Evaluation of Outcome and Tolerability of Combination Chemotherapy with Capecitabine and Oxaliplatin as First Line Therapy in Advanced Gastric Cancer
Background: Combination chemotherapy is accepted as a high efficacy treatment for gastric cancer, whereas choice of standard treatment is unclear. Multiple chemotherapeutic regimens have been used to achieve higher efficacy and lower toxicity. This study was designed to evaluate the treatment results of advanced gastric cancer with Capecitabine and Oxaliplatin regimen.
Subjects and Methods: All cases with documented gastric adenocarcinoma and advanced disease were candidates for receiving Xelox regimen (Capecitabine – 750 mg/m2/twice daily/ 1-14 days and Oxaliplatin 125 mg/m2 in 1st day).
Results: Twenty five cases with advanced gastric cancer entered in study while 24 cases continued treatment protocol and were evaluated. Mean age was 59.5 ± 12.1 years (range: 20-75), male and female cases were 66.7% and 33.3%, respectively. All cases received at least four cycles of Xelox regimen. Overall response rate was 74.99% with 29.16% complete response. Overall survival rate was 13 ± 0.53 months and DFS (disease-free survival) was 6 ± 1.09 months. Extremities neuropathy (62.5%), headache (45.8%) and muscle cramps (29.2%) were the most common complains. Haematological changes were rare and 16.7% of cases had mild cytopenia. Treatment related death was not observed.
Conclusion: Xelox regimen is a safe and highly effective first line treatment for gastric cancer; however, considering it as first line therapy needs larger studies.
Sasako M, Inoue M, Lin JT, et al. Gastric Cancer Working Group report. Jpn J Clin Oncol. 2010; 40 Suppl 1: i28-37.
Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011; 61(2): 69-90.
Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2007. CA Cancer J Clin. 2007; 57(1): 43-66.
Forman D, Burley VJ. Gastric cancer: global pattern of the disease and an overview of environmental risk factors. Best Pract Res Clin Gastroenterol. 2006; 20(4): 633–49.
Taghdisi SM, Danesh NM, Sarreshtehdar Emrani A, et al. Targeted delivery of Epirubicin to cancer cells by PEGylated A10 aptamer. J Drug Target. 2013; 21(8):739-44.
Lee JL, Kang YK. Capecitabine in the treatment of advanced gastric cancer. Future Oncol. 2008; 4(2):179-98.
Cunningham SC, Schulick RD. Palliative management of gastric cancer. Surg Oncol. 2007; 16(4):267–75.
Wöhrer SS, Raderer M, Hejna M. Palliative chemotherapy for advanced gastric cancer. Ann Oncol. 2004; 15(11):1585–95.
Rivera F, Veqa-Villegas ME, Lo´pez-Brea MF. Chemotherapy of advanced gastric cancer. Cancer Treat Rev. 2007; 33(4):315-24.
Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol. 2003; 21(19):3665–75.
Mashhadi MA, Heidari Z, Zakeri Z. Mild hypomagnesemia as the most common Cisplatin nephropathy in Iran. Iran J Kidney Dis. 2013;7(1):23-7.
Miwa M, Ura M, Nishida M, et al. Design of a novel oral fluoropyrimidine carbamate, capecitabine, which generates5-fluorouracil selectively in tumours by enzymes concentrated in human liver and cancer tissue. Eur J Cancer. 1998; 34(8): 1274-81.
Schüller J, Cassidy J, Dumont E, et al. Preferential activation of capecitabine in tumour following oral administration in colorectal cancer patients. Cancer Chemother Pharmacol. 2000; 45(4): 291-7.
Hong YS, Song SY, Lee SI, et al. A phase II trial of capecitabine in previously untreated patients with advanced and/or metastatic gastric cancer. Ann Oncol. 2004; 15(9):1344-7.
Park YH, Ryoo BY, Choi SJ, et al. A phase II study of capecitabine and docetaxel combination chemotherapy in patients with advanced gastric cancer. Br J Cancer. 2004; 90(7): 1329-33.
Ma Y, Tang L, Wang HX, et al. Capecitabine for the treatment for advanced gastric cancer: efficacy, safety and ethnicity. J Clin Pharm Ther. 2012; 37(3): 266-75.
Park YH, Kim BS, Ryoo BY, et al. A phase II study of capecitabine plus 3-weekly oxaliplatin as first-line therapy for patients with advanced gastric cancer. Br J Cancer. 2006; 94(7): 959–63.
Woynarowski JM, Faivre S, Herzig MC, et al. Oxaliplatin-induced damage of cellular DNA. Mol Pharmacol. 2000; 58(5): 920-7.
Extra JM, Espie M, Calvo F, et al. Phase I study of oxaliplatin in patients with advanced cancer. Cancer Chemother Pharmacol. 1990; 25(4): 299-303.
Haghighi S, Kasbkar H, Esmaeilpour K, et al. Oxaliplatin, 5Fluorouracil and Leucovorin (FOLFOX4) as First Line Chemotherapy in Elderly Patients with Advanced Gastric Cancer. Asian Pac J Cancer Prevention. 2016; 17(7):3277-80.
Quek R, Lim WT, Foo KF, et al. Capecitabine and oxaliplatin (XELOX) is safe and effective in patients with advanced gastric cancer. Acta Oncol. 2007; 46(7):1032-4.
Park YH, Lee JL, Ryoo BY, et al. Capecitabine in combination with Oxaliplatin (XELOX) as a first-line therapy for advanced gastric cancer. Cancer Chemother Pharmacol. 2008; 61(4):623-9.
Yang T, Shen X, Tang X, et al. Phase II trial of oxaliplatin plus oral capecitabine as first-line chemotherapy for patients with advanced gastric cancer. Tumori. 2011; 97(4): 466-72.
Dong N, Jiang W, Li H, et al. Triweekly OxaliplatinPlus Oral Capecitabine as First-Line Chemotherapy in Elderly Patients With Advanced Gastric Cancer. Am J Clin Oncol. 2009; 32(6):559-63.
Wang Y, Yu YY, Li W, et al. A phase II trial of Xeloda and oxaliplatin (XELOX) neo‑adjuvant chemotherapy followed by surgery for advanced gastric cancer patients with para‑aortic lymph node metastasis. Cancer Chemother Pharmacol. 2014; 73(6): 1155-61.
Mashhadi MA. Evaluation of Response, Tolerability and Toxicity of New Chemotherapeutic Regimen in Advanced Gastric Cancer. Int J Hematol Oncol Stem Cell Res. 2009; 3(1):7-11.