title: Phase II Trial of Paclitaxel/Cisplatin Followed by Surgery and Adjuvant Radiation Therapy and 5-Fluorouracil/Leucovorin for Gastric Cancer (ECOG E7296).
abstract: BACKGROUND
  Randomized trials have shown an increase in survival with perioperative chemotherapy as well as with postoperative chemoradiation. It was hypothesized that combining induction chemotherapy with postoperative chemoradiation would be well tolerated and improve pathologic complete response.
  
  
  METHODS
  Patients with resectable cancers of the stomach/gastroesophageal junction were eligible. Neoadjuvant chemotherapy consisted of 3 cycles of paclitaxel and cisplatin. Adjuvant therapy consisted of 1 cycle of 5-fluorouracil (FU) and leucovorin (LV) followed by chemoradiation (45 Gy with concurrent 5-FU/LV). Chemoradiation was followed by 2 additional cycles of 5-FU/LV. Response to neoadjuvant therapy was based on pathology.
  
  
  RESULTS
  From 1999 to 2002, 38 eligible patients were enrolled; 35 completed induction chemotherapy, and 29 went on to surgery. Sixteen patients did not develop metastatic progression, 10 developed metastatic disease, and 12 were unevaluable. There were no pathologic complete responses after induction therapy. Twenty-five of 38 patients suffered grade 3-4 toxicities during induction paclitaxel/cisplatin. Six of the 7 patients who received postoperative therapy suffered grade 3-4 toxicities. Only 3 of 38 (7.9%) eligible patients completed all assigned treatment. The median overall survival was 1.6 years, and the 2-year survival was 40%.
  
  
  CONCLUSIONS
  This regimen of neoadjuvant paclitaxel/cisplatin followed by postoperative 5-FU/LV-based chemoradiation did not have a high enough response rate and proved to be too toxic for further development.
authors.affiliation: Vanderbilt-Ingram Cancer Center Nashville, TN.
authors.forename: A Bapsi
authors.initials: AB
authors.lastname: Chakravarthy
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Catalano
authors.forename: Joshua K
authors.initials: JK
authors.lastname: Mondschein
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Haller
authors.forename: Richard
authors.initials: R
authors.lastname: Whittington
authors.forename: Francis R
authors.initials: FR
authors.lastname: Spitz
authors.forename: Henry
authors.initials: H
authors.lastname: Wagner
authors.forename: Elin R
authors.initials: ER
authors.lastname: Sigurdson
authors.forename: Loren K
authors.initials: LK
authors.lastname: Tschetter
authors.forename: Gerald K
authors.initials: GK
authors.lastname: Bayer
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson