J Gastric Cancer.  2017 Mar;17(1):21-32. 10.5230/jgc.2017.17.e3.

Perioperative Epirubicin, Oxaliplatin, and Capecitabine Chemotherapy in Locally Advanced Gastric Cancer: Safety and Feasibility in an Interim Survival Analysis

• Ostwal V
• Sahu A
• Ramaswamy
• Sirohi B
• Bose S
• Talreja V
• Goel M
• Patkar S
• Desouza A
• Shrikhande SV

• KMID: 2372579
• DOI: http://doi.org/10.5230/jgc.2017.17.e3

Abstract

PURPOSE
Perioperative chemotherapy improves survival outcomes in locally advanced (LA) gastric cancer.
MATERIALS AND METHODS
We retrospectively analyzed patients with LA gastric cancer who were offered perioperative chemotherapy consisting of epirubicin, oxaliplatin, and capecitabine (EOX) from May 2013 to December 2015 at Tata Memorial Hospital in Mumbai.
RESULTS
Among the 268 consecutive patients in our study, 260 patients (97.0%) completed neoadjuvant chemotherapy, 200 patients (74.6%) underwent D2 lymphadenectomy, and 178 patients (66.4%) completed adjuvant chemotherapy. The median follow-up period was 17 months. For the entire cohort, the median overall survival (OS), 3-year OS rate, median progression-free survival (PFS), and 3-year PFS rate were 37 months, 64.4%, 31 months, and 40%, respectively. PFS and OS were significantly inferior in patients who presented with features of obstruction than in those who did not (P=0.0001). There was no difference in survival with respect to tumor histology (well to moderately differentiated vs. poorly differentiated, signet ring vs. non-signet ring histology) or location (proximal vs. distal). Survival was prolonged in patients with an early pathological T stage and a pathological node-negative status. In a multivariate analysis, postoperative pathological nodal status and gastric outlet obstruction on presentation significantly correlated with survival.
CONCLUSIONS
EOX chemotherapy with curative resection and D2 lymphadenectomy is a suggested alternative to the existing perioperative regimens. The acceptable postoperative complication rate and relatively high resection, chemotherapy completion, and survival rates obtained in this study require further evaluation and validation in a clinical trial.

Keyword

Epirubicin; Oxaliplatin; Capecitabine; Stomach neoplasms; Resection; Gastrectomy; Lymph node; Involved

MeSH Terms

Capecitabine*
Chemotherapy, Adjuvant
Cohort Studies
Disease-Free Survival
Drug Therapy*
Epirubicin*
Follow-Up Studies
Gastrectomy
Gastric Outlet Obstruction
Humans
Lymph Node Excision
Lymph Nodes
Multivariate Analysis
Postoperative Complications
Retrospective Studies
Stomach Neoplasms*
Survival Analysis*
Survival Rate
Capecitabine
Epirubicin

Figure

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  Fig. 1 Outline of study. NACT = neoadjuvant chemotherapy; EOX = epirubicin, oxaliplatin, and capecitabine.

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  Fig. 2 Overall survival: surgery vs. no surgery.

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  Fig. 3 Progression-free survival: surgery vs. no surgery.

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  Fig. 4 Progression-free survival: pathological T staging.

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  Fig. 5 Progression-free survival: pathological nodal status.

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