Neoadjuvant chemotherapy, post-operative chemoradiation too toxic in gastric cancer
2011 ASTRO Annual Meeting
MIAMI - A regimen of neoadjuvant paclitaxel and cisplatin followed by surgery and post-operative chemoradiation with 5-FU and leucovorin did not result in a high response rate and was too toxic for patients with gastric cancer.
Anuradha Bapsi Chakravarthy, MD, a radiation oncologist and associate professor at Vanderbilt-Ingram Cancer Center, and colleagues enrolled 38 patients with resectable cancers of the stomach/GE junction from 1999 to 2002 into the phase 2 trial.
Patients received induction chemotherapy that consisted of paclitaxel 175 mg/m2 and cisplatin 75 mg/m2 every 21 days for three cycles. After surgery, patients received 5-FU 425 mg/m2 and leucovorin 20 mg/m2 on days 1 through 5. This was followed by chemoradiation, including 5-FU 400 mg/m2 and leucovorin 20 mg/m2 on weeks 1 and 5 of radiation. Finally, the chemoradiation was followed by two additional cycles of 5-FU 425 mg/m2 and leucovorin 20 mg/m2 on days 1 through 5, every 28 days. The total radiation dose was 4,500 cGy.
Of the 38 patients, 35 completed all three cycles of induction therapy and 29 of those went on to surgery. The response was assessed by pathology, and was defined as complete response, progressive disease or stable disease. Of the 29 patients, 16 patients had stable disease, 10 progressed and three were unevaluable. Of the 29 patients who had surgery, 19 of the patients were unable to receive post-operative therapy due to either positive margins or progression.
The majority of patients experienced grade-3 or grade-4 toxicity during the induction therapy. Of the seven patients who received postoperative therapy, six experienced grade-3 and grade-4 toxicity.
For more information:
- Chakravarty A. #131. Presented at: the 2011 ASTRO Annual Meeting; Oct. 2-6, 2011; Miami Beach, Fla.
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