Korean J Gastroenterol.  2011 Dec;58(6):311-317. 10.4166/kjg.2011.58.6.311.

Comparison of the Toxicities and Efficacies of the Combination Chemotherapy Regimens in Advanced Gastric Cancer Patients Who Achieved Complete Response after Chemotherapy

• Kim YJ
• Goh PG
• Kim ES
• Lee SY
• Moon HS
• Lee ES
• Sung JK
• Kim SH
• Lee BS
• Jeong HY

• KMID: 1043329
• DOI: http://doi.org/10.4166/kjg.2011.58.6.311

Abstract

BACKGROUND/AIMS
We retrospectively analyzed comparative toxicities and efficacies of chemotherapy regimens in advanced gastric cancer (AGC) patients who achieved complete response (CR) after chemotherapy.
METHODS
We reviewed the medical records of 1,203 patients, who were pathologically diagnosed as AGC in a single center between January 2001 and October 2007. On the basis of the Response Evaluation Criteria in Solid Tumors, CR was evaluated with abdominal computed tomography. Toxicities were evaluated using the National Cancer Institute's common toxicity criteria before each chemotherapy cycle.
RESULTS
Among the 1,203 AGC patients enrolled in this study, 568 received chemotherapy and 635 received best supportive care. The major chemotherapy regimens were 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX), docetaxel, cisplatin and 5-fluorouracil (DCF) and 5-fluorouracil, leucovorin and irinotecan (FOLFIRI). Among the 568 patients, 51 (9.0%) achieved CR (49 [8.6%] with FOLFOX [n=12], DCF [n=26], or FOLFIRI [n=11] and 2 [0.3%] with etoposide, leucovorin and 5-fluorouracil). For patients administered FOLFOX, DCF, and FOLFIRI, the median time to disease progression was 4 months (range, 1.8-59.5), 15 months (range, 2.9-31.2) and 10 months (range, 2.0-39.5), and the median survival times were 48 months (range, 5.9-74.0), 37 months (range, 14.0-86.0), and 30 months (range, 6.0-50.0), respectively. Grades 3-4 mucositis occurred mostly in patients administered DCF (n=8, 30.8%). Grades 3-4 leucopenia were observed in 1 (8.3%), 11 (42.3%), and 4 (36.4%) patients administered FOLFOX, DCF and FOLFIRI, respectively. No statistically significant differences were observed in the 3 regimens.
CONCLUSIONS
All 3 regimens (FOLFOX, DCF and FOLFIRI) were active and tolerable. Their efficacies and toxicities were not significantly different.

Keyword

Stomach cancer; Combination therapy; Treatment outcome; Drug toxicity

MeSH Terms

Adult
Aged
Antineoplastic Agents/*therapeutic use/toxicity
Antineoplastic Combined Chemotherapy Protocols/therapeutic use/toxicity
Camptothecin/analogs & derivatives/therapeutic use/toxicity
Cisplatin/therapeutic use/toxicity
Drug Therapy, Combination
Female
Fluorouracil/therapeutic use/toxicity
Humans
Leucovorin/therapeutic use/toxicity
Leukopenia/etiology
Male
Middle Aged
Mucositis/etiology
Nausea/etiology
Neoplasm Staging
Organoplatinum Compounds/therapeutic use/toxicity
Retrospective Studies
Stomach Neoplasms/*drug therapy/mortality
Survival Rate
Taxoids/therapeutic use/toxicity
Tomography, X-Ray Computed
Vomiting/etiology

Figure

• 

  Fig. 1. Distribution of enrolled patients. Complete response was observed in 51 patients. Of these 51 patients, 2 were treated etoposide, leucovorin and 5-fluorouracil (ELF); therefore, we enrolled the remaining 49 patients who were treated with 5-fluorouracil- leucovorin-oxaliplatin (FOLFOX), docetaxel-cisplatin-5-fluorouracil (DCF) and 5-fluorouracil-leucovorin-irinotecan (FOLFIRI). AGC, advanced gastric cancer.

• 

  Fig. 2. Survival rates of patients according to regimens. Statistical difference among in 1-year survival rates (p=0.035), but no difference in 3-year survival rates was observed among the 3 regimen groups. FOLFOX, 5-fluorouracil-leucovorin-oxaliplatin; DCF, docetaxel-cisplatin-5-fluorouracil; FOLFIRI, 5-fluorouracil-leucovorin-irinotecan.

• 

  Fig. 3. Comparison of the toxicities of chemotherapy regimens. No statistical difference was observed among the 3 regimen groups. FOLFOX, 5-fluorouracil-leucovorin-oxaliplatin; DCF, docetaxel-cispla-tin-5-fluorouracil; FOLFIRI, 5-fluorouracil-leucovorin-irinotecan.

Reference

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