For patients with advanced gastric cancer, chemotherapy can improve rates of overall survival. The combination of docetaxel, oxaliplatin, and capecitabine has shown to be a treatment regimen worth investigation.
Researchers sought to study this combination in patients with PS ECOG of 2 who were age 70 or older and had weight loss between 10% and 25%—these patients were defined as “suboptimal.” The researchers studied 43 patients with advanced gastric cancer who met “suboptimal” criteria who were previously untreated.
These patients received the “miniDOX” treatment regimen, which consisted of docetaxel 40 mg/m2 iv, day 1; oxaliplatin 80 mg/m2 iv, day 1; capecitabine 625 mg/m2 po bid, day 1 to day 21, every 21 days; after six courses, only capecitabine was maintained.
The primary endpoint of the study was response rate. Secondary study endpoints were overall survival, progression-free survival, and adverse events. Twelve patients has a PS ECOG of 2; 23 patients had weight loss between 10% and 25%; the median age of patients was 73.3 years (range 40-87; 28 patients were age 70 or older); 32 patients were male. Grade 3-4 adverse events included neutropenia (5 patients), febrile neutropenia (3 patients), pulmonary embolism (4 patients; 3 of which suffered sudden death), diarrhea (9 patients), paronychia (2 patients), ictus (1 patients), renal failure (1 patients, patient was diagnosed with infection/bacteriemia and died), hand-foot syndrome (4 patients), and asthenia (5 patients).
One patient experienced complete response, 23 patients experienced partial response (response rate: 56%). Three patients experienced disease progression. Median and 1-year progression-free survival was 5.5 months (18%) and overall survival was 13.3 months (52%).
The researchers concluded that toxicity associated with miniDOX was of concern but the treatment proved to be worthy of further research in patients with advanced gastric cancer who are classified as “suboptimal.”
The authors defined “suboptimal” pts as those with PS ECOG = 2, weight loss 10-25 % and/or age ≥70 years. This population is usually underrepresented in AGC clinical trials. Although miniDOX’s toxicity (mainly PE) has been important, its activity has been promising in “suboptimal” pts with AGC, and this combination should be further investigated in this setting.