Farrokhi Pegah, Sadeghi Alireza, Sharifi Mehran, Riechelmann Rachel, Moghaddas Azadeh
Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Minneapolis, USA.
Department of Internal Medicine-Haematology-Oncology Section, School of Medicine, Isfahan University of Medical Sciences, Isfahan, I.R. Iran.
Res Pharm Sci. 2022 Oct 29;17(6):621-634. doi: 10.4103/1735-5362.359430. eCollection 2022 Dec.
This study aimed to compare the efficacy and toxicity of perioperative chemotherapy regimens including epirubicin, cisplatin, 5-fluorouracil (ECF), docetaxel, cisplatin, 5-fluorouracil (DCF), leucovorin, 5-fluorouracil, oxaliplatin (FOLFOX), and 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) to identify the most effective chemotherapy regimen with less toxicity.
This retrospective cohort study (2014-2021) was based on 152 eligible resectable gastric cancer patients who had received one of the perioperative mentioned chemotherapy regimens and followed for at least two years. The primary endpoint of this study was overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and R0 resection.
FINDINGS / RESULTS: Of included patients, 21%, 33.7%, 24.3%, and 21% had received ECF, DCF, FOLFOX and FLOT, respectively. After the median 30-month follow-ups, OS was higher with the FLOT regimen in comparison with other regimens (hazard ratio = 0. 276). The median OS of the FLOT regimen was 39 months. Besides, the median OS was 28, 25, and 21 months for DCF, FOLOFX, and ECF regimens, respectively. Moreover, a median PFS of 24, 18, 17, and 14 months was observed for FLOT, DCF, FOLFOX, and ECF regimens, respectively (Log-rank < 0.001). FLOT regimen showed 84. 4% ORR which was notably higher than other groups.
For resectable gastric cancer patients, the perioperative FLOT regimen led to a significant improvement in patients' OS and PFS versus ECF, DCF, and FOLFOX regimens. As such, the FLOT regimen could be considered the optimal option for managing resectable gastric cancer patients.
本研究旨在比较包括表柔比星、顺铂、5-氟尿嘧啶（ECF）、多西他赛、顺铂、5-氟尿嘧啶（DCF）、亚叶酸钙、5-氟尿嘧啶、奥沙利铂（FOLFOX）以及5-氟尿嘧啶、亚叶酸钙、奥沙利铂和多西他赛（FLOT）在内的围手术期化疗方案的疗效和毒性，以确定毒性较小的最有效化疗方案。
这项回顾性队列研究（2014 - 2021年）基于152例符合条件的可切除胃癌患者，这些患者接受了上述围手术期化疗方案之一，并随访至少两年。本研究的主要终点是总生存期（OS）、无进展生存期（PFS）、总缓解率（ORR）和R0切除。
在纳入的患者中，分别有21%、33.7%、24.3%和21%接受了ECF、DCF、FOLFOX和FLOT方案。经过中位30个月的随访，与其他方案相比，FLOT方案的OS更高（风险比 = 0.276）。FLOT方案的中位OS为39个月。此外，DCF、FOLOFX和ECF方案的中位OS分别为28个月、25个月和21个月。而且，FLOT、DCF、FOLFOX和ECF方案的中位PFS分别为24个月、18个月、17个月和14个月（对数秩检验<0.001）。FLOT方案的ORR为84.4%，明显高于其他组。
对于可切除的胃癌患者，围手术期FLOT方案与ECF、DCF和FOLFOX方案相比，可显著改善患者的OS和PFS。因此，FLOT方案可被视为治疗可切除胃癌患者的最佳选择。
