A Phase II Study of Preoperative Chemotherapy With Modified FOLFOX6 Followed by Surgery and Postoperative Chemoradiation in Patients With Localized Gastric Adenocarcinoma

Abstract

The optimal neoadjuvant and adjuvant treatment for gastric cancer remains controversial. We conducted a phase II study using preoperative chemotherapy with modified FOLFOX6 followed by surgical resection and postoperative chemoradiation in patients with gastric carcinoma. Preoperative chemotherapy (two or three cycles) consisted of a 2-h infusion of oxaliplatin (100 mg/m2) and folinic acid (100 mg/m2) followed by a 46-h continuous infusion of 5-fluorouracil (5-FU; 2,400 mg/m2). Surgical resection was planned 4 weeks after the last chemotherapy cycle. Patients underwent postsurgical chemoradiation, receiving a total dose of 45 Gy and 5-FU continuous infusion (350 mg/m2/day). The primary end points were feasibility, overall response rate, and R0 resectability rate after preoperative chemotherapy. The secondary end points were tolerability, treatment-associated complications, disease-free survival, and overall survival. Nineteen patients were enrolled in this study. After neoadjuvant treatment, four patients (21.1%) experienced progressive disease, six patients (31.6%) showed partial remission, and nine patients (47.3%) showed stable disease. In 15 patients (78.9%) R0 resectability could be achieved. Eleven of these patients (73.3%) were able to undergo postoperative chemoradiation. Notably, eight (72.7%) of these patients were disease free and alive at median follow-up of 60 months. Chemotherapy associated neutropenia, neutropenic fever, and anastomotic dehiscence were observed. The combination of preoperative chemotherapy and postoperative chemoradiation is feasible in a significant subset of gastric cancer patients.

Comparison of FOLFOX and DOF regimens as first-line treatment in East Asian patients with advanced gastric cancer

“…During the last few decades, the FOLFOX (oxaliplatin, fluorouracil, and leucovorin) regimen has been reported to have considerable antitumor activity and tolerable toxicity in patients with AGC in several Phase II clinical trials. 20 – 23 Considering these findings, we substituted oxaliplatin for cisplatin in the DCF regimen and retrospectively compared the efficacy and toxicity of DOF versus FOLFOX regimens as the first-line treatment in patients with untreated locally AGC.…”

Curcumin Induces Apoptosis in SGC-7901 Gastric Adenocarcinoma Cells via Regulation of Mitochondrial Signaling Pathways

“…Chemotherapy is the main adjuvant treatment for postoperative and advanced gastric cancer therapy. Currently, platinum, 5-fuorouracil (5-FU), and taxanes are recommended as the first-line chemotherapy for the treatment of gastric cancer (Chen et al, 2013). However, the response rate of drug chemotherapy remains lower than 20% and the chemotherapeutics sometimes lead to severe toxicity at their therapeutic dose (Lorenzen et al, 2013).…”

Investigation of the potential role of preoperative chemotherapy in treatment for gastric cancer with outlet obstruction

“…In already published clinical trials regarding preoperative chemotherapy for gastric cancer patients, ORR varies from 27 to 74.4% (36)(37)(38)(39)(40)(41)(42)(43), DCR from 78.9 to 100% (37,38,40,41) and R0 resection rate from 59 to 90.7% (36)(37)(38)40,41,(43)(44)(45). In future trials on gastric cancer patients with GOO, if comparable outcomes can be achieved, it can be considered as promising results.…”