Published online Feb 14, 2017. doi: 10.3748/wjg.v23.i6.1090
Peer-review started: October 24, 2016
First decision: October 28, 2016
Revised: December 19, 2016
Accepted: January 17, 2017
Article in press: January 17, 2017
Published online: February 14, 2017
To evaluate the feasibility of chemotherapy including fluoropyrimidine, platinum and taxane with modified dosages for unresectable gastric cancer in Japanese patients.
We performed a feasibility study of a modified docetaxel, cisplatin and capecitabine (DCX) regimen for stage IV gastric cancer. In particular, 30 or 40 mg/m2 of docetaxel on day 1, 60 mg/m2 of cisplatin on day 1, and 2000 mg/m2 of capecitabine for 2 wk were administered every three weeks.
Three patients were treated with modified DCX (mDCX) with 30 mg/m2 docetaxel, and five patients were treated with this regimen with 40 mg/m2 docetaxel. Grade 3 or 4 neutropenia was observed in six of the eight patients; no patients exhibited febrile neutropenia. Partial response was achieved in four of the eight patients. Three patients underwent gastrectomy, which achieved R0 resection without residual tumors in dissected lymph nodes. In one of these three patients, resected specimens revealed pathological complete response in the primary lesion and in lymph nodes.
mDCX was well tolerated by Japanese patients with stage IV gastric cancer. This regimen might be useful for allowing gastric cancer patients with distant lymph node metastasis to undergo conversion surgery.
Core tip: A combination of fluoropyrimidine and platinum is a standard treatment for unresectable gastric cancer. Although the addition of a taxane to this doublet is expected to improve effectiveness, research has demonstrated that such triplet regimens often cause adverse effects, including neutropenia. To reduce adverse events but maintain therapeutic effectiveness, we devised a triplet regimen with modified dosages. Modified docetaxel, cisplatin and capecitabine treatment was safe and effective for stage IV gastric cancer. Three of the eight treated patients underwent conversion surgery and achieved long-term survival without recurrence.