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Abstract
Background/Aims
We retrospectively analyzed comparative toxicities and efficacies of chemotherapy regimens in advanced gastric cancer (AGC) patients who achieved complete response (CR) after chemotherapy.
Methods
We reviewed the medical records of 1,203 patients, who were pathologically diagnosed as AGC in a single center between January 2001 and October 2007. On the basis of the Response Evaluation Criteria in Solid Tumors, CR was evaluated with abdominal computed tomography. Toxicities were evaluated using the National Cancer Institute's common toxicity criteria before each chemotherapy cycle.
Results
Among the 1,203 AGC patients enrolled in this study, 568 received chemotherapy and 635 received best supportive care. The major chemotherapy regimens were 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX), docetaxel, cisplatin and 5-fluo-rouracil (DCF) and 5-fluorouracil, leucovorin and irinotecan (FOLFIRI). Among the 568 patients, 51 (9.0%) achieved CR (49 [8.6%] with FOLFOX [n=12], DCF [n=26], or FOLFIRI [n=11] and 2 [0.3%] with etoposide, leucovorin and 5-fluorouracil). For patients administered FOLFOX, DCF, and FOLFIRI, the median time to disease progression was 4 months (range, 1.8–59.5), 15 months (range, 2.9–31.2) and 10 months (range, 2.0–39.5), and the median survival times were 48 months (range, 5.9–74.0), 37 months (range, 14.0–86.0), and 30 months (range, 6.0–50.0), respectively. Grades 3–4 mucositis occurred mostly in patients administered DCF (n=8, 30.8%). Grades 3–4 leucopenia were observed in 1 (8.3%), 11 (42.3%), and 4 (36.4%) patients administered FOLFOX, DCF and FOLFIRI, respectively. No statistically significant differences were observed in the 3 regimens.
References
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Fig. 1.
Distribution of enrolled patients. Complete response was observed in 51 patients. Of these 51 patients, 2 were treated etoposide, leucovorin and 5-fluorouracil (ELF); therefore, we enrolled the remaining 49 patients who were treated with 5-fluorouracil- leucovorin-oxaliplatin (FOLFOX), docetaxel-cisplatin-5-fluorouracil (DCF) and 5-fluorouracil-leucovorin-irinotecan (FOLFIRI). AGC, advanced gastric cancer.
Fig. 2.
Survival rates of patients according to regimens. Statistical difference among in 1-year survival rates (p=0.035), but no difference in 3-year survival rates was observed among the 3 regimen groups. FOLFOX, 5-fluorouracil-leucovorin-oxaliplatin; DCF, docetaxel-cisplatin-5-fluorouracil; FOLFIRI, 5-fluorouracil-leucovorin-irinotecan.
Fig. 3.
Comparison of the toxicities of chemotherapy regimens. No statistical difference was observed among the 3 regimen groups. FOLFOX, 5-fluorouracil-leucovorin-oxaliplatin; DCF, docetaxel-cispla-tin-5-fluorouracil; FOLFIRI, 5-fluorouracil-leucovorin-irinotecan.
Table 1.
Baseline Characteristics of the Patients with Complete Response
| FOLFOX (n=12) | DCF (n=26) | FOLFIRI (n=11) | p-value | |
|---|---|---|---|---|
| Age (yr) | 51 (41–77) | 58 (35–75) | 51 (37–75) | 0.368 |
| Sex (male： female) | 10：2 | 8：18 | 5：6 | 0.303 |
| Follow-up (months) | 36 (6–74) | 39 (14–86) | 30 (8–50) | |
| Prior surgery | 0.919 | |||
| None | 0 (0.0) | 1 (3.8) | 0 (0.0) | |
| Subtotal | 5 (41.7) | 10 (38.5) | 4 (36.4) | |
| Total | 7 (58.3) | 15 (57.5) | 7 (63.6) | |
| Pathological stage | 0.566 | |||
| Ib | 0 (0.0) | 1 (3.8) | 0 (0.0) | |
| II | 1 (8.3) | 2 (7.7) | 1 (9.1) | |
| IIIa | 2 (16.6) | 3 (11.5) | 2 (18.2) | |
| IIIb | 3 (25.0) | 4 (15.4) | 0 (0.0) | |
| IV | 6 (50.0) | 16 (61.5) | 8 (72.7) | |
| R0/R1/R2 resection | 0.062 | |||
| R0 | 11 | 23 | 6 | |
| R1 | 1 | 3 | 5 | |
| R2 | 0 | 0 | 0 | |
| Borrhman type | 0.331 | |||
| B1 | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
| B2 | 7 (58.3) | 10 (38.5) | 5 (45.5) | |
| B3 | 5 (42.7) | 11 (42.3) | 4 (36.4) | |
| B4 | 0 (0.0) | 5 (19.2) | 2 (18.2) | |
| Location of cancer a | ||||
| Antrum | 3 (25.0) | 10 (38.5) | 2 (18.2) | |
| Body | 7 (58.3) | 17 (65.4) | 3 (27.3) | |
| Cardia | 2 (16.7) | 1 (3.8) | 2 (18.2) | |
| Angle | 2 (16.7) | 3 (11.5) | 1 (9.1) | |
| Histologic classification | ||||
| Adenocarcinoma | 11 | 24 | 9 | |
| Signet ring cell type | 0 | 0 | 1 | |
| Other type | 1 | 2 | 1 | |
| CEA level before Tx | ||||
| Elevation | 1 | 2 | 2 | |
| Normal range | 5 | 17 | 9 | |
| Not checked | 6 | 7 | 0 | |
| Prior chemotherapy | ||||
| Yes | 0 | 0 | 0 | |
| No | 12 | 26 | 11 |
Table 2.
Comparisons of Toxicity according to Chemotherapy Regimens
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