Purpose: This study was designed to assess the effectiveness of FLEEOX (5-Fu, leucovorin, etoposide, oxaliplatin, and epirubicin) compared with XELOX (capecitabine and oxaliplatin) as neoadjuvant chemotherapy (NAC) for initially unresectable advanced gastric cancer (AGC).
Methods: This study reviewed patients who underwent FLEEOX or XELOX for initially unresectable AGC. To reduce the bias in patient selection, we conducted propensity score match (PSM) with 1:1 ratio. Tumor and pathological response, surgical characteristics, chemotherapy-related toxicity and overall survival (OS) were analyzed.
Results: From January 2004 to December 2012, 436 patients were enrolled; 99 pairs of patients were generated after PSM. The tumor response rates were 80.8% and 68.7% in FLEEOX and XELOX (=0.018). 80 patients (80.8%) in FLEEOX and 63 (63.6%) in XELOX received radical resection (<0.001). The pathological complete response rate and R0 rate were 11.1% and 69.7% in FLEEOX, respectively, while 4.8% and 38.4% in XELOX (<0.001). Median OS time was longer in FLEEOX (30.0 vs. 25.1 months, <0.001). In addition, more toxicities occurred in FLEEOX, including leukocytopenia (17.2% vs. 7.1%, =0.024), nausea (17.2% vs. 6.1%, =0.012) and vomiting (22.2% vs. 10.1%, =0.016). The overall toxicity rate was higher in FLEEOX (71.7% vs. 35.4%, <0.001).
Conclusion: The FLEEOX regimen as NAC for patients with initially unresectable AGC can improve tumor response rate, radical resection rate, R0 rate, and OS as compared to XELOX regimen. More chemotherapy-related toxicity was observed in FLEEOX group, although no chemotherapy-related deaths and aborting were observed. Further randomized clinical trials on the FLEEOX regimen are necessary.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689733 | PMC |
http://dx.doi.org/10.18632/oncotarget.19004 | DOI Listing |
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