title: DCF intraperitoneal and intravenous dual chemotherapy regimen for advanced gastric cancer: A feasibility study.
abstract: Gastric cancer is the fourth most common type of cancer globally and accounts for the second highest cancer-associated mortality rate in the world. Current treatment strategies for gastric cancer include surgery, radiotherapy, chemotherapy and targeted therapy. Intraperitoneal (IP) chemotherapy may increase the IP concentrations of chemotherapy drugs and reduce the systemic toxicity. At present, IP chemotherapy is used to treat patients with advanced gastric cancer, which has a high rate of peritoneal recurrence. The present study evaluated the feasibility of using docetaxel, cisplatin and fluorouracil (DCF) in an IP and intravenous (IV) dual chemotherapy regimen for the treatment of advanced gastric cancer. The treatment-associated adverse reactions and preliminary efficacy were reported. The first dose level utilized the full dose of DCF: Docetaxel, day one, 45 mg/m2 (IP) and day eight, 30 mg/m2 (IV); cisplatin (DDP), day one, 75 mg/m2 (IP); and fluorouracil (FU), days one to five, 750 mg/m2 (continuous IV). A total of six patients were treated at this level and two patients withdrew due to serious adverse reactions. Taking into account that the the tolerated doses used in combination regimens for Eastern populations are lower than that of the corresponding doses for Western populations, the dosages of the three drugs were all reduced by 20% in the application of the second dose level: Docetaxel, day one, 30 mg/m2 (IP) and day eight, 30 mg/m2 (IV); DDP, day two, 60 mg/m2 (IP); and FU, days one to five, 600 mg/m2 (continuous IV). A total of 26 patients were treated at this level. The main adverse reaction was bone marrow suppression, with grade III/IV neutropenia, leukopenia and febrile neutropenia accounting for 61.5, 53.8 and 19.2% of reactions, respectively, and grade III/IV anemia and thrombocytopenia accounting for 19.2 and 15.4% of reactions, respectively. Gastrointestinal adverse reactions primarily consisted of abdominal pain, with grade III/IV abdominal pain accounting for 30.8% of reactions. Only 7.7% of the patients withdrew from the treatment. The median time to progression (TTP) was five months [95% confidence interval (CI), 1.0-9.0 months], and the median overall survival (OS) was nine months (95% CI, 7.4-10.6 months). It was concluded that the DCF regimen with reduced dosage should be applied. IP and IV dual chemotherapy for the treatment of unresectable advanced gastric cancer is tolerated and demonstrated a good initial efficacy. Strategies for mitigating and reducing the adverse gastrointestinal reactions, particularly abdominal pain, may be the focus of future studies.
authors.affiliation: Department of General Surgery, North China Petroleum Bureau General Hospital of Hebei Medical University, Renqiu, Hebei 062552, P.R. China.
authors.forename: Zeng-Li
authors.initials: ZL
authors.lastname: Feng
authors.affiliation: Department of Ultrasound Radiology, North China Petroleum Bureau Youjian Hospital, Renqiu, Hebei 062552, P.R. China.
authors.forename: Liu-Bin
authors.initials: LB
authors.lastname: Chen
authors.affiliation: Department of Surgery, North China Petroleum Bureau Caiyi Hospital, Renqiu, Hebei 062552, P.R. China.
authors.forename: Zhen-Yu
authors.initials: ZY
authors.lastname: Liu
authors.affiliation: Department of Oncology, North China Petroleum Bureau General Hospital of Hebei Medical University, Renqiu, Hebei 062552, P.R. China.
authors.forename: Xue-Ji
authors.initials: XJ
authors.lastname: Chen
authors.affiliation: Department of Oncology, North China Petroleum Bureau General Hospital of Hebei Medical University, Renqiu, Hebei 062552, P.R. China.
authors.forename: Xiao-Can
authors.initials: XC
authors.lastname: Ren
authors.affiliation: Department of Oncology, North China Petroleum Bureau General Hospital of Hebei Medical University, Renqiu, Hebei 062552, P.R. China.
authors.forename: Yue-E
authors.initials: YE
authors.lastname: Liu
authors.affiliation: Department of Oncology, North China Petroleum Bureau General Hospital of Hebei Medical University, Renqiu, Hebei 062552, P.R. China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Peng
authors.affiliation: Department of General Surgery, North China Petroleum Bureau General Hospital of Hebei Medical University, Renqiu, Hebei 062552, P.R. China.
authors.forename: Hai-Gang
authors.initials: HG
authors.lastname: Wang
authors.affiliation: Department of General Surgery, North China Petroleum Bureau General Hospital of Hebei Medical University, Renqiu, Hebei 062552, P.R. China.
authors.forename: Shun-Mao
authors.initials: SM
authors.lastname: Ma
authors.affiliation: Department of General Surgery, North China Petroleum Bureau General Hospital of Hebei Medical University, Renqiu, Hebei 062552, P.R. China.
authors.forename: Feng-Jie
authors.initials: FJ
authors.lastname: Meng
authors.affiliation: Department of Oncology, North China Petroleum Bureau General Hospital of Hebei Medical University, Renqiu, Hebei 062552, P.R. China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Lin
keywords: cisplatin; docetaxel; dual chemotherapy; fluorouracil; gastric cancer; intraperitoneal chemotherapy