Comparison Of FOLFOX And DOF Regimens As First-line Treatment In East Asian Patients With Advanced Gastric Cancer

Background and Purpose: Our study retrospectively assesses the safety and efficacy of the FOLFOX(oxaliplatin,fluorouracil,and leucovorin)versus DOF(docetaxel,oxaliplatin,and fluorouracil)regimens in untreated locally advanced gastric cancer(AGC).Methods: A total of 108 patients underwent DOF(N=58)and FOLFOX(N=50)regimens respectively.The end points were objective response rate(ORR),survival,and toxicity.Kaplan-Meir curve was used to estimate overall survival(OS)and progression-free survival(PFS)between the two groups,and Cox-regression for multivariate analysis.Results: The ORR was 50% for DOF and 30%for FOLFOX group(P<0.05),and the respective disease control rate(DCR)were 91.4% and 72%.Median PFS and OS in DOF group were significantly better compared with FOLFOX group(8.2 versus 6.4months,P<0.05;16.3 versus 11.2 months,P<0.001,respectively).Both groups showed acceptable level of toxicity,all grades and grade 3-4 had no significantly different(P=0.071;P=0.247).However,in the DOF group,the incidence of grade 3-4 peripheral neuropathy was significantly higher compared with FOLFOX(10.3% vs.2%,p<0.05).In the subgroup analysis,for elderly(?65 years)AGC patients,DOF also resulted in a significantly superior PFS(8.5 vs.5.9 months;P=0.038)and an OS(15.3 vs.9.8 months;P=0.004)compared with FOLFOX.However,FOLFOX had reduced toxicity than DOF.The triple combination was associated with more neutropenia(67%vs.30%;P<0.05),thrombocytopenia(61%vs.52%;P<0.05),and peripheral neuropathy(49% vs.22%;P<0.05).Conclusion: The data demonstrated that DOF was more effective than FOLFOX for patients with AGC,both in younger and elderly patients.The adverse effects of the two regimens were both manageable.The combination of docetaxel/oxaliplatin/ fluorouracil was a relatively active and well-tolerated regimen in patients with AGC and deserves further evaluation.As for elderly patients,the DOF group was associated with worse toxicities,therefore,the FOLFOX regimen might be a more suitable choice for the elderly patients with AGC.