Petrelli Fausto, Tomasello Gianluca, Ghidini Michele, Passalacqua Rodolfo, Barni Sandro
aOncology Unit, Department of Oncology, ASST Bergamo Ovest, Treviglio (BG) bOncology Unit, Department of Oncology, ASST Ospedale di Cremona, Cremona, Italy.
Anticancer Drugs. 2017 Feb;28(2):133-141. doi: 10.1097/CAD.0000000000000436.
Combination of docetaxel, cisplatin, and 5-fluorouracil (DCF) is an active but not well-tolerated regimen for advanced gastric cancer (GC) with standard 3-weekly doses. Several modified schedules (mDCFs) have been designed to reduce acute toxicities and improve feasibility as first-line therapy in patients with metastatic GC. The objective of this systematic review was to evaluate overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and grade (G) greater than or equal to 3 adverse event of mDCF chemotherapy in this setting. MEDLINE, SCOPUS, Embase, Web of Science, LILACS, CINAHL, Google Scholar, and the Cochrane Library were searched for studies with mDCF schedules in advanced GC. Pooled median OS, PFS, ORR (the primary endpoints), and G3 or G4 adverse events (secondary endpoints) were presented according to random effect model. Twenty-four studies were included for a total of 1311 patients, with weekly or biweekly (n=11) and reduced doses 3-weekly (n=13) schedules. The median pooled PFS and OS were 7.2 months [95% confidence interval (CI): 5.9-8.8] and 12.3 months (95% CI: 10.6-14.3), respectively. Among 23 studies with available data for ORR, the pooled result was 49% (95% CI: 43.4-54.4). The incidence of grade 3/4 neutropenia, thrombocytopenia, anemia, febrile neutropenia, stomatitis, diarrhea, nausea+vomiting, and neurotoxicity were 29.1, 5.6, 8.9, 7.6, 6.6, 4.9, and 9.9%, respectively. mDCF chemotherapy with splitted weekly or biweekly schedules, or reduced 3-weekly doses, is a very effective and well-tolerated regimen in metastatic GC. By providing a 50% ORR, such regimens may be particularly indicated for younger and fit patients for cytoreductive purposes (conversion therapy) or in case of symptomatic tumor burden.
多西他赛、顺铂和5-氟尿嘧啶联合方案（DCF）是一种用于晚期胃癌（GC）的有效但耐受性不佳的方案，采用标准的每3周给药一次的剂量。已设计了几种改良方案（mDCF），以降低急性毒性并提高转移性GC患者一线治疗的可行性。本系统评价的目的是评估在这种情况下mDCF化疗的总生存期（OS）、无进展生存期（PFS）、总缓解率（ORR）以及≥3级不良事件的发生率。检索了MEDLINE、SCOPUS、Embase、Web of Science、LILACS、CINAHL、谷歌学术和Cochrane图书馆，以查找有关晚期GC中mDCF方案的研究。根据随机效应模型呈现汇总的中位OS、PFS、ORR（主要终点）以及3级或4级不良事件（次要终点）。纳入了24项研究，共1311例患者，采用每周或每两周一次（n = 11）以及每3周减少剂量（n = 13）的方案。汇总的中位PFS和OS分别为7.2个月[95%置信区间（CI）：5.9 - 8.8]和12.3个月（95% CI：10.6 - 14.3）。在23项有ORR可用数据的研究中，汇总结果为49%（95% CI：43.4 - 54.4）。3/4级中性粒细胞减少、血小板减少、贫血、发热性中性粒细胞减少、口腔炎、腹泻、恶心 + 呕吐以及神经毒性的发生率分别为29.1%、5.6%、8.9%、7.6%、6.6%、4.9%和9.
