Background: CDH is a Ca2+-dependent cell adhesion molecule with tumor metastasis suppressor activity. Mutations of CDH1 and its E-cadherin product have been associated with the origin, development, invasion, metastasis, and prognosis of gastric cancer (GC). The present study analyzed CDH1 gene polymorphisms and their impacts on chemotherapeutic event free response (EFS) and survival (OS) in patients with metastatic gastric cancer (MGC) treated with DOC2 (Docetaxel, Oxaliplatin) regimen. The original chemotherapeutic program DOC was developed at the CRO - Cancer Center in Aviano. The phase I study determined the Maximum Tolerated Dose (MTD) and, as per protocol, indicated the level just below the MTD as appropriate for a phase II study. Patients and methods: This is a multi-centre, phase II single arm study of DOC combination in patients with previously untreated surgically unresectable or metastatic gastric cancer. Eligible subjects will be enrolled to receive first-line combination therapy consisting of DOC2 treatment. The foreseen schedule consists of: Docetaxel 30 mg/m2, Oxaliplatin 70 mg/m2, both i.v., on days 1 and 8, associated to Capecitabine 500 mg/m2, p.o., bid, on day 2 to 15, on a three week basis. The study has been designed to determine the activity and safety of the DOC regimen in previously untreated patients. Each patient will be treated for a maximum of 6 cycles until disease progression, unacceptable toxicity, or patient refusal, whichever occur first. However, Capecitabine 1000 mg/m2/die tablets p.o. alone is allowed in patients without tumor progression at the end of chemotherapy (maintenance treatment) for further 4-6 cycles. Up to now the study enrolled 29 out 71 foreseen MGC patients treated with first-line DOC2 chemotherapy with a mean follow-up of 1.2 years (range 0.2 to 3.2). Polymorphisms of the entire CDH1 exons and promoter regions were determined. Results: Among the 37 regions we analyzed, polymorphism in the promoter (P1) was significantly associated with EFS (HR 4.8, 95%CI 1.8-12.7, p = 0.004) and showed an increasing trend of OS (HR 2.8, 95%CI 0.9-8.7). Conclusions: Our result suggest promoter region of CDH1 might be independent predictor of chemotherapeutic clinical outcome.
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