Single-center experience with paclitaxel (T), carboplatin (C), and capecitabine (X) in the treatment of advanced esophagogastric cancer.

Abstract

116 Background: Epirubicin, cisplatin, and 5-FU (ECF) improves overall survival for advanced esopgagogastric adenocarcinoma compared with other protocols but is associated with considerable toxicity. A triple chemotherapy with TCX has shown improved survival with less toxicity at our institution. The aims of this study were to retrospectively analyze overall survival and toxicity of TCX in our patient population and to compare them with published results from ECF and paclitaxel, cisplatin, and 5-FU (TCF), a similar regimen to ours. Methods: We analyzed pts with locally advanced and/or metastatic esophagogastric adenocarcinoma treated in our institution from 2005 to 2012 with TCX (paclitaxel 80mg/m^2 day 1 & 8, carboplatin 5 AUC day 1, capecitabine 750mg/m^2 BID for 14 days). Pts had received no prior chemotherapy. Primary endpoint was overall survival and secondary endpoint was toxicity. We compared our data to historical results from trials of ECF and TCF. Results: 35 pts who received TCX were identified. The median age was 64 years (range 37-91). 20 pts had metastatic disease and 15 had locally advanced disease. Median survival was 21 months (95% CI: 13, 25 months). 1 year survival was 72% (95% CI: 54%, 90%). These data compare favorably to published ECF data (table) with a significant survival benefit of TCX over ECF (p<0.05%). When compared to TCF in pts with metastatic disease 2 year survival was 18%, compared to 32% (95% CI: 10%, 54%) with TCX. Though there is a survival benefit, it was not statistically significant. Grade 3-4 toxicity with ECF has been documented in several studies as above 40%. In our patients treated with TCX, only 4 pts (11%) suffered grade 3-4 toxicity (nausea, vomiting, hearing loss, and neutropenia). Conclusions: In our patient population, triple therapy of paclitaxel, carboplatin, and capecitabine (TCX) is associated with significant improvement in overall survival in advanced esophagogastric cancer with a low rate of toxicity compared to published ECF results. [Table: see text]

Treatment Outcome and Safety of the TCX Regimen for Advanced Gastric Cancer: A Prospective Cohort Study

“…Sample size was calculated based on OS among esophagogastric cancer patients treated with TCX in a previous study. 23 Assuming a 2-year OS of 30%, a margin of error of 10%, and a confidence level of 95%, the minimum sample size was 81 patients. Accounting for 8% loss-to-follow-up, we planned to recruit 88 patients.…”

“… 22 However, no trial has been conducted to investigate the efficacy of the TCX regimen on advanced gastric cancer patients, with the exception of two studies on metastatic distal esophageal cancer and esophagogastric junction cancer. 23 , 24 …”

“…22 However, no trial has been conducted to investigate the efficacy of the TCX regimen on advanced gastric cancer patients, with the exception of two studies on metastatic distal esophageal cancer and esophagogastric junction cancer. 23,24 In Vietnam, ECF (epirubicin, cisplatin, and 5-fluorouracil), EOX (epirubicin, oxaliplatin, and capecitabine), DCF (docetaxel, cisplatin, and 5-fluorouracil), and DCX (docetaxel, cisplatin, and capecitabine) are commonly used for cancer patients at the late stages. The TCX regimen has been introduced in Vietnam since 2016, but no studies have been done to describe its treatment outcome on advanced gastric cancer.…”