Bax predicts outcome in gastric cancer patients treated with 5-fluorouracil, leucovorin, and oxaliplatin palliative chemotherapy.
BACKGROUND
Platinum and 5-fluorouracil (5-FU)-based regimens have been used the most frequently in palliative chemotherapy for gastric cancer. The present study evaluated the prognostic significance of Bax, excision repair cross-complementation group 1 (ERCC1), and thymidylate synthase (TS) in advanced gastric cancer patients treated with 5-FU, leucovorin, and oxaliplatin (FOLFOX) palliative chemotherapy.


METHODS
Seventy-two patients with metastatic or recurrent gastric cancer were treated with FOLFOX regimen. Pretreatment tumor biopsy specimens were analyzed for Bax, ERCC1, and TS expression by immunohistochemistry.


RESULTS
High expression of Bax, ERCC1, and TS was observed in 31 (43%), 33 (46%), and 35 (49%) patients, respectively. The median overall survival (OS) of patients was 12 months. Low expression of Bax was associated with poor OS (median, 9 months vs. 18 months; 2-year, 10% vs. 48%; p=0.0005) in univariate analysis, while expression of ERCC1 and TS was not correlated with patient outcome. In multivariate analysis, low expression of Bax was a significant independent predictor of poor OS (p=0.028). Low expression of Bax was significantly associated with poor survival of patients with metastatic or recurrent gastric cancer treated with FOLFOX chemotherapy.


CONCLUSIONS
Immunohistochemical staining for Bax with pretreatment biopsy specimen may be useful in selecting FOLFOX regimen as a treatment option for advanced gastric cancer patients.
Jeong
Seong Hyun
SH
Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, 443-721, Republic of Korea.
Han
Jae Ho
JH
Kim
Jang Hee
JH
Ahn
Mi Sun
MS
Hwang
Yoon Ho
YH
Lee
Hyun Woo
HW
Kang
Seok Yun
SY
Park
Joon Seong
JS
Choi
Jin-Hyuk
JH
Lee
Kwang Jae
KJ
Sheen
Seung Soo
SS
Lim
Ho-Yeong
HY
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism; D001706:Biopsy; D004268:DNA-Binding Proteins / Q000378:metabolism; D004720:Endonucleases / Q000378:metabolism; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005753:Gastric Mucosa / Q000378:metabolism; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism*; D013940:Thymidylate Synthase / Q000378:metabolism; D016896:Treatment Outcome; D051028:bcl-2-Associated X Protein / Q000378:metabolism*
D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; D009944:Organoplatinum Compounds; D051028:bcl-2-Associated X Protein; D013940:Thymidylate Synthase; C071447:ERCC1 protein, human; D004720:Endonucleases; D002955:Leucovorin; D005472:Fluorouracil