Abstract
Purpose This paper is aimed at comparing the short-term efficacy of the combination of docetaxel, oxaliplatin, and capecitabine (DOX) with the combination of oxaliplatin and capecitabine (XELOX) as neoadjuvant chemotherapy regimens for the treatment of patients with resectable gastric or gastroesophageal junction adenocarcinoma. Methods A total of 300 patients aged 20-60 years with resectable gastric or gastroesophageal junction adenocarcinoma who were evaluated with cT3/4Nany were randomly assigned into 3 groups: DOX group (n = 100, treated with neoadjuvant DOX plus adjuvant XELOX), XELOX group (n = 100, treated with perioperative XELOX), and surgery group (n = 100, treated with adjuvant XELOX). Results A total of 93, 92, and 95 patients were enrolled in the DOX, XELOX, and surgery groups, respectively. The pathological complete response (pCR) rate was 16.1% in the DOX group and 4.3% in the XELOX group (P = 0.008). There were 56 (61.3%) patients in the DOX group who presented with surgical complications, 22 (23.9%) patients in the XELOX group, and 37 (38.9%) patients in the surgery group. The most common grade 3-4 adverse events in these three groups were neutropenia (32.3%, 30.4%, and 21.1%), leucopenia (21.5%, 22.8%, and 15.8%), nausea (15.1%, 16.3%, and 12.6%), and fatigue (10.8%, 7.6%, and 8.4%). Conclusions Neoadjuvant DOX is an effective and feasible regimen and might represent an option for young and middle-aged patients with locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma.
Highlights
This paper is aimed at comparing the short-term efficacy of the combination of docetaxel, oxaliplatin, and capecitabine (DOX) with the combination of oxaliplatin and capecitabine (XELOX) as neoadjuvant chemotherapy regimens for the treatment of patients with resectable gastric or gastroesophageal junction adenocarcinoma
20-60 years with resectable gastric or gastroesophageal junction adenocarcinoma who were evaluated with cT3/4Nany were randomly assigned into 3 groups: DOX group (n = 100, treated with neoadjuvant DOX plus adjuvant XELOX), XELOX group (n = 100, treated with perioperative XELOX), and surgery group (n = 100, treated with adjuvant XELOX)
There were 93, 92, and patients enrolled in the DOX group, the XELOX group, and the surgery group, respectively
Summary
More than 50% of gastric cancer (GC) patients are neglected and diagnosed with a locally advanced stage as there is a lack of specific screening programs. Even in the cases of curative resection, the prognosis of patients with positive lymph node metastases remains poor, with five-year survival rates of 20-30% [1]. In the prospective clinical trials of the FLOT regimen [3,4,5,6], rare Asian patients are included, and the efficacy and tolerance of the regimen to Chinese GC patients remain unclear. Our previous clinical trial (NCT01516944) has shown the efficacy and safety of the XELOX regimen (oxaliplatin and capecitabine) and SOX regimen (tegafur, gimeracil, and oteracil potassium (S-1) plus oxaliplatin) as neoadjuvant chemotherapy [7, 8]. Based on previous results [8], whether the docetaxel-based triplet chemotherapy DOX regimen can improve the pathological complete response (pCR) rate, prolong the survival, and obtain better tolerance or not needs to be confirmed. Considering potential better efficacy and more toxicity of triplet chemotherapy compared with doublet chemotherapy, middle-
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