Cancer Res Treat.  2007 Sep;39(3):99-103.

Oxaliplatin, 5-FU, Folinic Acid as First-line Palliative Chemotherapy in Elderly Patients with Metastatic or Recurrent Gastric Cancer

Affiliations
  • 1Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. jhkimmd@snu.ac.kr
  • 2Department of Internal Medicine, Seoul Municipal Boramae Hospital, Seoul, Korea.
  • 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract

PURPOSE: We investigated the efficacy and safety of a combination of oxaliplatin, 5-fluorouracil (5-FU), and folinic acid (FA) as first-line palliative chemotherapy for elderly patients with metastatic or recurrent gastric cancer.
MATERIALS AND METHODS
The study patients were chemotherapy-naive patients (> 65 years old) with histologically confirmed, metastatic or recurrent gastric cancer. Chemotherapy consisted of oxaliplatin 100 mg/m2 and FA 100 mg/m2 (2-hour infusion), and then 5-FU 2400 mg/m2 (46-hour continuous infusion) every 2 weeks.
RESULTS
A total of 37 patients were studied between April 2004 and October 2006. Of the 34 evaluable patients, none achieved a complete response (CR) and 14 achieved a partial response (PR), resulting in an overall response rate of 41.2%. The median time to progression (TTP) was 5.7 months (95% CI: 4.2~6.3 months) and the median overall survival (OS) was 9.8 months (95% CI: 4.4~12.0 months). The main hematologic toxicities were anemia and neutropenia, which were observed in 56.7% and 32.4% of the patients, respectively. Grade 3/4 neutropenia was observed in 8.1% of the patients. None of the patients experienced febrile neutropenia. Peripheral neuropathy occurred in 35.1% of the patients and all were grade 1/2.
CONCLUSION
This oxaliplatin/5-FU/FA regimen showed good efficacy and an acceptable toxicity profile in elderly patients with metastatic or recurrent gastric cancer.

Keyword

Stomach neoplasms; Elderly; Chemotherapy; Oxaliplatin

MeSH Terms

Aged*
Anemia
Drug Therapy*
Febrile Neutropenia
Fluorouracil*
Humans
Leucovorin*
Neutropenia
Peripheral Nervous System Diseases
Stomach Neoplasms*
Fluorouracil
Leucovorin

Figure

  • Fig. 1 Time to progression curve.

  • Fig. 2 Overall survival curve.


Reference

1. Pisters PWT, Kelsen DP, Powell SM, Tepper JE. De Vita VT, Hellman S, Rosenberg SA, editors. Cancer of the stomach. Cancer: Principles and Practice of Oncology. 2005. 7th edn. Philadelphia: Lippincott Williams & Wilkins;p. 909–944.
2. Shin HR, Won YJ, Jung KW, Kong HJ, Yim SH, Lee JK, et al. Nationwide cancer incidence in Korea, first result using the national cancer incidence database. Cancer Res Treat. 2005; 37:325–331.
3. Pyrhonen S, Kuitunen T, Nyandoto P, Kouri M. Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer. 1995; 71:587–591. PMID: 7533517.
Article
4. Murad AM, Santiago FF, Petroianu A, Rocha PR, Rodriques MA, Rausch M. Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer. 1993; 72:37–41. PMID: 8508427.
Article
5. Glimelius B, Ekstrom K, Hoffman K, Graf W, Sjoden PO, Haglund U, et al. Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol. 1997; 8:163–168. PMID: 9093725.
Article
6. Webb A, Cunningham D, Scarffe JH, Harper P, Norman A, Joffe JK, et al. Randomized trial comparing epirubicin, cisplatin and fluorouracil versus fluorouracil, doxorubicn and methotrexate in advanced esophagogastric cancer. J Clin Oncol. 1997; 15:261–267. PMID: 8996151.
7. Waters JS, Norman A, Cunningham D, Scarffe JH, Webb A, Harper P, et al. Long-term survival after epirubicin, cisplatin, and fluorouracil for gastric cancer: results of a randomized trial. Br J Cancer. 1999; 80:269–272. PMID: 10390007.
Article
8. Vanhoefer U, Rougier P, Wilke H, Ducreux MP, Lacave AJ, Van Cutsem E, et al. Final results of a randomized phase III trial of sequential high-dose methotrexate, fluorouracil and doxorubicin versus etoposide, leucovorin, and fluorouracil versus infusional fluorouracil and cisplatin in advanced gastric cancer: a trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cancer Cooperative Group. J Clin Oncol. 2000; 18:2648–2657. PMID: 10894863.
Article
9. Moiseyenko VM, Ajani J, Tjulandin SA, Majlis A, Constenla M, Boni C, et al. Final results of a randomized controlled phase III trial (TAX 325) comparing docetaxel (T) combinded with cisplatin (C) and 5-fluorouracil (F) to CF in patients (pts) with metastatic gastric carcinoma (MGC). Proc Am Soc Clin Oncol. 2005; 23:308s. abstr 4002.
10. Louvet C, Andre T, Tigaud JM, Gamelin E, Douillard JY, Brunet R, et al. Phase II study of oxaliplatin, fluorouracil, and folinic acid in locally advanced or metastatic gastric cancer patients. J Clin Oncol. 2002; 20:4543–4548. PMID: 12454110.
Article
11. Lordick F, Lorenzen S, Stollfuss J, Vehling-Kaiser U, Kullmann F, Hentrich M, et al. Phase II study of weekly oxaliplatin plus infusional fluorouracil and folinic acid (FUFOX regimen) as first-line treatment in metastatic gastric cancer. Br J Cancer. 2005; 93:190–194. PMID: 16012522.
Article
12. Al-Batran SE, Atmaca A, Hegewisch-Becker S, Jaeger D, Hahnfeld S, Rummel MJ, et al. Phase II trial of biweekly infusional fluorouracil, folinic acid, and oxaliplatin in patients with advanced gastric cancer. J Clin Oncol. 2004; 22:658–663. PMID: 14966088.
Article
13. Chao Y, Yeh KH, Chang CJ, Chen LT, Chao TY, Wu MF, et al. Phase II study of weekly oxaliplatin and 24-h infusion of high-dose 5-fluorouracil and folinic acid in the treatment of advanced gastric cancer. Br J Cancer. 2004; 91:453–458. PMID: 15226770.
Article
14. Bang YJ, Kang YK, Kang WK, Kim YH, Kim TY, Park BJ, et al. Phase II study of oxaliplatin, 5-fluorouracil and folinic acid in recurrent or metastatic gastric cancer. Proc Am Soc Clin Oncol. 2002; 21:109b. abstr 2249.
15. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer treatment trials. N Engl J Med. 1999; 341:2061–2067. PMID: 10615079.
16. Lewis JH, Kilgore ML, Goldman DP, Trimble EL, Kaplan R, Montello MJ, et al. Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol. 2003; 21:1383–1389. PMID: 12663731.
Article
17. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000; 92:205–216. PMID: 10655437.
18. Kranenbarg EK, Van de Velde CJ. Gastric cancer in the elderly. Eur J Surg Oncol. 1998; 5:384–390. PMID: 9800965.
19. Wilke H, Preusser P, Fink U, Achterrath W, Lenaz L, Stahl M, et al. High dose folinic acid/etoposide/5-fluorouracil in advanced gastric cancer: a phase II study in elderly patients or patients with cardiac risk. Invest New Drugs. 1990; 8:65–70. PMID: 2345071.
Article
20. Cascinu S, Fedeli A, Catalano G. Etoposide, leucovorin 5-fluorouracil and interferon alpha-2b in elderly gastric cancer patients: a pilot study. Cancer Chemother Pharmacol. 1994; 34:72–74. PMID: 8174205.
Article
21. Cascinu G, Catalano G. Intensive weekly chemotherapy for elderly gastric cancer patients using 5-fluorouracil, cisplatin, epi-doxorubicin, 6S-leucovorin and gluthatione with the support of G-CSF. Tumori. 1995; 81:32–35. PMID: 7538704.
22. Di Bartolomeo M, Bajetta E, de Braud F, Bochicchio AM, Gebbia V, Bozzetti F, et al. Phase II study of the etoposide, leucovorin and fluorouracil combination for patients with advanced gastric cancer unsuitable for aggressive chemotherapy. Oncology. 1995; 52:41–44. PMID: 7800341.
Article
23. Hartung G, Hofheinz R, Buchheidt D, Rost A, Brecht A, Forche K, et al. Combination of bolus 5-fluorouracil, folinic acid and mitomycin-C in advanced gastric cancer: results of a phase II trial. Onkologie. 2000; 23:444–447. PMID: 11441239.
24. Graziano F, Santini D, Testa E, Catalano V, Beretta GD, Mosconi S, et al. A phase II study of weekly cisplatin, 6S-stereoisomer leucovorin and fluorouracil as first-line chemotherapy for elderly patients with advanced gastric cancer. Br J Cancer. 2003; 89:1428–1432. PMID: 14562012.
Article
25. Santini D, Graziano F, Cantalo V, Di Seri M, Testa E, Baldelli AM, et al. Weekly oxaliplatin, 5-fluorouracil and folinic acid (OXALF) as first-line chemotherapy for elderly patients with advanced gastric cancer: results of a phase II trial. BMC cancer. 2006; 6:125–131. PMID: 16686939.
Article
Full Text Links
  • CRT
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr