Multicenter randomized phase II study of cisplatin and fluorouracil plus docetaxel (DCF) compared with cisplatin and fluorouracil plus Adriamycin (ACF) as preoperative chemotherapy for resectable esophageal squamous cell carcinoma (OGSG1003)

BACKGROUND

This phase II trial evaluated the efficacy of cisplatin and fluorouracil (CF)-based combination neoadjuvant chemotherapy on the outcome of patients with resectable locally advanced esophageal squamous cell carcinoma (ESCC). We compared the recurrence-free survival (RFS) associated with CF plus Adriamycin (ACF) with that associated with CF plus docetaxel (DCF) to select an alternative regimen in a new phase III trial investigating the optimal neoadjuvant treatment of patients with ESCC.

PATIENTS AND METHODS

Patients with resectable advanced ESCC were randomly assigned to either ACF (Adriamycin 35 mg/m2, cisplatin 70 mg/m2 i.v. on day 1, fluorouracil 700 mg/m2 continuous infusion for 7 days) every 4 weeks or DCF (docetaxel 70 mg/m2, cisplatin 70 mg/m2 i.v. on day 1, fluorouracil 700 mg/m2 continuous infusion for 5 days) every 3 weeks. Surgery was scheduled after completion of two cycles of chemotherapy. The primary end point was RFS, analyzed by the intention-to-treat.

RESULTS

Between October 2011 and October 2013, 162 patients at 10 institutions were enrolled in the study, all of whom were eligible and randomly assigned to the two groups (81 to the ACF group and 81 to the DCF group). The R0 resection rates for the ACF and DCF groups were equivalent (95.9% versus 96.2%, P = 0.93). The 2-year RFS and overall survival rates for DCF versus ACF were 64.1% versus 42.9% (hazard ratio 0.53, 95% confidence interval 0.33-0.83, P = 0.0057) and 78.6% versus 65.4% (P = 0.08), respectively.

CONCLUSION

Compared with ACF, DCF chemotherapy was associated with prolonged RFS for patients with resectable advanced ESCC. Thus, DCF chemotherapy has potential as a standard neoadjuvant therapy for resectable ESCC.

CLINICAL TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry of Japan (identification number UMIN000004555/000004616).

S-1 and intraperitoneal and intravenous paclitaxel as neoadjuvant chemotherapy for gastric cancer with positive peritoneal cytology

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Background: The prognosis of gastric cancer with positive peritoneal cytology is dismal. Standard treatments for these patients have not been established. The purpose of this study was to evaluate the safety and response of the regimen.

Methods: Patients who were diagnosed with advanced gastric cancer between 2007 and 2010 underwent staging laparoscopy and received intraperitoneal paclitaxel when peritoneal cytology were positive and sequential systemic chemotherapy, S-1 combined with intravenous paclitaxel within 14 days after staging laparoscopy. Paclitaxel was administered intraperitoneally at 80 mg/m2. S-1 was administered at 80 mg/m2/day for 14 consecutive days, followed by 7 days rest. Paclitaxel was administered intravenously at 50 mg/m2 on day 1 and day 8. After 2 courses of S-1 combined with paclitaxel were administered, clinical response was assessed by gastroendoscopy and computed tomography. Additional 2 or 3 courses were administered unless progression of disease was proved. Patients who achieved complete response (CR) or partial response (PR) and patients with stable disease (SD) underwent second-look laparoscopy following gastrectomy when peritoneal cytology turned negative.

Results: 8 (7 male, 1 female) patients were enrolled: median age was 64 years (range 40-75). Of 8 patients, 1 patient achieved CR, and 5 PR. 2 patients showed progressive disease (PD). Grade 3 neutropenia occurred in 1 patient. 6 patients underwent second-look laparoscopy and peritoneal cytology turned negative in all 6 patients. Total or distal gastrectomy with lymphnode dissection was performed consecutively in 3 or 3 patients, respectively. Median follow-up duration was 775 days (range 187-1,028). No recurrence has not been observed, while the 1-year and 2-year survival rates of 14 patients with peritoneal cytology positive gastric cancer who have not received neoadjuvant chemotherapy were 58.3% and 33.3%, respectively.

Conclusions: S-1, intraperitoneal and intravenous paclitaxel as neoadjuvant chemotherapy seems to be a effective strategy against gastric cancer with positive peritoneal cytology.

No significant financial relationships to disclose.

Impact of Intraperitoneal Chemotherapy after Gastrectomy with Positive Cytological Findings in Peritoneal Washings

<i>Background:</i> There is no standard treatment available for gastric cancer patients whose sole ‘non-curative factor’ is positivecytological findings in peritoneal washings (CFPW). The aim of this study was to examine the safety, pharmacokinetics and efficacy for free intraperitoneal cancer cells of intraperitoneal chemotherapy with paclitaxel after gastrectomy with en bloc D2 lymph node dissection in cases of gastric cancer with positive CFPW. <i>Methods:</i> Ten patients with gastric cancer who underwent gastrectomy and systemic lymphadenectomy with D2 dissection, without any other non-curative factors besides positive CFPW, were treated with early postoperative intraperitoneal paclitaxel. Intra-chemotherapeutic toxicity and operative complications were measured using NCI-CTC version 3.0. Intraperitoneal and plasma paclitaxel concentrations were measured using a high-performance liquid chromatographic assay. <i>Results:</i> Grade 3/4 toxic effects included anemia (20%) and neutropenia (10%) that required no treatment. Operative complications were, for example, superficial surgical site infections (10%) that were treated with antibiotics. No viable cancer cells were observed in the intra-abdominal fluid 24 h after intraperitoneal administration of paclitaxel. The intraperitoneal/plasma area under the drug concentration-time curve ratio was 2,003.3:1. <i>Conclusion:</i> Intraperitoneal chemotherapy with paclitaxel is a safe and effective treatment modality for free intraperitoneal cancer cells.