DCF for gastric cancer – pro
The DCF regimen is SOC for gastric cancer. Most cases of stage IV gastric cancer cannot be curatively treated with surgery alone, except for those with N3 or T4N2 cancers. Chemotherapy is indicated for patients with unresectable tumor with good performance status and combination chemotherapy with cisplatin (CDDP), and 5 fluorouracil (5FU) or its derivatives may be the regimen of preference and recommendation. A number of controlled studies of two-drug combination chemotherapies, especially cisplatin-containing regimens, have shown a significant improvement in median survival and quality of life compared with best supportive care. Of these, 5-FU and cisplatin combination (FP) has been considered an active and safe regimen for a long time. More recently drugs such as paclitaxel, docetaxel, oxaliplatin and irinotecan have been added in various trials.
“In a head-to-head comparison of preoperative chemotherapy for locally advanced gastric and esophagogastric adenocarcinoma, FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) significantly improved overall survival compared with ECF. Assessing response to induction chemotherapy prior to combined preoperative chemoradiotherapy in PET nonresponding patients allowed a change in chemotherapy during subsequent radiotherapy with improved rates of pathologic complete response. In human epidermal growth factor receptor-2-positive advanced esophagogastric adenocarcinoma, second-line treatment with the chemotherapy/trastuzumab drug conjugate emtansine/trastuzumab failed to improve response or overall survival compared with treatment using paclitaxel chemotherapy. The immune checkpoint inhibitor, nivolumab, improved survival in refractory gastric cancer.” (Ilson 2017).
“Gastric cancer is one of the most common malignant tumors in the digestive system. Surgery is currently considered to be the only radical treatment. As surgical techniques improve and progress is made in traditional radiotherapy, chemotherapy, and the implementation of neoadjuvant therapy, the 5-year survival rate of early gastric cancer can reach >95%. However, the low rate of early diagnosis means that most patients have advanced-stage disease at diagnosis and so the best surgical window is missed. Therefore, the main treatment for advanced gastric cancer is the combination of neoadjuvant chemoradiotherapy, molecular-targeted therapy, and immunotherapy. In this article, we summarize several common methods used to treat advanced gastric cancer and discuss the progress made in the treatment of gastric cancer in detail. Only clinical practice and clinical research will allow us to prolong the survival time of patients and allow the patients to truly benefit by paying attention to the individual patient characteristics, drug choice, and developing a reasonable and comprehensive treatment plan.” (Song et al 2017).
“In the randomized controlled phase II/III FLOT4 trial, Al-Batran et al compared perioperative chemotherapy with fluorouracil, Leucovorin, oxaliplatin, and docetaxel (FLOT). Various modifications of the DCF regimen have demonstrated improved safety in clinical trials of patients with advanced gastric cancer compared to the DCF regimen evaluated in the V325 study. Due to concerns regarding toxicity, dose-modified DCF or other DCF modifications should be used a s alternative options to the standard DCF regimen for first-line therapy.” (NCCN 2019).
Ilson D. H. (2017). Advances in the treatment of gastric cancer. Current opinion in gastroenterology, 33(6), 473476. doi:10.1097/MOG.0000000000000395.
Song, Z., Wu, Y., Yang, J., Yang, D., & Fang, X. (2017). Progress in the treatment of advanced gastric cancer. Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine, 39(7), 1010428317714626. doi:10.1177/1010428317714626
National Comprehensive Cancer Network (NCCN). (2019). NCCN Guidelines Version 4.2019-Gastric Cancer.