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Management of Hematologic Toxicity in Patients with Advanced or Metastatic Gastric Cancer Treated with Docetaxel, Cisplatin and Fluorouracil (DCF): Results of Monocentric Experience

Received: 26 September 2014    Accepted: 28 October 2014    Published: 30 October 2014
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Abstract

Background: Gastric adenocarcinoma is the second most common cause of cancer death worldwide. There is no standard regimen of chemotherapy for metastatic disease, although the regimen of ECF is the most used regimen, with a median survival of 7-9 months. With new regimens of chemotherapy, such as DCF, the median survival has increased, despite a major toxicities and 1-2% of toxic death.Patients And Methods: This is a monocentric experience. In three years (2009-2012) we have treated 36 chemo-naïve patients with histological diagnosis of locally advanced or metastatic gastric cancer with a DCF regimen. All patients were treated with a prophilactic Peg-filgrastim injection at 6th day of therapy. Results: A total of 168 cycles were administered (median 5 per patient, range 3–8). Major responses were observed in 10 patients, with 2 complete (5,5%) and 8 partial remissions (22,2%); 16 additional pts showed disease stabilization (44,4%) and 10 progressed (27,9%). Median OS times were 12 months. Median TTP were 9,5 months. Toxicity was acceptable, worst per patient toxicities were neutropenia (grade 3-4 in 15%), feverish neutropenia (11,1%) diarrhoea (grade 2 in 25% , grade 3 in 25%, grade 4 in 18,8%), asthenia (grade 2 in 8%), neurotoxicity (grade 3 in 4%), anhemia (grade 4 in 10%), four pts received blood transfusion. Conclusion: Time to response and ORR favor DCF over other schedule’s treatment according to literature. A trend towards increased myelosuppression and infectious complications was observed but the management of this and others side-effects is possible and not too difficult if pts is managed by an expert toxicities team. Infact we don’t have no-one toxic death.

Published in Clinical Medicine Research (Volume 3, Issue 6)
DOI 10.11648/j.cmr.20140306.12
Page(s) 166-170
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Gastric Cancer, DCF, Hematologic Toxicity

References
[1] La Bianca R., Beretta G., Bozzetti F., Milesi L., Mosconi S. ,Quadri A. . Neoplasie dell’apparato digerente da G. Bonadonna , G.Robustelli Della Cruna , P. Valagussa , MEDICINA ONCOLOGICA VIII ed. Masson Milano 1025 – 1026 . 2007
[2] Murad AM., Santiago FF., Petroianu A., et al. “Modified therapy with 5-fluorouracil, doxorubicin and methotrexate in advanced gastric cancer”. Cancer;72:37.1993
[3] Glimelius B., Hotfmann K., Haglund U., et al. “Initial or delayed chemotherapy with best supportive care in advanced gastric cancer”. Ann Oncol;5:189. 1994
[4] Pyrhönen S., Kuitumen T., Kouri M. “A randomized phase III trial comparing fluorouracil, epidoxorubicin and methotrexate (FEMTX) with best supportive care in non resectable gastric cancer”. Ann Oncol;3(Suppl 5):12. 1992
[5] Scheithauer W., Kornck G., Zeh B., et al. “Palliative chemotherapy versus supportive care in patients with metastatic gastric cancer: a randomized trial”. Second International Conference on Biology, Prevention and Treatment og GI Malignancy, Köln, Germany,:68. 1995
[6] Schipper DL, Wagener DJT et al: Chemotherapy of gastric cancer. Anticancer Drugs, 7: 137-149, 1996.
[7] Cascinu S: La gestione del paziente con carcinoma gastrico. Tumori vol 1, n° 1: S3-S10, 2002.
[8] Wils JA, Klein HO, Wagener H et al: Sequential high-dose methotrexate and fluorouracil combined with doxorubicin—a step ahead in the treatment of advanced gastric cancer: a trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. J. Clin. Oncol. 9: 827-831, 1991.
[9] Cocconi G, Bella M, Zironi S et al: Fluorouracil, doxorubicin, and mitomycin combination versus PELF chemotherapy in advanced gastric cancer: a prospective randomized trial of the Italian Oncology Group for Clinical Research. J. Clin. Oncol. 12: 2687-2693, 1994.
[10] Cocconi G, Carlini P, Gamboni A et al: PELF is More Active than FAMTX in Metastatic Gastric Carcinoma (MGC) Proc. Am. Soc. Clin. Oncol. Abst. 501. 2001
[11] Waters JS, Norman A, Cunningham D et al: Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: results of a randomized trial. Br. J. Cancer 80: 269-72, 1999.
[12] Vanhofer U, Rougier P, Wilke H et al: Final results of a randomized phase III trial of sequential high-dose methotrexate, fluorouracil and doxorubicin versus etoposide, leucovorin and fluorouracil versus infusional fluorouracil and cisplatin in advanced gastric cancer: A trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cancer Cooperative Group. J. Clin. Oncol. 18: 2648-2657, 2000.
[13] Roth AD et al. Ann Oncol; 11:301;). 2000
[14] MoiseyenkoV et al. ASCO, Abstr 587. 2002
[15] Roth AD et al. ASCO, Abstr 4020. 2004
[16] Van Cutsem E, Moiseyenko VM, Tjulandin S et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as firstline therapy for advanced gastric cancer: A report of the V325 study group. J Clin Oncol; 24: 4991–4997. 2006
[17] Bhana N. Granulocyte colony-stimulating factors in the management of chemotherapy-induced neutropenia : evidence based review. Curr Opin Oncol ;19:328-335. 2007
[18] Pro B, Fayad L, McLaughlin P,et al. Pegfilgrastim administered in a single fixed dose is effective in inducing neutrophil count recovery after paclitaxel and topotecan chemotherapy in patients with relapsed aggressive non- Hodgkin’s lymphoma. Leuk Lymphoma;47:481-485. 2006
[19] Lyman GH . Pegfilgrastim: a granulocyte colony-stimulating factor with sustained duration of action . Expert Opin Biol Ther;5:1635-1646. 2005
[20] Rader M. Granulocyte colony-stimulating factor use in patients with chemotherapy-induced neutropenia : clinical and economic benefits . Oncology ( Williston Park ); 20(5 Suppl 4) 16-21. 2006
[21] Andre N , Kababri ME, Bertrand P, et al. Safety and efficacy of pegfilgrastim in children with cancer receiving myelosuppressive chemotherapy . Pharmacotherapy; 23(8 Pt 2) : 15S-19S. 2003
[22] Crawford J , Dale DC , Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer; 100:228-237. 2004
[23] Ajani JA, Moiseyenko VM, Tjulandin S, et al. Quality of Life With Docetaxel Plus Cisplatin and Fluorouracil Compared With Cisplatin and Fluorouracil From a Phase III Trial for Advanced Gastric or Gastroesophageal Adenocarcinoma: The V-325 Study Group. J. Clin. Oncol. 22: 3210-3216, 2007.
[24] 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 25:3205-3209, 2007
[25] Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM. Gastric adenocarcinoma. Review and considerations for future directions. Ann Surg (2005) 241:27–39.
[26] Neuss MN, Desch CE, McNiff KK, et al. A process for measuring the quality of cancer care: the Quality Oncology Practice Initiative. J Clin Oncol. 2005;23:6233-39.
[27] Schneider EC, Epstein AM, Malin JL, et al. Developing a system to assess the quality of cancer care: ASCO’s national initiative on cancer care quality. J Clin Oncol. 2004;22:2985-91.
[28] Twombly R. Medicare demonstration projects acknowledge evidence-based medicine in cancer care. J Natl Cancer Inst. 2005;97:6-7.
[29] Lipscomb J, Donaldson MS. Outcomes research at the National Cancer Institute: measuring, understanding, and improving the outcomes of cancer care. Clin Ther.;25:699-712. 2003
[30] Malin JL. Bridging the divide: integrating cancer-directed therapy and palliative care. J Clin Oncol.;22:3438-40. 2004
[31] Patrick D, Ferketich S, Frame P, et al. National Institutes of Health State-ofthe-Science Panel. National Institutes of Health State-of-the-Science conference. July 15-17. 2002
[32] Agency for Healthcare Research and Quality. Outcomes of Pharmaceutical Therapy Program (OPT) update. AHRQ Publication No. 04-R205, Agency for Healthcare Research and Quality, Rockville, MD: Agency for Healthcare Research and Quality. Available at: http://www.ahrq.gov/clinic/pharmtherapy/ optupdat.htm. Accessed June 2004.
[33] De Vita F, Giuliani F, Silvestris N, Rossetti S, Pizzolorusso A, Santabarbara G, Galizia G, Colucci G, Ciardiello F, Orditura M. Current status oftargeted therapies in advanced gastric cancer Expert Opin Ther Targets. 2012 Apr;16 Suppl 2:S29-34. doi: 10.1517/14728222.2011.652616. Epub Mar 23. 2012
[34] Giuffrè G, Ieni A, Barresi V, et al. HER2 status in unusual histological variants of gastric adenocarcinomas. J Clin Pathol.;65:237–241. 2012
[35] Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet.;376:687–697. doi: 10.1016/S0140-6736(10)61121-X. 2010
[36] Javle M, Smyth EC, Chau I. Ramucirumab: Successfully Targeting Angiogenesis in Gastric Cancer. Clin Cancer Res. 2014 Oct 3. pii: clincanres.1071. [Epub ahead of print] 2014
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    Turano Salvatore, Biamonte Rosalbino, Conforti Serafino, Mastroianni Candida Maria, Manfredi Caterina, et al. (2014). Management of Hematologic Toxicity in Patients with Advanced or Metastatic Gastric Cancer Treated with Docetaxel, Cisplatin and Fluorouracil (DCF): Results of Monocentric Experience. Clinical Medicine Research, 3(6), 166-170. https://doi.org/10.11648/j.cmr.20140306.12

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    Turano Salvatore; Biamonte Rosalbino; Conforti Serafino; Mastroianni Candida Maria; Manfredi Caterina, et al. Management of Hematologic Toxicity in Patients with Advanced or Metastatic Gastric Cancer Treated with Docetaxel, Cisplatin and Fluorouracil (DCF): Results of Monocentric Experience. Clin. Med. Res. 2014, 3(6), 166-170. doi: 10.11648/j.cmr.20140306.12

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    AMA Style

    Turano Salvatore, Biamonte Rosalbino, Conforti Serafino, Mastroianni Candida Maria, Manfredi Caterina, et al. Management of Hematologic Toxicity in Patients with Advanced or Metastatic Gastric Cancer Treated with Docetaxel, Cisplatin and Fluorouracil (DCF): Results of Monocentric Experience. Clin Med Res. 2014;3(6):166-170. doi: 10.11648/j.cmr.20140306.12

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  • @article{10.11648/j.cmr.20140306.12,
      author = {Turano Salvatore and Biamonte Rosalbino and Conforti Serafino and Mastroianni Candida Maria and Manfredi Caterina and Palazzo Salvatore},
      title = {Management of Hematologic Toxicity in Patients with Advanced or Metastatic Gastric Cancer Treated with Docetaxel, Cisplatin and Fluorouracil (DCF): Results of Monocentric Experience},
      journal = {Clinical Medicine Research},
      volume = {3},
      number = {6},
      pages = {166-170},
      doi = {10.11648/j.cmr.20140306.12},
      url = {https://doi.org/10.11648/j.cmr.20140306.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20140306.12},
      abstract = {Background: Gastric adenocarcinoma is the second most common cause of cancer death worldwide. There is no standard regimen of chemotherapy for metastatic disease, although the regimen of ECF is the most used regimen, with a median survival of 7-9 months. With new regimens of chemotherapy, such as DCF, the median survival has increased, despite a major toxicities and 1-2% of toxic death.Patients And Methods: This is a monocentric experience. In three years (2009-2012) we have treated 36 chemo-naïve patients with histological diagnosis of locally advanced or metastatic gastric cancer with a DCF regimen. All patients were treated with a prophilactic Peg-filgrastim injection at 6th day of therapy. Results: A total of 168 cycles were administered (median 5 per patient, range 3–8). Major responses were observed in 10 patients, with 2 complete (5,5%) and 8 partial remissions (22,2%); 16 additional pts showed disease stabilization (44,4%) and 10 progressed (27,9%). Median OS times were 12 months. Median TTP were 9,5 months. Toxicity was acceptable, worst per patient toxicities were neutropenia (grade 3-4 in 15%), feverish neutropenia (11,1%) diarrhoea (grade 2 in 25% , grade 3 in 25%, grade 4 in 18,8%), asthenia (grade 2 in 8%), neurotoxicity (grade 3 in 4%), anhemia (grade 4 in 10%), four pts received blood transfusion. Conclusion: Time to response and ORR favor DCF over other schedule’s treatment according to literature. A trend towards increased myelosuppression and infectious complications was observed but the management of this and others side-effects is possible and not too difficult if pts is managed by an expert toxicities team. Infact we don’t have no-one toxic death.},
     year = {2014}
    }
    

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  • TY  - JOUR
    T1  - Management of Hematologic Toxicity in Patients with Advanced or Metastatic Gastric Cancer Treated with Docetaxel, Cisplatin and Fluorouracil (DCF): Results of Monocentric Experience
    AU  - Turano Salvatore
    AU  - Biamonte Rosalbino
    AU  - Conforti Serafino
    AU  - Mastroianni Candida Maria
    AU  - Manfredi Caterina
    AU  - Palazzo Salvatore
    Y1  - 2014/10/30
    PY  - 2014
    N1  - https://doi.org/10.11648/j.cmr.20140306.12
    DO  - 10.11648/j.cmr.20140306.12
    T2  - Clinical Medicine Research
    JF  - Clinical Medicine Research
    JO  - Clinical Medicine Research
    SP  - 166
    EP  - 170
    PB  - Science Publishing Group
    SN  - 2326-9057
    UR  - https://doi.org/10.11648/j.cmr.20140306.12
    AB  - Background: Gastric adenocarcinoma is the second most common cause of cancer death worldwide. There is no standard regimen of chemotherapy for metastatic disease, although the regimen of ECF is the most used regimen, with a median survival of 7-9 months. With new regimens of chemotherapy, such as DCF, the median survival has increased, despite a major toxicities and 1-2% of toxic death.Patients And Methods: This is a monocentric experience. In three years (2009-2012) we have treated 36 chemo-naïve patients with histological diagnosis of locally advanced or metastatic gastric cancer with a DCF regimen. All patients were treated with a prophilactic Peg-filgrastim injection at 6th day of therapy. Results: A total of 168 cycles were administered (median 5 per patient, range 3–8). Major responses were observed in 10 patients, with 2 complete (5,5%) and 8 partial remissions (22,2%); 16 additional pts showed disease stabilization (44,4%) and 10 progressed (27,9%). Median OS times were 12 months. Median TTP were 9,5 months. Toxicity was acceptable, worst per patient toxicities were neutropenia (grade 3-4 in 15%), feverish neutropenia (11,1%) diarrhoea (grade 2 in 25% , grade 3 in 25%, grade 4 in 18,8%), asthenia (grade 2 in 8%), neurotoxicity (grade 3 in 4%), anhemia (grade 4 in 10%), four pts received blood transfusion. Conclusion: Time to response and ORR favor DCF over other schedule’s treatment according to literature. A trend towards increased myelosuppression and infectious complications was observed but the management of this and others side-effects is possible and not too difficult if pts is managed by an expert toxicities team. Infact we don’t have no-one toxic death.
    VL  - 3
    IS  - 6
    ER  - 

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  • U. O. C. Oncologia Medica S. O. “Mariano Santo” Azienda Ospedaliera Cosenza; Ospedale Mariano Santo UOC Oncologia Medica (dir S. Palazzo) c/da Muoio Piccolo 87100 Cosenza, Italy

  • U. O. C. Oncologia Medica S. O. “Mariano Santo” Azienda Ospedaliera Cosenza

  • U. O. C. Oncologia Medica S. O. “Mariano Santo” Azienda Ospedaliera Cosenza

  • U. O. C. Oncologia Medica S. O. “Mariano Santo” Azienda Ospedaliera Cosenza

  • U. O. C. Oncologia Medica S. O. “Mariano Santo” Azienda Ospedaliera Cosenza

  • U. O. C. Oncologia Medica S. O. “Mariano Santo” Azienda Ospedaliera Cosenza

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