Clinical Observation Of MFLOT And MFOLFOX6 In The Treatment Of Advanced Or Locally Advanced Gastric Cancer

Objective: To explore the advantages of mFLOT(docetaxel + oxaliplatin + leucovorin + 5-FU)over mFOLFOX6(oxaliplatin + leucovorin +5-FU)in the treatment of advanced or locally advanced gastric cancer,and to guide clinical medication.To explore the efficacy and side effects of mFLOT in the treatment of advanced or locally advanced gastric cancer,and to provide a new direction and evidence for the chemotherapy of gastric cancer.Methods: A total of 80 patients diagnosed with advanced or locally advanced gastric cancer in the affiliated hospital of Qinghai university from September 2017 to May 2020 were collected in strict accordance with the inclusion criteria and exclusion criteria,all of whom were pathologically confirmed as gastric cancer.Eighty patients were divided into experimental group and control group according to random number method.Patients in the experimental group received chemotherapy with the mFLOT regimen consisting docetaxel(TXT)50mg/ m~2,2h;Oxaliplatin(L-OHP)85mg/m~2,2h;leucovorin9(LV)200mg/m~2,2h;5-FU(2400mg/m~2 as a 24 hr infusion),all given on day 1.This procedure was performed every 3 weeks.Another group of patients received an mFOLFOX6 regimen of 85mg/m~2 oxaliplatin and 400 mg/m~2 leucovorin administered as 2-h infusions on day 1 followed by a 400 mg/m~2 bolus of 5-FU with a 46-h infusion of 2400 mg/m~2 5-fluorouracil over days 1 and 2.The chemotherapy regimen was repeated once every 2 weeks until disease progression.Symptomatic supportive treatment such as preventive antiemetics can be given during chemotherapy,Dexamethasone was administered orally before and after treatment of docetaxel following the protocol to prevent fluid retention and allergic reactions.Prophylactic use of G-CSF and Any drugs that promotes thrombocyte were permitted if necessary.Results: 1.According to the evaluation standard of solid tumor curative effect,the short-term curative effect was evaluated,the DCR of mFLOT was 92.5%,higher than that of mFOLFOX6(85%),however,no statistically significant difference(P > 0.05).2.The median progression free survival(PFS)of mFLOT group and mFOLFOX6 group were 10 months and 6 months,respectively,with significant difference(P > 0.042),mFLOT regimen has certain advantages in extending progression-free survival of gastric cancer patients,and the median PFS is not lower than other chemotherapy regimens for gastric cancer.3.Comparing mFLOT group and mFOLFOX6 group with all patients receiving chemotherapy,the rate of surgery(R0 resection)was 60% and 37.5%,there was significant statistical differences between the data of two groups(P = 0.044),the mFLOT regimen can be used as a new neoadjuvant chemotherapy regimen for preoperative treatment of locally advanced gastric cancer.4.The main side effects of mFLOT regimen were neutropenia(45%),leucopenia(30%),Thrombocytopenia(10%)and anemia(7.5%),The percentage of neutropenia was significantly higher than that of mFOLFOX6 group(P = 0.012).There was no significant difference in non hematologic toxicity such as diarrhea,oral mucositis,nausea and vomiting and peripheral neurotoxicity between the two groups(P > 0.05).Conclusions: In the treatment of advanced or locally advanced gastric cancer,mFLOT is safe and reliable compared with m FLOFOX6,which had acceptable toxity in patients with GC,Significantly increased median progression-free survival and surgical rates,it is an effective treatment.mFLOT is a fresh chemotherapy regimen in GC patients with advanced or locally advanced gastric cancer and it is worthy of further promotion and as a first-line treatment used in clinical practice.