Abstract
BackgroundsCisplatin-based chemotherapy, in combination with fluoropyrimidines or taxanes, have demonstrated efficacy against advanced gastric cancer (AGC). This retrospective study was performed with the data obtained from our cancer chemotherapy registry and eight another cancer centers.MethodsIn 2008, a total of 283 AGC patients were treated with cisplatin-based doublet chemotherapy in the first-line setting: capecitabine plus cisplatin (XP, n = 77), S-1 plus cisplatin (SP, n = 97), taxanes (docetaxel, paclitaxel) plus cisplatin (TP, n = 72), and 5-fluorouracil plus platinum (FP, n = 37). The primary endpoint of this study was overall survival (OS) and the secondary endpoints were safety, response rate and progression-free survival (PFS).ResultsThe median age was 54 years with a range of 28-78 years and median delivered number of chemotherapy cycles were XP: 4, SP: 5, TP: 5 and FP: 5, respectively. Objective tumor responses (38%; 95% CI, 32-43%) were 40% for XP, 42% for SP, 36% for DP, and 24% for FP. The estimated median PFS was 4.5 months (95% CI, 3.6-5.4 months) and the median OS was 12.3 months (95% CI, 10.8-13.7 months). No statistically significant difference was found between each regimen used as first-line chemotherapy. At multivariate analysis, independent prognostic parameters for OS were prior gastrectomy, peritoneal dissemination, performance status and hemoglobin levelConclusionAll of the cisplatin-based doublet chemotherapy regimens appear to be active as first-line chemotherapy for AGC. With better patient selection according to clinical parameters and molecular markers, clinical outcomes of AGC patients in first-line setting can be improved.
Highlights
Gastric cancer is the most frequently occurring malignancy in Korea, and is one of the main causes of cancer death [1]
Despite the lack of evidence for benefit associated with cisplatin-based combination chemotherapy, it is a common practice to offer cisplatin-based doublet or triplet chemotherapy for advanced gastric cancer (AGC) patients in the first-line setting, because 5-FU monotherapy has only limited activity
Administration of docetaxel, as a component of cisplatin-based doublet or triplet, has produced significant benefit for AGC patients [8,9,10]. It is currently unclear whether combination of 3 active drugs is superior to doublet combination, our recent randomized study suggested that cisplatin-based doublet and triplet chemotherapy showed similar outcomes [11]
Summary
Gastric cancer is the most frequently occurring malignancy in Korea, and is one of the main causes of cancer death [1]. Oral fluoropyrimidines, including capecitabine and S-1, are replacing infusional 5-FU Both capecitabine and S-1 are considered to be more tolerable than 5-FU, and has been shown to exhibit antitumor activity against AGC [5,6,7]. Administration of docetaxel, as a component of cisplatin-based doublet or triplet, has produced significant benefit for AGC patients [8,9,10]. It is currently unclear whether combination of 3 active drugs is superior to doublet combination, our recent randomized study suggested that cisplatin-based doublet and triplet chemotherapy showed similar outcomes [11]
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