Modified DOF regimen in advanced stomach cancer - A single centre experience from Bangalore.

Introduction: Palliative chemotherapy in patients with advanced gastric cancer yields better results regarding the improvement of Overall Survival (OS) and the relief of symptoms with minimal mortality and morbidity compared to patients treated with the best supportive care. There is no standard international regimen that has been approved for palliative chemotherapy in patients with advanced gastric cancer. Patients who received chemotherapy including a platinum experienced higher rates of hematologic toxicity, particularly neutropenia, and nausea and vomiting than chemotherapy without a platinum. There are very few publications from India regarding docetaxel and oxaliplatin based regimen in stomach cancer. We decided to evaluate the activity and safety of Docetaxel, oxaliplatin and 5fluorouracil (DOF) in patients with advanced gastric or gastroesophageal junction (GEJ) cancer. Methods: 51 untreated locally advanced or metastatic (29 gastric and 22 GEJ) cancer patients with good Performance status were treated with modified DOF regimen. Docetaxel 60mg/m2 –D1, oxaliplatin 100 mg/m2 on D2 and continuous infusion 5FU 750 mg/m2 days 1–3 (DOF) with Peg GCSF 6 mg support every 3 weeks for 3-6 cycles was the regimen followed at our Health Care Global Hospital, Bangalore from Jan 2014 to Feb 2016. The efficacy and toxicity of above regimen were analyzed. Results: 51 patients treated at our institute showed male: Female ratio was 1.55:1, median age-52 years, 15 patients were Locally Advanced Disease (LAD), remaining were metastatic (Liver 18, Bone 16, Pulmonary 12, Peritoneal 27 and No regional Lymph node metastasis 13). 33.3% of LAD underwent surgery and 2 patients had pathological complete response. Efficacy DOF regimen in LAD vs Metastatic disease were shown in the following order: Complete response in 6.66% vs 5.5%, Partial response in 40% vs 33.3%, Stable disease in 33.3.% vs 38.8%,Progressive disease in 20% vs 22.2%, Median PFS in months 9 vs 7, Median OS in months 16 vs12, 1 year survival 66.6% vs 52.7% respectively Hematological toxicity: anemia (37.2%, grade 3-4-9.8%), neutropenia (62.7%, grade 3-4-19.6%), Febrile neutropenia (21.56%), thrombocytopenia (33.3%). Nonhematological toxicity: Nausea/vomiting (37.25%, grade 3-4-15.6%), Diarrhea (47%, grade 3-4-21.56%), Abdominal pain 31.3%, Alopecia 88.2%, Mucositis (35.3%Gr 3-4- 13.7%), peripheral neuropathy (23.5% grade 1-2), Skin and nail changes 51%, dose reductions was required in 21.8% patients and chemotherapy delay in 35.29%. Conclusion: The modified DOF is an effective and feasible regimen in well-selected patients with advanced gastric or GEJ cancer and shows promising survival results. Further studies are required to compare modified and original DOF/DCF regimens in terms of Overall Survival and other parameters.