Combination Chemotherapy Plus Panitumumab or Bevacizumab for Inoperable Cholangiocarcinoma Without KRAS Mutations

Inclusion Criteria:

* Histologically verified adenocarcinoma arisen from gall bladder, extra- or intrahepatic bile ducts or malignant cells consistent with the above and simultaneous radiologic findings consistent with cholangiocarcinoma
* Minimum 18 years of age
* Curative treatment currently not an option (operation, stereotactic radiation treatment or similar)
* KRAS analyzed and found wild-type (wt)
* Performance status 0-2
* Evaluable disease according to RECIST, i.e. the disease need not be measurable
* Hematology: ANC ≥1.5x10\^9/l. Thrombocytes ≥ 100x10\^9/l
* Biochemistry: Bilirubinemia ≤ 3 x upper normal level. ALAT ≤ 5 x upper normal level.
* Creatinine ≤ upper normal level. At raised creatinine level the measured or calculated GFR must be at least 50% of the lower normal level
* Fertile women must present a negative pregnancy test and use secure birth control during and 6 months after treatment. Men with fertile partners must also take care of secure birth control.
* Written and orally informed consent

Exclusion Criteria:

* Previous cytostatic treatment of inoperable cholangiocarcinoma
* Adjuvant or neoadjuvant chemotherapy, radiation therapy or immunotherapy within 4 weeks prior to treatment start
* Other concomitant experimental treatment
* Severe medical disease such as considerable heart disease, serious active infection or other disease making the patient unfit for study participation as assessed by investigator
* Other malignant disease within 5 years prior to enrolment except from non-melanotic skin cancer and carcinoma in situ cervicis uteri
* Interstitial pneumonitis or subsequent pulmonary fibrosis
* Pregnant or breastfeeding women
* Large-scale surgical intervention, excision biopsy or significant traumatic lesions within 28 days prior to treatment start or presumption that large-scale surgery will become necessary during study treatment.
* Significant non-healing wound or ulcers
* Active hemorrhage or increased risk of hemorrhage (e.g. tumor invasion in large vessels or known esophagus varices)
* Known hypersensitivity to panitumumab, bevacizumab or any of the auxiliary agents
* Grade IV fistulas
* Uncontrolled hypertension, i.e. symptomatic hypertension or non-medically stabilized hypertension \>160/100
* Haemoptysis \> 2.5 ml within 2 weeks prior to enrolment
* Previous serious and unexpected reactions or know hypersensitivity to two or more of the applied cytostatics