Efficacy of Different Number of XELOX or SOX Chemotherapy Cycles After D2 Resection for Stage III Gastric Cancer

Abstract

Purpose We aimed to explore whether the prognosis of patients treated with capecitabine and oxaliplatin (XELOX) or S-1 and oxaliplatin (SOX) regimens who received fewer cycles of chemotherapy after D2 radical resection for gastric cancer (GC) would be non-inferior to that of patients who received the standard number of cycles of chemotherapy. Materials and Methods Data on patients who received XELOX or SOX chemotherapy after undergoing D2 radical resection at Harbin Medical University Cancer Hospital between January 2011 and May 2016 were collected. Results In patients who received 4, 6, and 8 cycles of chemotherapy, the 5-year overall survival (OS) rates were 59.4%, 64.8%, and 62.7%, respectively. Compared to patients who received 4 cycles of chemotherapy, those who received 6 cycles (hazard ratio [HR], 0.882; 95% confidence interval [CI], 0.599–1.299; P=0.52) or 8 cycles (HR, 0.882; 95% CI, 0.533–1.458; P=0.62) of chemotherapy did not exhibit significantly prolonged OS. The 3-year disease-free survival (DFS) rate of patients who received 4, 6, and 8 cycles of chemotherapy was 62.1%, 67.2%, and 60.8%, respectively. Compared to patients who received 4 cycles of chemotherapy, those who received 6 cycles (HR, 0.835; 95% CI, 0.572–1.221; P=0.35) or 8 cycles (HR, 0.972; 95% CI, 0.606–1.558; P=0.91) of chemotherapy did not show significantly prolonged DFS. However, the 3-year DFS and 5-year OS rates of patients who received 6 cycles of chemotherapy appeared to be superior to those of patients who received 4 and 8 cycles of chemotherapy. Conclusions For patients with stage III GC, 4 to 6 cycles of XELOX or SOX chemotherapy may be a favorable option. This study provides a rationale for further randomized clinical trials.

Optimal Duration of Adjuvant Chemotherapy for Gastric Cancer: Might Less Be More?

“…In previous retrospective studies, six cycles of oxaliplatin-containing chemotherapy led to a favorable survival outcome, and an additional two cycles did not provide additional clinical benefit [ 10 11 12 ]. These results are comparable to those reported by Yu et al [ 9 ] in the Journal of Gastric Cancer . The results of these retrospective reports highlight the need for a prospective study examining strategies to shorten the duration of oxaliplatin-containing adjuvant chemotherapy in patients with resected gastric cancer.…”

“…The standard 6-month treatment period of adjuvant oxaliplatin-containing chemotherapy for gastric cancer is not based on the results of robust clinical trials, but rather than on clinical experience. In this issue of the Journal of Gastric Cancer , Yu et al [ 9 ] reported that gastric cancer patients who received 6 or 8 cycles of XELOX or SOX chemotherapy over a 21-day cycle did not show significantly prolonged survival compared to those who received four cycles of the same chemotherapy. However, patients who received 6 cycles had better overall survival than those who received 4 or 8 cycles of chemotherapy.…”

Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with gastric cancer

“… 47 , 48 , 50 The optimal number of cycles of CAPOX or SOX adjuvant ChT for patients with stage III GC after D2 resection is being investigated. 51 …”