Efficacy of preoperative chemotherapy regimens in patients with initially unresectable locally advanced gastric adenocarcinoma: capecitabine and oxaliplatin (XELOX) or with epirubicin (EOX)

// Yan Wang 1,* , Rong-yuan Zhuang 1,* , Yi-yi Yu 1 , Shan Yu 1 , Jun Hou 2 , Yuan Ji 2 , Yi-hong Sun 3 , Kun-tang Shen 3 , Zhen-bin Shen 3 , Feng-lin Liu 3 , Nai-qing Zhao 4 and Tian-shu Liu 1,5 1 Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China 2 Department of Pathology, Fudan University, Zhongshan Hospital, Shanghai, China 3 Department of General Surgery, Fudan University, Zhongshan Hospital, Shanghai, China 4 Department of Biostatistics and Social Medicine, School of Public Health, Fudan University, Shanghai, China 5 Center of Evidence-based Medicine, Fudan University, Shanghai, China * These authors are co-first authors and contributed equally to this work Correspondence to: Tian-shu Liu, email: // Keywords : locally advanced gastric cancer, preoperative chemotherapy, resection rate Received : May 07, 2016 Accepted : August 25, 2016 Published : September 01, 2016 Abstract Purpose We assessed the effectiveness of EOX (capecitabine, oxaliplatin and epirubicin) compared with XELOX (capecitabine and oxaliplatin) as preoperative chemotherapy for initially unresectable locally advanced gastric cancer. Methods This is a prospective observational study. Patients with unresectable locally advanced gastric cancer were performed EOX regimen or XELOX regimen at the discretion of the investigators. They were assessed for response every 2 cycles by CT (computed tomography) scan. A multidisciplinary team reassessed resectability after 4 cycles. The primary endpoint was the response rate. Secondary end points included the R0 resection rate, survival and adverse events. Results From November 2008 to May 2015, 242 patients were enrolled; 112 of them were assigned to EOX regimen and 130 to XELOX regimen. The response rates were 33.0% and 33.8% respectively in EOX group and XELOX group ( P = 0.997). After 4 cycles of chemotherapy, 63 patients (56.3%) in EOX group and 81 patients (62.3%) in XELOX group received radical operation ( P = 0.408). There was no significant difference in progress-free survival (PFS, 12.0m vs . 15.4m, P = 0.925) and overall survival (OS, 25.7m vs . 29.0m, P = 0.783) in two groups. In addition, more adverse effects occurred in EOX group, such as more leucopenia (22.3% vs . 10.0%, P = 0.014), neutropenia (23.2% vs . 11.5%, P = 0.025), fatigue (11.6% vs . 3.8%, P = 0.041) and vomiting (10.7% vs . 2.3%, P = 0.015). Conclusions For unresectable locally advanced gastric cancer patients, XELOX regimen showed similar effects in response rate, radical resection rate and survival benefits, but with less toxicity effects.