Clinical Comparison Of Capecitabine Combined With Docetaxel And L-OHP+5-FU/CF In Treating Advanced Gastric Cancer

Objective:Gastric cancer is the one of most common cancers, chemotherapy has a important role in the treatment of Gastric cancer, especially for the patients unsuitable for operation.Despite the numerous efforts of randomized studies on advanced gastric cancer, no standard chemotherapy regimen has yet been established. Capecitabine and docetaxel, which have distinct mechanisms of action and toxicity profiles, have each shown high activity as single agents in gastric cancer.Synergistic interaction between these two drugs was suggested by taxane induced upregulation of thymidine phosphorylase. We, therefore, evaluate the efficacy, time to progression (TTP) and toxicities between capecitabine combined with docetaxel and oxaliplatin (L-OHP) combined with 5-FU/CF in the treatment for advanced gastric cancer.Methods:61 patients with pathologically confirmed advanced gastric cancer were enrolled in 1st Affiliated Hospital of Dalian Medical University from Jun 2003 to Dec 2006.31 cases of advanced gastric cancer were assigned to the study group(SG)and treated with capecitabine (1 250 mg/㎡,po,twice a day,14 days totally)and docetaxel(35-70mg/㎡,ivgtt,day l and 8).Repeated every 3 weeks.Other 30 cases were allocated to the control group (CG)and treated with oxaliplatin (100 mg/㎡ ,ivgtt,day1)+5-FU(400 mg/㎡ ,bolus,day1,2),5-FU(600mg/㎡ ,civ,day1,2)+CF(200mg/㎡ ,iv, day1,2). Repeated every 2 weeks.The efficacy were evaluated according to RECIST (response evaluation criteria in solid tumor) and safety according to NCI-CTCAEv3.0 (common terminology criteria of adverse events v3.0). Survival analysis was performed using Kaplan-Meier method and log-rank test and P< 0.05 was considered as significant by software of SPSS16.0.Results:57 patients could be evaluated for the efficacy.The total response rate in SG was58.6% (16/29).Median Time to Progress was 5.5 months.The overall response rate in CG was 32.1% (9/28),with one CR and eight PRs.In SG,the main toxicity was myelosupression (67.7%),includingⅢ-Ⅳgrade neutropenia(25.8%).32.25% of the patients developed hand-foot syndrome.In CG,the toxicity was myelosupression(50%) and 53.3% peripheral neuritis.Conclusions:1.Capecitabine combined with docetaxel was an effective in the treatmean of advanced gastric cancer can prolong time to progression (TTP).2.The main adverse events include diarrhea,nausea,leucopenia, hand- foot syndrome,and all of patients are well-tolerated.So we advise to take the capecitabine combined with docetaxel as one of chemotherapeutic schemes for the advanced gastric cancer.3.The capecitabine can be taken orally,conveniently and safely,gives a similar effect to the 5-FU injection,and avoiding the adverse effects of central venous catheterization.