Docetaxel-based chemo promising in stomach and esophageal cancer

Last Updated: 2016-11-02

By David Douglas

NEW YORK (Reuters Health) - Perioperative treatment with docetaxel-based triplet chemotherapy may beat anthracycline-based triplet chemotherapy in resectable gastric or gastro-esophageal junction adenocarcinoma, according to a randomized clinical trial.

As Dr. Salah-Eddin Al-Batran told Reuters Health by email, "Currently the majority of patients with cancer of the stomach and esophagus, even after resection, experience recurrence and finally die from this very malignant disease."

"In our study, which is phase II, but with 265 analyzed patients still a very large study," he added, "we observed a significant improvement in pathological regression using the new fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) regimen as compared to the epirubicin, cisplatin, and fluorouracil (ECF) or epirubicin, cisplatin, and capecitabine (ECX) regimen, which has been the current standard of care in the perioperative chemotherapy."

The findings were published online October 21 in The Lancet Oncology.

Dr. Al-Batran of the University Cancer Center in Frankfurt, Germany, and colleagues examined outcomes in 128 patients who had had up to eight cycles of FLOT and 137 who had had up to six cycles of ECF/ECX.

In a modified intention-to-treat analysis, FLOT was associated with a significantly higher proportion of pathological complete regression than was ECF/ECX (16% vs. 6%). In addition, more ECF/ECX patients had at least one serious adverse event involving a perioperative medical or surgical complication (40% vs. 25%).

Tumor regression was most frequent in patients with intestinal type tumors (18 of 112 patients) and least frequent in patients with diffuse type histology (two of 73 patients).

In fact, Dr. Al-Batran pointed out, "The increased benefit with FLOT was limited to the intestinal-type histology. In my opinion this finding is very interesting, because pathological regression is associated with better survival. The clinical implication is that FLOT might represent a more favorable therapy option for the patients who have an intestinal-type histology."

A phase III trial is ongoing. Dr. Al-Batran said that results are expected at the end of 2017 or "perhaps a little bit earlier."

In an accompanying editorial, Dr. Brian Badgwell and colleagues at The University of Texas MD Anderson Cancer Center, Houston, say that the findings "are limited in importance because data to document patient benefit associated with pathological complete regression or treatment group are not provided."

"However," they add, "we fully support the preoperative strategies for this patient population because these strategies compel experts from various disciplines to communicate and develop a consensus strategy before initiation of any therapy."

The authors reported no funding for the trial.

SOURCE: http://bit.ly/2fbWorS and http://bit.ly/2emG3lt

Lancet Oncol 2016.