Paclitaxel combined with oxaliplatin as first-line chemotherapy for locally advanced or metastatic gastric cancer

Abstract

Purpose: This retrospective study was designed to evaluate the efficacy and safety of Paclitaxel (PTX) combined with Oxaliplatin (OXA) as first-line chemotherapy for locally advanced or metastatic gastric cancer (AGC). Methods: Untreated patients with histologically confirmed AGC who received PTX at 135 mg/m² and OXA at 85 mg/m² every 2 weeks were studied. Antitumor activity was assessed by imaging and toxicities were evaluated. Results: Thirty-nine (39) patients were enrolled. With 9.83 months median time of follow-up, 1 year OS rate was 42.0%. Complete response, partial response, stable disease and progressive disease was 2.6, 66.7, 17.9 and 12.0% respectively, the overall response rate was 69.2%. The mPFS was 8.5 months and the mOS 14.4 months. Grade 3/4 of toxicities included neutropenia (38.5%), febrile neutropenia (20.5%), vomiting (7.7%) and hypertransaminasemia (7.7%). Grade 2 peripheral neuropathy occurred in 33.3% patients. Conclusions: The combination of PTX combined with OXA is an active and safe regime for AGC and has a high overall response rate.

Keywords:

• advanced gastric cancer
• chemotherapy
• first-line
• oxaliplatin
• paclitaxel

Acknowledgements

The authors thank Yao Wang for his assistance in statistical analysis.

Financial & competing interests disclosure

The work was supported by science and technology key projects of Fujian Province Development and Reform Commission 2013YZ0201. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Currently, the optional first-line doublets treatment for locally advanced or metastatic gastric cancer (AGC) is fluorouracil-based regimen, including fluoropyrimidine (fluorouracil, capecitabine or S-1) with platinum (cisliain or oxaliplatin [OXA]), fluoropyrimidine with irinotecan. Alternative doublet chemotherapy regimen is taxane-containing combinations, which consist of paclitaxel and cisplatin, docetaxel and cisplatin or docetaxel and irinotecan.

• Paclitaxel (PTX) is a cell-cycle-specific agent and OXA is a non-cell-cycle-specific agent, so the paclitaxel and oxaliplatin combination (PTX plus OXA) may be a reasonable doublet regimen for AGC.

• In this study, we showed that the combination of PTX combined with OXA was an active and safe first-line regime for AGC and had a high ORR.

• Grade 3/4 neutropenia was the leading cause of dose reduction and delay, and neurotoxicity was another side effect we should be aware of, which cause treatment discontinued without PD.

• Special attention should be paid to hypersensitivity, especially for those who have received OXA-containing adjuvant chemotherapy and for whom the cumulative dose of OXA had reached 600–700 mg/m².

• Patients with low histologically differentiated tumors has shorter PFS compared to those with moderately and well-differentiated tumors, and with ascites associated with shorter OS time.

Notes