is not required. Stable disease will be considered the best response only if a second assessment has been carried out which confirms SD at least 4 weeks after registration. The proportion of patients whose best overall response is complete or partial will be presented.
4. The duration of overall response is measured from the time of best overall response until the date of objective disease progression on CT and/or MRI.
5. Sites of treatment failure measured using CT and/or MRI assessment of local progression, regional progression and distant metastases according to protocol-defined radiological criteria, at all scheduled follow-up visits from treatment completion.
6. The potential for CisGem + SBRT to downstage inoperable disease to operable disease, measured using the proportion of patients achieving downstaging permitting surgical resection, at treatment completion.
7. Overall survival measured from the date of randomisation to the date of death from any cause. The effect of treatment on overall survival will be summarised using Kaplan-Meier curves. Cox regression will be used to assess the effect of treatment on overall survival, and hazard ratios, 95% confidence interval and p-values will be reported.
8. Quality of life (QoL) measured using the EQ5D and EORTC QLQ- BIL21 questionnaires. Analysis of covariance will be used to assess treatment differences in the quality of life scores at completion of treatment and at 3 months follow-up, adjusting for baseline scores (registration and end of cycle 4).

Completion date12/08/2026

Eligibility

Participant type(s)Patient
Age groupMixed
Lower age limit16 Years
Upper age limit100 Years
SexAll
Target sample size at registration83
Total final enrolment83
Key inclusion criteriaCurrent inclusion criteria as of 19/07/2017:
1. A histopathological/cytological diagnosis of locally advanced, non­-resectable biliary tract carcinoma (intra­ or extrahepatic), or ampullary carcinoma
2. Not suitable for radical surgery, or medically unfit for surgery as decided by a hepatobiliary MDT
3. Tumour visible on cross­sectional imaging
4. Measurable disease (according to RECIST criteria v1.1) (If disease is not measurable using RECIST v1.1, due to location in the vicinity of the hilum, the tumour must be visible for targeting with radiation using other multimodality imaging such as ERCP, MRCP)
5. Tumour (and nodes if involved) must be ≤12 cm in the longest dimension. For patients with non-measurable disease, sites should use the CT reconstructions (coronal or sagittal views) to measure tumour size.
6. Adequate biliary drainage
7. WHO performance status (PS) 0 or 1
8. Adequate haematological function:
8.1. Haemoglobin ≥ 100 g/L (the use of transfusion to achieve desired Hb is acceptable)
8.2. White blood cell count (WBC) ≥ 3.0 x 109/L
8.3. Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
8.4. Platelet count ≥ 100 x 109/L
9. Adequate liver function:
9.1. Total bilirubin ≤ 1.5 x ULN (except for patients with known documented cases of Gilbert’s syndrome)
9.2. ALT and/or AST ≤ 2.5 x ULN
9.3. ALP ≤ 5 x ULN
9.4. Albumin >25g/L
10. Adequate renal function:
10.1. Serum urea < 1.5 x ULN
10.2. Serum creatinine < 1.5 x ULN
10.3. GFR ≥ 45 mL/min using a validated creatinine clearance calculation (e.g. Cockroft­Gault or Wright formula). If the calculated creatinine clearance is less than 45 mL/min, GFR should be assessed using an isotopic clearance method to confirm GFR ≥ 45 mL/min
11. Life expectancy of more than 12 weeks
12. Aged 16 years or over
13. Patients may have had prior chemotherapy as long as patient meets all other inclusion/exclusion criteria
14. Patient must have given written informed consent

Previously inclusion criteria:
1. A histopathological/cytological diagnosis of locally advanced, non­-resectable biliary tract carcinoma (intra­ or extrahepatic), or ampullary carcinoma
2. Not suitable for radical surgery, or medically unfit for surgery as decided by a hepatobiliary MDT
3. Tumour visible on cross­sectional imaging
4. Measurable disease (according to RECIST criteria v1.1)
5. Tumour must be ≤ 6 cm in the longest dimension
6. Adequate biliary drainage
7. WHO performance status (PS) 0 or 1
8. Adequate haematological function:
8.1. Haemoglobin ≥ 100 g/L (the use of transfusion to achieve desired Hb is acceptable)
8.2. White blood cell count (WBC) ≥ 3.0 x 109/L
8.3. Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
8.4. Platelet count ≥ 100 x 109/L
9. Adequate liver function:
9.1. Total bilirubin ≤ 1.5 x ULN (except for patients with known documented cases of Gilbert’s syndrome)
9.2. ALT and/or AST ≤ 2.5 x ULN
9.3. ALP ≤ 5 x ULN
9.4. Albumin >25g/L
10. Adequate renal function:
10.1. Serum urea < 1.5 x ULN
10.2. Serum creatinine < 1.5 x ULN
10.3. GFR ≥ 45 mL/min using a validated creatinine clearance calculation (e.g. Cockroft­Gault or Wright formula). If the calculated creatinine clearance is less than 45 mL/min, GFR should be assessed using an isotopic clearance method to confirm GFR ≥ 45 mL/min
11. Life expectancy of more than 12 weeks
12. Aged 16 years or over
13. Patients may have had prior chemotherapy as long as patient meets all other inclusion/exclusion criteria
14. Patient must have given written informed consent
Key exclusion criteriaCurrent exclusion criteria as of 19/07/2017:
1. Metastatic disease
2. Direct tumour extension in the duodenum, stomach, small bowel or large bowel.
3. Previous abdominal radiotherapy or previous selective internal radiotherapy such as hepatic arterial Yttrium therapy
4. Previous hypersensitivity to platinum salts
5. Any evidence of severe or uncontrolled systemic diseases which, in the view of the investigator, makes it undesirable for the patient to participate in the trial (including diabetes with established sensory peripheral neuropathy, unstable or uncompensated respiratory, cardiac, hepatic or renal disease)
6. History of prior malignancy that could interfere with the response evaluation or survival. (Exceptions include: in­situ carcinoma of the cervix treated by cone­biopsy/resection, non­metastatic basal and/or squamous cell carcinomas of the skin, or any early stage malignancy radically treated in the last two years, early prostate cancer under surveillance.
7. Other concomitant anti­cancer therapy (except steroids)
8. Any psychiatric or other disorder likely to impact on informed consent.
9. Women who are pregnant or lactating
10. Whilst not specifically excluded, patients with significant hearing impairment must be made aware of potential ototoxicity and may choose not to be included. If included, it is recommended that audiograms be carried out at baseline and prior cycle 2 of CisGem.

Previous exclusion criteria:
1. Metastatic disease
2. Direct tumour extension in the duodenum, stomach, small bowel or large bowel.
3. Previous abdominal radiotherapy or previous selective internal radiotherapy such as hepatic arterial Yttrium therapy
4. Previous hypersensitivity to platinum salts
5. Any evidence of severe or uncontrolled systemic diseases which, in the view of the investigator, makes it undesirable for the patient to participate in the trial (including diabetes with established sensory peripheral neuropathy, unstable or uncompensated respiratory, cardiac, hepatic or renal disease)
6. History of prior malignancy that could interfere with the response evaluation (exceptions include in­situ carcinoma of the cervix treated by cone­biopsy/resection, non­metastatic basal and/or squamous cell carcinomas of the skin, or any early stage (stage I) malignancy adequately resected for cure greater than 5 years previously)
7. Other concomitant anti­cancer therapy (except steroids)
8. Any psychiatric or other disorder likely to impact on informed consent.
9. Women who are pregnant or lactating
10. Whilst not specifically excluded, patients with significant hearing impairment must be made aware of potential ototoxicity and may choose not to be included. If included, it is recommended that audiograms be carried out at baseline and prior cycle 2 of CisGem.
Date of first enrolment01/11/2015
Date of final enrolment03/08/2022

Locations

Countries of recruitment

  • United Kingdom
  • England
  • Scotland
  • Wales

Study participating centres

Churchill Hospital
Old Road
Headington
Oxford
OX3 7LE
England
University College Hospital
235 Euston Road
Fitzrovia
London
NW1 2BU
England
The Royal Marsden Hospital (Surrey)
Downs Road
Sutton
SM2 5PT
England
The Royal Marsden Hospital
Fulham Road
Chelsea
London
SW3 6JJ
England
Mount Vernon Cancer Centre
Rickmansworth Road
Northwood
HA6 2RN
England
Lister Hospital
Chelsea Bridge Road
London
SG1 4AB
England
Royal Free Hospital
Pond Street
London
NW3 2QG
England
Velindre Cancer Centre
Velindre Road
Cardiff
CF14 2TL
Wales
St Bart’s Hospital
W Smithfield
London
EC1A 7BE
England
Hammersmith Hospital
Du Cane Road
White City
London
W12 0HS
England
Southampton General Hospital
Tremona Road
Southampton
SO16 6YD
England
Addenbrooke’s Hospital
Hills Road
Cambridge
CB2 0QQ
England
Queen Elizabeth Hospital
Mindelsohn Way
Birmingham
B15 2TH
England
Christie Manchester
550 Wilmslow Road
Manchester
M20 4BX
England
Nottingham City Hospital
Hucknall Road
Nottingham
NG5 1PB
England
Beatson West of Scotland Cancer Centre
1053 Great Western Road
Glasgow
G12 0YN
Scotland
Bristol Haematology & Oncology Centre
Horfield Road
Bristol
BS2 8ED
England
Guy's and St Thomas' Hospitals
Trust Offices
Guy's Hospital
Great Maze Pond
London
SE1 9RT
England
Leeds Teaching Hospitals NHS Trust
St. James's University Hospital
Beckett Street
Leeds
LS9 7TF
England
Weston Park Hospital
Whitham Road
Sheffield
S10 2SJ
England

Results and Publications

Individual participant data (IPD) Intention to shareNo

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
HRA research summary 28/06/2023 No No
Other publications Radiotherapy quality assurance 04/12/2025 12/01/2026 Yes No
Protocol file version 5.0 06/08/2020 17/11/2021 No No
Protocol file version 7.0 01/05/2024 17/08/2026 No No

Additional files

ISRCTN10639376_Protocol_v5.0_06Aug20.pdf
Protocol file
ISRCTN10639376_Protocol_v7.0_01May2024.pdf
Protocol file

Editorial Notes

17/08/2026: The following changes were made to the study record:
1. The ethics approval, primary and secondary outcomes, study participating centres and contact details were updated.
2. The completion date was changed from 30/06/2024 to 12/08/2026.
3. Protocol uploaded.
12/01/2026: Publication reference added.
04/08/2022: The following changes were made to the trial record:
1. The recruitment end date was changed from 30/09/2022 to 03/08/2022.
2. The total final enrolment was added.
23/06/2022: The recruitment end date was changed from 30/06/2022 to 30/09/2022.
17/11/2021: The following changes have been made:
1. The recruitment end date has been changed from 01/11/2021 to 30/06/2022.
2. The overall trial end date has been changed from 01/11/2023 to 30/06/2024.
3. The intention to publish date has been changed from 31/07/2017 to 30/06/2025.
4. The trial website has been added.
5. The individual participant data (IPD) sharing statement has been added.
6. The protocol (not peer reviewed) has been uploaded as an additional file.
20/09/2021: Internal review.
02/04/2019: The condition has been changed from "Topic: Cancer; Subtopic: Upper Gastro-Intestinal Cancer; Disease: Biliary Tract" to "Biliary tract cancer" following a request from the NIHR.
19/07/2017: Updated interventions and inclusion/exclusion criteria. Added Addenbrooke’s Hospital, Cambridge, Queen Elizabeth Hospital Birmingham, Christie, Manchester and Nottingham City Hospital as trial participating centres. Please note that the changes to the study record became effective from July 5th 2017.
09/11/2016: Verified study information with principal investigator.
19/05/2016: Plain English summary link added.