Perioperative Epirubicin, Oxaliplatin, and Capecitabine Chemotherapy in Locally Advanced Gastric Cancer: Safety and Feasibility in an Interim Survival Analysis.
OBJECTIVE
Perioperative chemotherapy improves survival outcomes in locally advanced (LA) gastric cancer.


METHODS
We retrospectively analyzed patients with LA gastric cancer who were offered perioperative chemotherapy consisting of epirubicin, oxaliplatin, and capecitabine (EOX) from May 2013 to December 2015 at Tata Memorial Hospital in Mumbai.


RESULTS
Among the 268 consecutive patients in our study, 260 patients (97.0%) completed neoadjuvant chemotherapy, 200 patients (74.6%) underwent D2 lymphadenectomy, and 178 patients (66.4%) completed adjuvant chemotherapy. The median follow-up period was 17 months. For the entire cohort, the median overall survival (OS), 3-year OS rate, median progression-free survival (PFS), and 3-year PFS rate were 37 months, 64.4%, 31 months, and 40%, respectively. PFS and OS were significantly inferior in patients who presented with features of obstruction than in those who did not (P=0.0001). There was no difference in survival with respect to tumor histology (well to moderately differentiated vs. poorly differentiated, signet ring vs. non-signet ring histology) or location (proximal vs. distal). Survival was prolonged in patients with an early pathological T stage and a pathological node-negative status. In a multivariate analysis, postoperative pathological nodal status and gastric outlet obstruction on presentation significantly correlated with survival.


CONCLUSIONS
EOX chemotherapy with curative resection and D2 lymphadenectomy is a suggested alternative to the existing perioperative regimens. The acceptable postoperative complication rate and relatively high resection, chemotherapy completion, and survival rates obtained in this study require further evaluation and validation in a clinical trial.
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India .
Vikas
V
Ostwal
Department of Medicine, H.M. Patel Center for Medical Care and Education, Karamsad, Anand, Gujarat, India .
Arvind
A
Sahu
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India .
Anant
A
Ramaswamy
Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK .
Bhawna
B
Sirohi
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India .
Subhadeep
S
Bose
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India .
Vikas
V
Talreja
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India .
Mahesh
M
Goel
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India .
Shraddha
S
Patkar
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India .
Ashwin
A
Desouza
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India .
Shailesh V
SV
Shrikhande
Capecitabine; Epirubicin; Gastrectomy; Involved; Lymph node; Oxaliplatin; Resection; Stomach neoplasms