title: Neoadjuvant chemotherapy with FOLFOX: improved outcomes in Chinese patients with locally advanced gastric cancer.
abstract: BACKGROUND
  Although the role of peri-operative chemotherapy is established in the treatment of locally advanced gastric cancer, the optimal regime remains to be determined. FOLFOX has been used in palliative setting with good response rates but its role in a neoadjuvant setting is not well established.
  
  
  METHODS
  This is a prospective non-randomized study comparing peri-operative FOLFOX versus adjuvant FOLFOX in patients with resectable locally advanced gastric cancer. Response to chemotherapy was assessed according to WHO criteria and pathological changes. Kaplan-Meier log rank test was used to calculate and compare survival differences.
  
  
  RESULTS
  There were 73 patients (neoadjuvant = 36). Complete and partial response was observed in 2 (6%) and 21 (64%) patients, respectively. Four-year overall survival (OS) in the neoadjuvant arm was 78% versus 51% in the adjuvant arm (P = 0.031). Subgroup analysis found R0 resection (86% vs. 55%, P = 0.011) and patients with proximal cancers (87% vs. 14%, P < 0.001) to have improved OS. The most common side effect was grade 1-2 leukopenia. There were no grade 3 neuropathies, grade 4 cytopaenias, or treatment related deaths.
  
  
  CONCLUSIONS
  Peri-operative treatment with FOLFOX shows promise in patients with resectable locally advanced gastric cancer. It warrants further evaluation and should be considered an alternative to peri-operative ECF.
authors.affiliation: Department of Gastrointestinal Surgery, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China.
authors.forename: Zi-Yu
authors.initials: ZY
authors.lastname: Li
authors.forename: Cherry E
authors.initials: CE
authors.lastname: Koh
authors.forename: Zhao-De
authors.initials: ZD
authors.lastname: Bu
authors.forename: Ai-Wen
authors.initials: AW
authors.lastname: Wu
authors.forename: Lian-Hai
authors.initials: LH
authors.lastname: Zhang
authors.forename: Xiao-Jiang
authors.initials: XJ
authors.lastname: Wu
authors.forename: Qi
authors.initials: Q
authors.lastname: Wu
authors.forename: Xiang-Long
authors.initials: XL
authors.lastname: Zong
authors.forename: Hui
authors.initials: H
authors.lastname: Ren
authors.forename: Lei
authors.initials: L
authors.lastname: Tang
authors.forename: Xiao-Peng
authors.initials: XP
authors.lastname: Zhang
authors.forename: Ji-You
authors.initials: JY
authors.lastname: Li
authors.forename: Ying
authors.initials: Y
authors.lastname: Hu
authors.forename: Lin
authors.initials: L
authors.lastname: Shen
authors.forename: Jia-Fu
authors.initials: JF
authors.lastname: Ji
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002955:Leucovorin; D005472:Fluorouracil