Optimizing docetaxel chemotherapy in patients with cancer of the gastric and gastroesophageal junction

Abstract

Advanced gastroesophageal cancer patients are often treated with systemic combination chemotherapy. The V-325 study demonstrated that adding docetaxel (D) to a frequently used regimen of cisplatin and 5-fluorouracil (CF) provided benefits with regard to overall survival, response rate, time-to-disease progression, clinical benefit, and health-related quality of life. Although the DCF regimen provides these advantages, it is accompanied by an increase in toxicity compared with the doublet regimen. The toxicity profile of DCF is acceptable only with appropriately selected patients and comprehensive toxicity management strategies. The objective of the current review was to identify trials that investigated modifications to the original DCF regimen to improve its toxicity profile and summarize response rate and toxicities. An attempt was also made to summarize ongoing modifications of the DCF regimen. MEDLINE, major meeting proceedings, and the government clinical trials website were searched until 2007. The modified DCF regimens appear to improve the toxicity profile when compared with the original DCF regimen. The docetaxel-based triplet combinations appear to have a higher response rate than the doublet combinations. Many institutions and cooperative groups continue to study docetaxel-based modifications of the DCF regimen to treat patients with gastroesophageal carcinoma. However, although modified DCF reduces the frequency of severe toxicities previously reported with DCF, considerably more advances are needed to improve the safety, survival, and convenience of patients with advanced gastroesophageal cancer.

Safety and efficacy of bidirectional chemotherapy for treatment of patients with peritoneal dissemination from gastric cancer: Selection for cytoreductive surgery

“…On the other hand, response rate achieved in 71.4% (5/7). In addition, Ajani et al reported a excellent response rate (55.7%) of systemic DCF therapy combined with docetaxel 75 mg/m 2 on day 1 for 3 weeks, CDDP 75 mg/m 2 day 1 for 3 weeks, and 5FU 750 mg/m 2 day 1-5 for 3 weeks [12]. The dose of the docetaxel and CDDP per 1 course of DCF therapy is similar to those of the present study.…”

“…Recently, Ajani reported that DCF therapy (a combination chemotherapy using docetaxel, CDDP and 5FU) showed a significant better survival than CF (CDDP þ 5FU) therapy [12]. However, there has been no report to study the efficacy of systemic chemotherapy on patients with PC from gastric cancer.…”

A new angiogenesis prognostic index with VEGFA, PlGF, and angiopoietin1 predicts survival in patients with advanced gastric cancer

“…The disease stabilization rates in both trials are similar (66.7% vs. 67%). Our results and other reports with the DCF regimen suggest that along with their cytotoxic effects on gastric cancer the drugs in this combination might change the behavior of the disease, possibly by inhibition of angiogenesis, to improve the survival (21,22).…”

Bimonthly regimen of high-dose leucovorin, infusional 5-fluorouracil, docetaxel, and cisplatin (modified DCF) in advanced gastric adenocarcinoma

“…Cisplatin plus 5-fluorouracil (CF) and epirubicin plus CF (ECF) regimens have been investigated widely in clinical studies and were, until recently, presented as the reference regimens [2][3][4][5][6][7][8][9][10][11][12]. The activity of docetaxel in gastric cancer was first demonstrated in phase II single-agent studies: reported overall response rates (ORRs) were 16-24 % in the first-line setting [13][14][15][16][17]. The combination of docetaxel and cisplatin (DC) as a first-line chemotherapy was revealed to have a modest anti-tumor effect and manageable toxicity for the palliative treatment of AGC [18][19][20].…”

“…Despite a higher incidence of some toxicities as a result of the addition of docetaxel to CF, the quality-of-life results of the V325 trial consistently favored DCF over CF, supporting the benefit of DCF [25]. Following the results of the V325 trial, the DCF has become a new reference regimen in AGC [3,13]. However, the toxicity profile of the DCF regimen has contributed to the limitations of using this combination.…”