A Retrospective Study of the Safety and Efficacy of a First-Line Treatment with Modified FOLFOX-4 in Unresectable Advanced or Recurrent Gastric Cancer Patients

Abstract

Aim: Dismal clinical results in patients with unresectable advanced or recurrent gastric cancer highlight the need for effective systemic chemotherapy. An increase in adverse events associated with systemic chemotherapy is shown in elderly patients, but it remains controversial whether they should receive the same chemotherapy used for younger patients. We retrospectively studied 73 patients with unresectable advanced or recurrent gastric cancer, including 48 nonelderly patients (<65 years old) and 25 elderly patients (≥65 years old) who received a combination of oxaliplatin, 5-fluorouracil and leucovorin (modified FOLFOX-4, mFOLFOX-4 regimen). Patients and Methods: From January 2006 to June 2011, 73 patients with histologically confirmed unresectable advanced or recurrent gastric cancer were enrolled in this study. All patients were treated with an mFOLFOX-4 regimen of 85 mg/m² of oxaliplatin and 200 mg/m² of leucovorin on the first day, followed by a 24-hour continuous infusion of 1,000 mg/m² of 5-fluorouracil in 2 days with a 2-week interval. Treatment continued until disease progression or intolerable adverse events occurred. Results: Overall response rates show clinical efficacy (41.1%, 30/73 patients), stable cancer (26.0%, 19/73 patients) and progressive cancer (32.9%, 24/73 patients). The response rate was 36.0% in the elderly group and 43.8% in the nonelderly group (p = 0.891). In elderly patients, the overall time to progression was 8.1 months and the median overall survival was 11.9 months. On the other hand, in nonelderly patients, the overall time to progression was 7.9 months (p = 0.483) and the median overall survival was 11.2 months (p = 0.953). The results show no statistical differences in efficacy and adverse events between elderly and nonelderly groups (all p > 0.05). Conclusion: The mFOLFOX-4 therapy is an effective and safe first-line treatment for unresectable advanced or recurrent gastric cancer patients. Moreover, mFOLFOX-4 was well tolerated and effective in both nonelderly and elderly patients.

Efficacy and Safety of Docetaxel or Epirubicin, Combined with Cisplatin and Fluorouracil, (DCF and ECF) Regimens as First Line Chemotherapy for Advanced Gastric Cancer: a Retrospective Analysis from Turkey

“…The most common grade 3-4 toxicity was neutropenia (41%) in that trial wheras 9,1 and 16,7 in ECF and DCF group respectively in our study (Louro et al, 2013). Yeh et al showed that FOLFOX has 11,2 months median OS in first line setting in advanced or recurrent gastric cancer (Yeh et al, 2012). The result of our study was correlated with literature.…”

Comparative analysis of the efficacy and safety of modified FOLFOX-6 and DCF regimens as first-line treatment in advanced gastric cancer

“…In numerous phase II studies, combination chemotherapy with 5-FU, folinic acid (leucovorin; LV) and oxaliplatin (FOLFOX regimens), has exhibited considerable antitumor activity and a tolerable toxicity profile in AGC patients using different doses and schedules (10)(11)(12)(13)(14).…”

Advanced Gastric Cancer with Liver and Lymph Node Metastases Successfully Resected after Induction Chemotherapy with Docetaxel, Cisplatin and 5-Fluorouracil

“…In a study analyzing 643 patients enrolled in 5 separate chemotherapy trials by the Japanese Clinical Oncology Group, the 5-year survival for patients with metastasis confined to the liver and treated with systemic therapy alone was 1.7% [17]. Palliative chemotherapy using various regimens has been widely used as a treatment of choice, but only modest improvements in overall survival have been observed, with the median survival increasing from approximately 3 months to 7-15 months; long-term survival is rarely reported [18,19]. In particular considering the few trials evaluating systemic chemotherapy in the subset of patients with liver-only metastatic involvement, the 5-year survival rates do not reach 2% [20].…”