Modified chemotherapy advised for gastric cancer

Last Updated: 2015-10-13

By David Douglas

NEW YORK (Reuters Health) - Modifying the dose and administration schedule for docetaxel, cisplatin, and fluorouracil (mDCF) reduces toxicity in advanced gastric or gastroesophageal junction (GEJ) adenocarcinoma, according to new study results.

As Dr. Manish A. Shah told Reuters Health by email, "This multicenter randomized study demonstrates that there is a better way to give docetaxel, cisplatin, and fluorouracil - one that is less toxic and possibly more effective."

In a paper released October 5 by the Journal of Clinical Oncology, Dr. Shah, of Weill Cornell Medical College, New York City, and colleagues report on 85 previously untreated patients (median age, 58) who were randomly assigned to receive either the parent DCF regimen (docetaxel 75 mg/m2, cisplatin 75 mg/m2, and fluorouracil 750 mg/m2 IV over 5 days with granulocyte colony-stimulating factor, every 3 weeks) or the mDCF protocol (fluorouracil 2,000 mg/m2 IV every 48 hours, docetaxel 40 mg/m2 IV on day 1, cisplatin 40 mg/m2 IV on day 3, every 2 weeks) ).

Median follow-up overall was 19.5 months.

The parent DCF arm was closed after enrollment of 31 patients because of 71% grade 3 to 4 toxicity within the first three months. About half the patients required hospitalization. Over the course of treatment, the rate of grade 3 to 4 toxicity rose to 90% in this group.

In the 54 mDCF patients, there was 54% grade 3 to 4 toxicity (22% hospitalized) within the first three months and 76% grade 3 to 4 toxicity overall.

Progression-free survival in the first six months was 63% in the mDCF patients and 53% in DCF patients. The mDCF group also showed significantly greater median overall survival (18.8 versus 12.6 months, p=0.007).

Thus, concluded Dr. Shah, "The mDCF regimen should now be a new standard option for patients with advanced gastroesophageal cancers."

Sanofi-aventis supported this research. Four coauthors reported relevant relationships.

SOURCE: http://1.usa.gov/1LLSgfL

J Clin Oncol 2015.