Abstract
PurposeThis study was designed to assess the effectiveness of FLEEOX (5-Fu, leucovorin, etoposide, oxaliplatin, and epirubicin) compared with XELOX (capecitabine and oxaliplatin) as neoadjuvant chemotherapy (NAC) for initially unresectable advanced gastric cancer (AGC).MethodsThis study reviewed patients who underwent FLEEOX or XELOX for initially unresectable AGC. To reduce the bias in patient selection, we conducted propensity score match (PSM) with 1:1 ratio. Tumor and pathological response, surgical characteristics, chemotherapy-related toxicity and overall survival (OS) were analyzed.ResultsFrom January 2004 to December 2012, 436 patients were enrolled; 99 pairs of patients were generated after PSM. The tumor response rates were 80.8% and 68.7% in FLEEOX and XELOX (P=0.018). 80 patients (80.8%) in FLEEOX and 63 (63.6%) in XELOX received radical resection (P<0.001). The pathological complete response rate and R0 rate were 11.1% and 69.7% in FLEEOX, respectively, while 4.8% and 38.4% in XELOX (P<0.001). Median OS time was longer in FLEEOX (30.0 vs. 25.1 months, P<0.001). In addition, more toxicities occurred in FLEEOX, including leukocytopenia (17.2% vs. 7.1%, P=0.024), nausea (17.2% vs. 6.1%, P=0.012) and vomiting (22.2% vs. 10.1%, P=0.016). The overall toxicity rate was higher in FLEEOX (71.7% vs. 35.4%, P<0.001).ConclusionThe FLEEOX regimen as NAC for patients with initially unresectable AGC can improve tumor response rate, radical resection rate, R0 rate, and OS as compared to XELOX regimen. More chemotherapy-related toxicity was observed in FLEEOX group, although no chemotherapy-related deaths and aborting were observed. Further randomized clinical trials on the FLEEOX regimen are necessary.
Highlights
Gastric cancer is one of the leading cause of cancerrelated deaths worldwide [1] and causes 697,000 new diagnosed cases and 499,000 related deaths in China each year [2]
More toxicities occurred in FLEEOX, including leukocytopenia (17.2% vs. 7.1%, P=0.024), nausea (17.2% vs. 6.1%, P=0.012) and vomiting (22.2% vs. 10.1%, P=0.016)
More chemotherapy-related toxicity was observed in FLEEOX group, no chemotherapy-related deaths and aborting were observed
Summary
Gastric cancer is one of the leading cause of cancerrelated deaths worldwide [1] and causes 697,000 new diagnosed cases and 499,000 related deaths in China each year [2]. Neoadjuvant chemotherapy (NAC) is a promising strategy of multimodality therapies. It is currently accepted as an effective treatment for ovarian, head and neck cancer www.impactjournals.com/oncotarget and extremity tumors, considered to have many clinical advantages [7]. Several studies have indicated that initially unresectable AGC can be successfully converted to resectable AGC by NAC and treated with curative surgery [8,9,10,11]. S-1 plus cisplatin has been reported with 63% response rate (RR) and 31.0% 3-year overall survival (OS) rate in initially unresectable AGC in a phase II clinical trial [12]. Further studies indicated that the addition of docetaxel to cisplatin and S-1 could improve the outcome of patients with unresectable gastric cancer [13, 14]. The clinical efficacy of these chemotherapy regimens and whether multi-drug regimens bring more benefits than double-drug therapies do for these patients remain unknown
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