227P - Efficacy of conversional radical surgery following upfront docetaxel, oxalipaltin and S1 (DOS) regimen for advanced gastric cancer with a single no...

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Cytotoxic agents
Gastric Cancer
Surgical oncology
Presenter Yan Wang
Citation Annals of Oncology (2016) 27 (suppl_9): ix68-ix85. 10.1093/annonc/mdw582
Authors Y. Wang, Y. Yu, C. Yuehong, Q. li, J. Hou, Y. Ji, Y. Sun, Z. Shen, F. Liu, N. Zhao, T. Liu
  • Medical Oncology, Zhongshan Hospital, Fudan University, 200032 - Shanghai/CN

Abstract

Background

Palliative chemotherapy is still the standard of care for incurable advanced gastric cancer. Several retrospective, single institutional studies have shown that the addition of gastrectomy to chemotherapy might improve patient survival among patients with metastatic gastric cancer with a single non-curable factor. We assessed the effectiveness of conversional radical surgery following docetaxel, oxalipaltin and S1 therapy for advanced gastric cancer with a single non-curable factor.

Methods

This is a retrospective observational study. Patients with advanced gastric cancer with a single non-curable factor were performed upfront triplet regimen including docetaxel, oxalipaltin and S1. All patients received oral S-1 80 mg/m2 per day (80-120 mg/day total dose depending on the patient's body surface area as follows: 1.5 m2, 120 mg) on days 1-21 of every 3-week cycle, oxlipatin 100 mg/m2 on day 1 of every 3-week cycle and docetaxel 40 mg/m2 on day 1 of every 3-weeks cycle. Patients were assessed for response every 2 cycles by CT (computed tomography) scan. A multidisciplinary team reassessed resectability of primary site and metastatic site after 4 cycles. After R0 resection, adjuvant chemotherapy with the original regimen was initiated within 42 days of surgery for another 4 cycles and then S1 single agent till one year. Second-line treatment was recommended for the patients who had evidence of disease progress. The primary endpoint was the response rate. Secondary end points included the R0 resection rate, survival and adverse events.

Results

From November 2012 to Feb 2016, 45 patients were enrolled. The response rate was 31.1% (14 patients achieve partial response) and disease control rate was 91.1% (27 patients achieved stable disease and 4 patients had progressive disease). After 4 cycles of chemotherapy, 25 patients achieved radical surgery of primary and metastatic site and one patient whose disease progressed received palliative gastrectomy because of bleeding. All the patients achieving partial response received surgery except for one who refused. After a median follow-up of 10 months (range 3.4–45.8 months), 13 patients showed disease progression (3 in the surgery group and 10 in the non-surgery group) or relapse, and 7 patients died (2 in the surgery group and 5 in the non-surgery group). Patients in the surgery group had much longer progression-free survival (not reached vs. 7.9 mo, P = 0.000) and overall survival (not reached vs. 17.5 mo, P = 0.035) compared with the non-surgery group. The most common adverse events were gastrointestinal issues and leukocytopenia which were mild and tolerable.

Conclusions

For advanced gastric cancer patients with a single non-curable factor, conversional radical surgery of primary and metastasis sites following upfront DOS regimen showed survival benefit and could be a possible treatment strategy.

Clinical trial indentification

Legal entity responsible for the study

N/A

Funding

NSFC (Natural Science Foundation of China); Grant number: 81273187;NSFC (Natural Science Foundation of China); Grant number: 30972551;

Disclosure

All authors have declared no conflicts of interest.