Docetaxel plus oxaliplatin with or without fluorouracil or capecitabine in metastatic or locally recurrent gastric cancer: a randomized phase II study

BACKGROUND

Docetaxel/cisplatin/infusional 5-fluorouracil (5-FU; DCF) is a standard chemotherapy regimen for patients with advanced gastric cancer (GC). This phase II study evaluated docetaxel/oxaliplatin (TE), docetaxel/oxaliplatin/5-FU (TEF), and docetaxel/oxaliplatin/capecitabine (TEX) in patients with advanced GC.

PATIENTS AND METHODS

Patients with metastatic or locally recurrent gastric adenocarcinoma (including carcinoma of the gastro-oesophageal junction) were randomly assigned (1 : 1 : 1) to TE, TEF, or TEX. Each regimen was tested at two doses before full evaluation at optimized dose levels. The primary end point was progression-free survival (PFS). Overall survival (OS), tumour response, and safety were also assessed. A therapeutic index (median PFS relative to the incidence of febrile neutropenia) was calculated for each regimen and compared with DCF (historical data).

RESULTS

Overall, 248 patients were randomly assigned to receive optimized dose treatment. Median PFS was longer with TEF (7.66 [95% confidence interval (CI): 6.97-9.40] months) versus TE (4.50 [3.68-5.32] months) and TEX (5.55 [4.30-6.37] months). Median OS was 14.59 (95% CI: 11.70-21.78) months for TEF versus 8.97 (7.79-10.87) months for TE and 11.30 (8.08-14.03) months for TEX. The rate of tumour response (complete or partial) was 46.6% (95% CI 35.9-57.5) for TEF versus 23.1% (14.3-34.0) for TE and 25.6% (16.6-36.4) for TEX. The frequency and type of adverse events (AEs) were similar across the three arms. Common grade 3/4 AEs were fatigue (21%), sensory neuropathy (14%), and diarrhoea (13%). Febrile neutropenia was reported in 2% (TEF), 14% (TE), and 9% (TEX) of patients. The therapeutic index was improved with TEF versus TEX, TE, or DCF.

CONCLUSION

These results suggest that TEF is worthy of evaluation as an arm in a phase III trial or as a backbone regimen for new targeted agents in advanced GC. CLINICALTRIALS.GOV: Identifier Trial registration number: NCT00382720.

[Management of non-small cell lung carcinoma following docetaxel-cisplatin. Results of an epidemiologic survey]

BACKGROUND

The purpose of this epidemiologic survey was to describe the management of second-line therapy for patients with stage IIIB-IV non-small cell lung carcinoma (NSCLC) following docetaxel-cisplatin as first-line therapy.

METHODS

Between June 2003 and December 2004, 265 patients were enrolled. The data registered were the choice of cytotoxics, the safety profile, the efficacy and the clinical benefit.

RESULTS

Two hundred and sixty one patients were treated with docetaxel-cisplatin as a first-line regimen and 181 received a second line. This second line was a single agent regimen in 58% of cases and a gemcitabine based treatment in 60.8%. The main criterion for the choice of second-line therapy was the safety profile in 34.3% of cases. The overall response rate was 16.6% after the second line and clinical benefit was reported in 43.6% of patients.

CONCLUSION

In more than 2/3 of patients with NSCLC the docetaxel-cisplatin combination leaves the opportunity to give a second-line treatment, providing satisfying results in terms of clinical benefit. In this study gemcitabine was the most widely prescribed second-line treatment, mainly as a single agent.

A multicentric phase II trial of gemcitabine (Gem), oxaliplatin (Oxa) and vinorelbine (VNB) in untreated stage IIIB and IV non-small cell lung cancer (NSCLC) patients (pts): Preliminary results of GON triplet regimen

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Background: Oxa, Gem and VNB are active agents against NSCLC and have shown synergy in combination. VNB plus Gem showed efficacy comparable to platinum combinations with a more favorable toxicity profile, while Oxa/VNB and Oxa/Gem combinations have established recommended doses. Platinum given on day 2 after Gem appears safer and more active. A fixed Gem infusion rate of 10 mg/m2/min is a pharmacologically optimized dosing intended to provide plasma concentrations (≈20 μmol/L) sufficient to maximize the rate of Gem triphosphate accumulation. The aim of the trial was to assess the efficacy (response rate) and safety of GON regimen. Methods: Chemo naive pts with stage IIIB and IV NSCLC received VNB 25 mg/m2, 20-min IV followed by Gem 700 mg/m2 in 10 mg/m2/min IV on day 1, and Oxa 85 mg/m2, 2h IV, on day 2, cycles repeated every 2 weeks. 88 pts are planned in a two-stage design. Results: From February 2004 to November 2005, 39 pts were eligible and treated: 26M/13F; median age: 58 (36–75) years; PS 0/1: 17/22; stage IIIB/IV: 6/33; 21 adenocarcinoma, 9 squamous, 9 large cell carcinoma. Metastatic sites were 67% lung, 21% liver, 36% bone. 229 cycles (cyc) were administered; median cycles/pt 8. Relative dose intensity: Oxa 89%, VNB 94%, Gem 100%. Thirty-four pts were assessable for response (RECIST, external radiological panel review), 5 pts too early: 1 CR, 14 PR (44% ORR, 95% CI 27–62%) with a median OR duration of 12.5 months (range: 3.1–19+), 9 SD, 10 PD. Median follow-up of 6 months (1–21) with median TTP of 4.6 months (95% CI: 1.0–8.3, range: 1–19+); estimated 6-month survival: 80%. Safety is assessable in 38 pts with grade 3–4 toxicities (pts/cyc): neutropenia 6/18, febrile neutropenia 1/1, anemia 1/2, neurotoxicity 3/4, diarrhea 2/3, vomiting 1/1, transaminitis 2/3. Conclusions: The GON triplet is a safe and active outpatient regimen in advanced NSCLC. If these promising results are confirmed in the full cohort, the regimen warrants comparison with standard doublet regimens.

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