Abstract
Purpose: Several studies have shown that fluoropyrimidine plus oxaliplatin (SOX) is non-inferior to fluoropyrimidine plus cisplatin as first-line chemotherapy for advanced gastric cancer. We investigated retrospectively the choice of second-line regimen, along with the proportion and feasibility of paclitaxel-containing regimen, in the subsequent treatment of patients with advanced gastric cancer treated with SOX as first-line chemotherapy. Materials and Methods: We retrospectively analyzed the impact of oxaliplatin-induced neuropathy on both the choice of subsequent regimens and feasibility of subsequent chemotherapy with paclitaxel, focusing on patients with advanced gastric cancer who received S-1 plus oxaliplatin as first-line chemotherapy. Results: Twenty-seven from a total of 31 patients enrolled into the phase 2 and phase 3 study assessing S-1 plus oxaliplatin were analyzed (4 patients were deemed ineligible). Among 24 patients that had received second-line treatment, paclitaxel was not selected in 2 patients due to oxaliplatin-induced neuropathy. Paclitaxel was selected as second-line chemotherapy in 16 patients, as third-line chemotherapy in 6 patients and fourth-line chemotherapy in one patient. Severity of sensory neuropathy was grade 0/1/2/3 in 11/10/2/0 patients, respectively, immediately before treatment with paclitaxel, while the worst toxicity profile during paclitaxel treatment was grade 0/1/2/3 in 7/13/1/2 patients, respectively. Although there were no patients requiring dose reductions of paclitaxel due to neuropathy, 2 patients discontinued paclitaxel use due to grade 3 sensory neuropathy after 4 or 8 administrations of paclitaxel. Conclusion: Oxaliplatin-induced neuropathy during first-line chemotherapy may affect the choice and feasibility of subsequent chemotherapy with paclitaxel in advanced gastric cancer patients.
Highlights
Gastric cancer is one of the major causes of death and the second leading cause of cancer death in the world [1]
We investigated retrospectively the choice of second-line regimen, along with the proportion and feasibility of paclitaxel-containing regimen, in the subsequent treatment of patients with advanced gastric cancer treated with shown that fluoropyrimidine plus oxaliplatin (SOX) as first-line chemotherapy
Patient characteristics The subjects of this study were 31 patients with advanced gastric cancer, of whom 21 patients were assigned to SOX in a phase 3 study and 10 patients were enrolled in a phase 2 study of SOX (Figure 1)
Summary
Gastric cancer is one of the major causes of death and the second leading cause of cancer death in the world [1]. Palliative systemic chemotherapy of advanced gastric cancer has been proven to improve survival and quality of life, compared to best supportive care [3] [4] [5]. Combination chemotherapy as first-line treatment provides better survival and quality of life than single agent chemotherapy, and it is accepted as the standard of care [6] [7]. Doublet combination chemotherapy with S-1 plus cisplatin has been commonly used in patients with advanced gastric cancer as first-line chemotherapy in Japan [8]. Other studies have reported that oxaliplatin-containing regimens for advanced gastric cancer as first-line chemotherapy are feasible and effective [10] [11] [12]
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