14. Neoadjuvant chemotherapy with FOLFOX: Improved outcomes in Chinese patients with locally advanced gastric cancer
Original Article

14. Neoadjuvant chemotherapy with FOLFOX: Improved outcomes in Chinese patients with locally advanced gastric cancer

Zi-Yu Li1, Cherry E. Koh2, Zhao-De Bu1, Ai-Wen Wu1, Lian-Hai Zhang1, Xiao-Jiang Wu1, Qi Wu1, Xiang-Long Zong1, Hui Ren1, Lei Tang3, Xiao-Peng Zhang3, Ji-You Li4, Ying Hu5, Lin Shen6, Jia-Fu Ji1

1Department of Gastrointestinal Surgery, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China; 2SOuRCe (Surgical Outcomes Research Centre), University of Sydney, Sydney, Australia; 3Department of Radiology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China; 4Department of Pathology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China; 5Tissue Bank, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China; 6Department of Medical Oncology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China

Background: Although the role of peri-operative chemotherapy is established in the treatment of locally advanced gastric cancer, the optimal regime remains to be determined. FOLFOX has been used in palliative setting with good response rates but its role in a neoadjuvant setting is not well established.
Methods: This is a prospective non-randomized study comparing peri-operative FOLFOX versus adjuvant FOLFOX in patients with resectable locally advanced gastric cancer. Response to chemotherapy was assessed according to WHO criteria and pathological changes. Kaplan–Meier log rank test was used to calculate and compare survival differences.
Results: There were 73 patients (neoadjuvant ¼ 36). Complete and partial response was observed in 2 (6%) and 21 (64%) patients, respectively. Four-year overall survival (OS) in the neoadjuvant arm was 78% versus 51% in the adjuvant arm (P ¼ 0.031). Subgroup analysis found R0 resection (86% vs. 55%, P ¼ 0.011) and patients with proximal cancers (87% vs. 14%, P<0.001) to have improved OS. The most common side effect was grade 1-2 leukopenia. There were no grade 3 neuropathies, grade 4 cytopaenias, or treatment related deaths.
Conclusions: Peri-operative treatment with FOLFOX shows promise in patients with resectable locally advanced gastric cancer. It warrants further evaluation and should be considered an alternative to peri-operative ECF.

Key words

Neoadjuvant chemotherapy; FOLFOX; gastric cancer

DOI: 10.3978/j.issn.2224-4778.2012.s014