Efficacy of preoperative chemotherapy regimens in patients with initially unresectable locally advanced gastric adenocarcinoma: capecitabine and oxaliplatin (XELOX) or with epirubicin (EOX).
Purpose We assessed the effectiveness of EOX (capecitabine, oxaliplatin and epirubicin) compared with XELOX (capecitabine and oxaliplatin) as preoperative chemotherapy for initially unresectable locally advanced gastric cancer.Methods This is a prospective observational study. Patients with unresectable locally advanced gastric cancer were performed EOX regimen or XELOX regimen at the discretion of the investigators. They were assessed for response every 2 cycles by CT (computed tomography) scan. A multidisciplinary team reassessed resectability after 4 cycles. The primary endpoint was the response rate. Secondary end points included the R0 resection rate, survival and adverse events.Results From November 2008 to May 2015, 242 patients were enrolled; 112 of them were assigned to EOX regimen and 130 to XELOX regimen. The response rates were 33.0% and 33.8% respectively in EOX group and XELOX group (P = 0.997). After 4 cycles of chemotherapy, 63 patients (56.3%) in EOX group and 81 patients (62.3%) in XELOX group received radical operation (P = 0.408). There was no significant difference in progress-free survival (PFS, 12.0m vs. 15.4m, P = 0.925) and overall survival (OS, 25.7m vs. 29.0m, P = 0.783) in two groups. In addition, more adverse effects occurred in EOX group, such as more leucopenia (22.3% vs. 10.0%, P = 0.014), neutropenia (23.2% vs. 11.5%, P = 0.025), fatigue (11.6% vs. 3.8%, P = 0.041) and vomiting (10.7% vs. 2.3%, P = 0.015).Conclusions For unresectable locally advanced gastric cancer patients, XELOX regimen showed similar effects in response rate, radical resection rate and survival benefits, but with less toxicity effects.
Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Yan
Y
Wang
Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Rong-Yuan
RY
Zhuang
Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Yi-Yi
YY
Yu
Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
Shan
S
Yu
Department of Pathology, Fudan University, Zhongshan Hospital, Shanghai, China.
Jun
J
Hou
Department of Pathology, Fudan University, Zhongshan Hospital, Shanghai, China.
Yuan
Y
Ji
Department of General Surgery, Fudan University, Zhongshan Hospital, Shanghai, China.
Yi-Hong
YH
Sun
Department of General Surgery, Fudan University, Zhongshan Hospital, Shanghai, China.
Kun-Tang
KT
Shen
Department of General Surgery, Fudan University, Zhongshan Hospital, Shanghai, China.
Zhen-Bin
ZB
Shen
Department of General Surgery, Fudan University, Zhongshan Hospital, Shanghai, China.
Feng-Lin
FL
Liu
Department of Biostatistics and Social Medicine, School of Public Health, Fudan University, Shanghai, China.
Nai-Qing
NQ
Zhao
Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.|Center of Evidence-Based Medicine, Fudan University, Shanghai, China.
Tian-Shu
TS
Liu
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D000069287:Capecitabine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010071:Oxaloacetates; D011300:Preoperative Care; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
D010071:Oxaloacetates; D003841:Deoxycytidine; D015251:Epirubicin; D000069287:Capecitabine; D005472:Fluorouracil
locally advanced gastric cancer; preoperative chemotherapy; resection rate