Modified Docetaxel and Cisplatin in Combination with Capecitabine (DCX) as a First-Line Treatment in HER2-Negative Advanced Gastric Cancer


Background: Docetaxel and cisplatin in combination with fluorouracil (DCF) regimen is accepted to be oneof the standard regimens in the treatment of advanced gastric cancer. However, substantial toxicity has limitedits use in daily clinical practice. Therefore, modification of DCF regimens, including introduction of capecitabinehas been investigated to improve the safety profiles. In the present study, the efficacy and toxicity of a regimenwith a modified dose of docetaxel and cisplatin in combination with oral capecitabine (DCX) was evaluated inuntreated patients with HER2-negative advanced gastric cancer. Materials and
Methods: Fifty-four patientswith HER2-negative locally advanced or metastatic gastric cancer were included in this cohort. Patients receiveddocetaxel 60 mg/m2 plus cisplatin 60 mg/m2 (day 1) combined with capecitabine 1650 mg/m2 (days 1–14) every3 weeks. Treatment response, survival, and toxicity were retrospectively analyzed.
Results: The median age was54 years (range: 24–76). The majority of patients (70%) had metastatic disease, while 11 patients (21%) hadrecurrent disease and underwent curative gastrectomy, and 5 patients (9%) had locally advanced disease (LAD).The median number of DCX cycles was 4. There were 28 partial responses and 11 complete responses, with anoverall response rate of 72%. Curative surgery could be performed in four patients among five with LAD. Atthe median follow-up of 10 months, the median progression-free survival (PFS) and overall survival (OS) of theentire cohort of patients were 7.4 and 12.1 months, respectively. Dose modification was done in 12 patients dueto toxicity in 8 and noncompliance in 4 patients. The most common hematological toxicity was neutropenia,which occurred at grade 3-4 intensity in 10 of 54 patients (27.7%). Febrile neutropenia was diagnosed only intwo cases.
Conclusions: DCX regimen offers prominent anti-tumor activity and considered to be effective firstlinetreatment with manageable toxicity for patients with HER2-negative advanced gastric cancer.