DCF in gastric cancer – pro

Most cases of stage IV gastric cancer cannot be curatively treated with surgery alone, except for those with N3 or T4N2 cancers. Chemotherapy is therefore essentially palliative.
There is no evidence of survival benefit for treatment modalities other than surgery for stage IV cancer, but some benefits are suggested for marginal life prolongation, tumor shrinkage, and relief of symptoms.

Chemotherapy is indicated for patients with unresectable tumor with good performance status. Standard regimens of chemotherapy for late stage cancer are not yet established, although combination chemotherapy with cisplatin (CDDP), and 5 fluorouracil ( 5FU) or its derivates 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.
Many trials using combinations of three drugs have been conducted to improve treatment results further in advanced gastric cancer. One of the three-drug combination is adding docetaxel, to ‘5-FU + cisplatin’ (DCF). A randomized phase II comparison of ECF, DC, and DCF had been conducted. The DCF regimen consisted of a 21-day continuous-infusion FU schedule (similar to ECF) and a higher dose of docetaxel (85 mg/m2) compared with a shorter 5-day infusion of FU and a lower dose of docetaxel (75 mg/m2). Although comparisons are again limited by the phase II trial design, QOL analysis using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 indicated improvement in QOL scores for patients receiving ECF and stable QOL scores on both of the docetaxel arms. DCF resulted in detrimental QOL effects of weight loss and decline in role functioning during therapy, which were likely a consequence of the severity of toxicity. The authors declare DCF to be the superior regimen based on a higher response rate compared with DC, although both regimens had similar overall survival. Ajani et al also opted to select DCF over DC for the V325 trial, despite comparable rates of antitumor response rate, time to progression, and overall survival for DC compared with DCF and despite greater rates of GI toxicity for DCF. It appears to be the mi\ost effective, albeit a toxic regimen.
DCF is listed by NCCN.

D.-Y. Oh, T.-Y. Kim, J. H. Kwon, J.-J. Lee, Y. Joh, D.-W. Kim, T.-Y. Kim, D. S. Heo, Y.-J. Bang, and N. K. Kim Docetaxel + 5-Fluorouracil + Cisplatin 3-day Combination Chemotherapy as a First-line Treatment in Patients with Unresectable Gastric Cancer
Jpn. J. Clin. Oncol., July 1, 2005; 35(7): 380 – 385.

NCCN, Gast-12, 2

Eric D Tetzlaff et al, Review of docetaxel in the treatment of gastric cancer Ther Clin Risk Manag. 2008 October; 4(5): 999–1007.

Ajani JA, Moiseyenko VM, Tjulandin S, et al. Clinical benefit with docetaxel plus fluorouracil and cisplatin compared with cisplatin and fluorouracil in a phase III trial of advanced gastric or gastroesophageal cancer adenocarcinoma: the V-325 Study Group. J Clin Oncol. 2007b;25:3205–9.

Ajani JA, Phan A, Ho L, et al. Phase I/II trial of docetaxel plus oxaliplatin and 5-fluorouracil (D-FOX) in patients with untreated, advanced gastric or gastroesophageal cancer. J Clin Oncol (Meeting Abstracts) 2007;25(18_suppl):4612.

Ajani J, Bekaii-Saab T, D’Amico TA, Fuchs C, Gibson MK, Goldberg M, Hayman JA, Ilson DH, Javle M, Kelley S, Kurtz RC, Locker GY, Meropol NJ, Minsky BD, Orringer MB, Osarogiagbon RU, Posey JA, Roth J, Sasson AR, Swisher SG, Wood DE, Yen Gastric Cancer Clinical Practice Guidelines.J Natl Compr Canc Netw. 2006 Apr;4(4):350-66.

D.-Y. Oh, T.-Y. Kim, J. H. Kwon, J.-J. Lee, Y. Joh, D.-W. Kim, T.-Y. Kim, D. S. Heo, Y.-J. Bang, and N. K. Kim
Docetaxel + 5-Fluorouracil + Cisplatin 3-day Combination Chemotherapy as a First-line Treatment in Patients with Unresectable Gastric Cancer
Jpn. J. Clin. Oncol., July 1, 2005; 35(7): 380 – 385.

Participate in our Forums

To ask questions or participate in a discussion, please visit our Forums. You must LOGIN to participate.

Help Us Help Others

You can become a Site Sponsor. Or you may wish to support our work with a Donation.

Focused Articles For You

Lay Portal

Professional