Management of Hematologic Toxicity in Patients with Advanced or Metastatic Gastric Cancer Treated with Docetaxel, Cisplatin and Fluorouracil (DCF): Results of Monocentric Experience

Abstract

Background: Gastric adenocarcinoma is the second most common cause of cancer death worldwide. There is no standard regimen of chemotherapy for metastatic disease, although the regimen of ECF is the most used regimen, with a median survival of 7-9 months. With new regimens of chemotherapy, such as DCF, the median survival has increased, despite a major toxicities and 1-2% of toxic death.Patients And Methods: This is a monocentric experience. In three years (2009-2012) we have treated 36 chemo-naïve patients with histological diagnosis of locally advanced or metastatic gastric cancer with a DCF regimen. All patients were treated with a prophilactic Peg-filgrastim injection at 6th day of therapy. Results: A total of 168 cycles were administered (median 5 per patient, range 3–8). Major responses were observed in 10 patients, with 2 complete (5,5%) and 8 partial remissions (22,2%); 16 additional pts showed disease stabilization (44,4%) and 10 progressed (27,9%). Median OS times were 12 months. Median TTP were 9,5 months. Toxicity was acceptable, worst per patient toxicities were neutropenia (grade 3-4 in 15%), feverish neutropenia (11,1%) diarrhoea (grade 2 in 25% , grade 3 in 25%, grade 4 in 18,8%), asthenia (grade 2 in 8%), neurotoxicity (grade 3 in 4%), anhemia (grade 4 in 10%), four pts received blood transfusion. Conclusion: Time to response and ORR favor DCF over other schedule’s treatment according to literature. A trend towards increased myelosuppression and infectious complications was observed but the management of this and others side-effects is possible and not too difficult if pts is managed by an expert toxicities team. Infact we don’t have no-one toxic death.