First Line Treatment for Advanced Gastroesophageal Cancer: Capecitabine Plus Oxaliplatin (CAPOX) versus Epirubicin, Oxaliplatin Plus Capecitabine (EOX)

Abstract

Chemotherapy is the mainstay of treatment for advanced gastroesophageal cancer (AGC). There is no consensus whether doublet or triplet chemotherapy is better. Hence our study aimed to compare CAPOX (capecitabine and oxaliplatin) with EOX (epirubicin, oxaliplatin plus capecitabine) as first line treatment for AGC. From December 2012 to July 2014, total of 69 patients were randomly assigned; 35 to EOX arm (epirubicin 50 mg/m 2 on day1, capecitabine 625 mg/m 2 twice daily for 21 day and oxaliplatin 130 mg/m 2 on day1 three weekly for 8 cycle) and 34 to CAPOX arm (capecitabine 1000 mg/m 2 twice daily for 14 days and oxaliplatin 130 mg/m 2 on day 1 in a three weekly cycle for 8 cycle). Median age at diagnosis was 55 years. The median number of chemotherapy cycle delivered was 7.45% completed planned treatment. 63.8% patient needed dose modification and 33.3% had treatment discontinuation due to grade 3/4 toxicity. Incidence of grade 3/4 neutropenia was significantly more in EOX where as diarrhoea and vomiting were more in CAPOX group. The ORR (overall response rate) was 63% in the entire cohort and 54.5% and 71.4% in the CAPOX and EOX group respectively. Median follow up was 15.2 month. Median OS (overall survival) was 8.1 and 10.3 months in the CAPOX and EOX groups respectively; p=0.298, however there was a trend favouring PFS (progression free survival) in the EOX group (5.5 vs. 8.3 months in CAPOX and EOX respectively; p=0.06). No significant difference was observed between the two regimens with respect to ORR, PFS and OS. Doublet chemotherapy regimen (CAPOX) has similar efficacy as a triplet regimen (EOX), however, with higher incidence of gastrointestinal toxicity.