Docetaxel and cisplatin [DC] versus epirubicin, cisplatin and 5 fluorouracil [ECF] as systemic chemotherapy treatment for advanced gastric carcinoma [AGC]

ABSTRACT

Docetaxel and Cisplatin [DC] versus Epirubicin, Cisplatin and 5 fluorouracil [ECF] as Systemic Chemotherapy Treatment for Advanced Gastric Carcinoma [AGC]. Our study was performed to compare between DC and ECF combination chemotherapy as regard the clinical activity in terms of toxicity and response [primary objective] and the survival [secondary objective] trying to reach to a new effective and well tolerated regimen to improve the poor treatment results for palliative chemotherapy in advanced gastric cancer. Forty patients [pts] with AGC [unresectable and/or metastatic], bi-dimentionally measurable disease, performance status is >/= 70%, normal blood counts, hepatic and renal functions and no prior chemotherapy were randomized to receive DC [Docetaxel 75mg/m[2] dl and Cisplatin 75mg/m[2] dl] every 3w or ECF [Epirubicin 50mg/m[2] dl/3w and Cisplatin 60mg/m[2] dl/3w and 5 fluorouracil 200mg/m[2]/d continuous intravenous infusion for a total of 6 cycles for each regimen. The overall response was 45% for DC [n=9] [8 partial response + 1 complete response] and 30% for ECF [n=6] [all are partial responses]. Median time to progression was 7.0 months for DC and 5 months for ECF p=0.03. Median overall survival time was 10.5 months for DC and 8.5 months for ECF p=0.67. The most frequent G3 and 4 events per patient was neutropenia [DC=85%, ECF=30%]. Febrile neutropenia was recorded in 20% with DC versus 5% with ECF. Grade >/= 3 for other events with DC were anemia 15%, thrombocytopenia 10%, vomiting 10%, Diarrhea 10%, Stomatitis 0%, peripheral neuropathy 10% and lethargy 20% versus 5%, 5%, 20%, 20%, 10%, 0% and 5%, with ECF, respectively. There was no treatment related deaths. DC tends to be more effective in AGC with a higher response rate and better median time to progression and overall survival than ECF but with significantly higher neutropenia which was manageable. Use of primary prophylaxis with G-CSF is reasonably recommended