Cagatay Arslan1, Fatos Dilan Atilla2. 1. Faculty of Medicine, Department of Internal Medicine, Division of Medical Oncology, Izmir University of Economics, Izmir, Turkey. 2. Department of Internal Medicine Division of Hematology, Bakircay University Cigli Training and Research Hospital, Izmir, Turkey. fatosdilanatilla@gmail.com.
Abstract
BACKGROUND: Little progress has been made, and there is an unmet medical need for treatment of metastatic gastric cancer (MGC). Docetaxel + cisplatin + 5-fluororacil (DCF) combination is an effective regimen with high rate of toxicity and is not well tolerated. We aimed to evaluate the efficacy and toxicity of a modified DCF (mDCF) combination regimen and capecitabine maintenance in MGC. METHOD: Data of MGC patients were treated with first-line mDCF regimen (two weekly docetaxel 60 mg/m2 day 1 iv, cisplatin 50 mg/m2 day 1 iv, 5-fluouracil 400 mg/m2 day 1 iv push, 2400 mg/m2; day 1-day 2 iv infusion, leucovorin 400 mg/m2 day 1 iv push) were recorded. Capecitabine maintenance was given as 2500 mg/m2/ day 1-day 14 po, every 3 weeks, to patients who do not have progressive disease and grade 3 treatment-related toxicity. A retrospective analysis was made. RESULTS: Forty patients were included. Mean age was 53 ± 11. Thirty-two patients had de novo metastasis. All patients' performance status was ECOG 1 or 2 (32/8). Median number of mDCF cycles given was 9 (min-max: 1-23). Overall response rate was 47.5%. Ten patients (25%) received capecitabine maintenance. Grade 3/4 toxicity was seen in 20 patients (50%). Hematologic grade 3/4 toxicity occurred in 13 patients (32.5%), and grade 3/4 neutropenia occurred in 11 patients (27.5%) and in 15 cycles. Nonhematologic grade 3/4 toxicity was seen in 7 patients (17.5%). Median follow-up time was 17.2 months. Median time to progression (TTP) was 10.8 ± 1.9 months (95% CI: 6.89-14.64). Median overall survival was 14.7 ± 1.73 months (95% CI: 11.30-18.10). CONCLUSIONS: mDCF protocol was a tolerable chemotherapy regimen for the first-line treatment of MGC with higher ORR and longer TTP compared to standard DCF protocol. Capecitabine maintenance might increase TTP.
BACKGROUND: Little progress has been made, and there is an unmet medical need for treatment of metastatic gastric cancer (MGC). Docetaxel + cisplatin + 5-fluororacil (DCF) combination is an effective regimen with high rate of toxicity and is not well tolerated. We aimed to evaluate the efficacy and toxicity of a modified DCF (mDCF) combination regimen and capecitabine maintenance in MGC. METHOD: Data of MGC patients were treated with first-line mDCF regimen (two weekly docetaxel 60 mg/m2 day 1 iv, cisplatin 50 mg/m2 day 1 iv, 5-fluouracil 400 mg/m2 day 1 iv push, 2400 mg/m2; day 1-day 2 iv infusion, leucovorin 400 mg/m2 day 1 iv push) were recorded. Capecitabine maintenance was given as 2500 mg/m2/ day 1-day 14 po, every 3 weeks, to patients who do not have progressive disease and grade 3 treatment-related toxicity. A retrospective analysis was made. RESULTS: Forty patients were included. Mean age was 53 ± 11. Thirty-two patients had de novo metastasis. All patients' performance status was ECOG 1 or 2 (32/8). Median number of mDCF cycles given was 9 (min-max: 1-23). Overall response rate was 47.5%. Ten patients (25%) received capecitabine maintenance. Grade 3/4 toxicity was seen in 20 patients (50%). Hematologic grade 3/4 toxicity occurred in 13 patients (32.5%), and grade 3/4 neutropenia occurred in 11 patients (27.5%) and in 15 cycles. Nonhematologic grade 3/4 toxicity was seen in 7 patients (17.5%). Median follow-up time was 17.2 months. Median time to progression (TTP) was 10.8 ± 1.9 months (95% CI: 6.89-14.64). Median overall survival was 14.7 ± 1.73 months (95% CI: 11.30-18.10). CONCLUSIONS: mDCF protocol was a tolerable chemotherapy regimen for the first-line treatment of MGC with higher ORR and longer TTP compared to standard DCF protocol. Capecitabine maintenance might increase TTP.