P-0047 - Perioperative chemotherapy with folfox in resectable gastro-oesophageal adenocarcinoma: an AGEO multicentric retrospective study

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Anti-Cancer Agents & Biologic Therapy
Oesophageal Cancer
Gastric Cancer
Presenter Florence Mary
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors F. Mary1, M. Boubaya2, E. Samalin3, R. Coriat4, B. Bachet Jean5, D. Tougeron6, M. Benallaoua1, P. Afchain7, C. Locher8, I. Baumgaertner9, C. Lecaille10, T. Aparicio11, A. Zaanan12, D. Malka13, P. Artru14
  • 1Hôpital Avicenne, Bobigny/FR
  • 2hôpital Avicenne, Bobigny/FR
  • 3Centre Val d'Aurelle Paul Lamarque, Montpellier/FR
  • 4Hopital Cochin, Paris/FR
  • 5Groupe Hospitalier Pitié Salpétrière, Paris/FR
  • 6CHU Poitiers, Poitiers/FR
  • 7Hôpital Saint-Atoine, Paris/FR
  • 8Hôpital de Meaux, Meaux/FR
  • 9Hôpital Henri Mondor, Creteil/FR
  • 10Polyclinique Bordeaux Nord Aquitaine, Bordeaux/FR
  • 11Hopital Avicenne, Bobibny/FR
  • 12Hôpital European Georges Pompidou, Paris/FR
  • 13Institut Gustave Roussy, Villejuif/FR
  • 14Hôpital Privé Jean Mermoz, Lyon/FR

Abstract

Introduction

Perioperative 5-fluorouracile (5-FU) chemotherapy associated with cisplatin improves overall and recurrence-free survivals, the R0 resection rate, in resectable gastro-oesophageal junction and gastric adenocarcinoma. Association of 5-fluorouracil + oxaliplatin (FOLFOX) demonstrates efficacy in metastatic setting but has never been evaluated in perioperative setting. The aim of this retrospective multicentric study is to evaluate the feasibility, R0 resection rate, survival and tolerance of perioperative chemotherapy with FOLFOX.

Methods

We enrolled all the resectable gastric or gastro-oesophageal adenocarcinoma who had at least 3 cycles of pre-operative FOLFOX based regimen (oxaliplatin 85 to 100 mg/m2, 5-FU bolus 400 mg/m2, and 5-FU 2400 mg/m2 during 48 hours). The following data were collected: age, weight, height, Body Mass Index (BMI), Karnofsky index, toxicity, carcino-embryonic antigen (ACE), surgery R0, R1 or R2, recurrence and death. Overall and recurrence-free survivals were calculated with the Kaplan-Meyer method.

Results

We enrolled 109 patients in 12 centers. The median follow up after surgery was 19.7 months. There were 74 (66.67%) men, the median age was 66, and BMI 23.7 kg/m2. Gastro-oesophageal junction represented 28.3% (30 cases). We observed 35 single ringlet cell tumors in the 106 tumors evaluable. The median number of preoperative courses of chemotherapy was 4 (range 3-5) and 20 patients received 6 (18.3%) cures. After surgery the median number of chemotherapy courses was 2.5 (0-4) and 13 patients received 6 courses. In univariate analysis the Karnofsky index at inclusion was the only factor associated with the realization of 8 cures of chemotherapy. Grade 3-4 toxicity occurred in 14 (12.6%) patients with 11 patients before and 4 patients after surgery. The R0 rate was achieved in 102 patients (95.3%). The 5 year overall recurrence-free survivals were 42.8% and 35.0% respectively. The prognostic factors of overall survival were in univariate analysis: elevated ACE, Karnofsky index and the number of post surgery course of chemotherapy.

Conclusion

Folfox perioperative chemotherapy in gastric and gastro-oesophageal junction adenocarcinoma seems to be a good alternative to 5FU cisplatin in frail patients with few severe toxicities and the same efficacy. A 12 cycle treatment is rarely achievable, 8 cycles seems to be more feasible. This results need confirmation with a randomized prospective trial.