Phase II trial of paclitaxel/cisplatin followed by surgery and adjuvant radiation therapy and 5-fluorouracil/leucovorin for gastric cancer (ECOG E7296)

A. Bapsi Chakravarthy*, Paul J. Catalano, Joshua K. Mondschein, David I. Rosenthal, Daniel G. Haller, Richard Whittington, Francis R. Spitz, Henry Wagner, Elin R. Sigurdson, Loren K. Tschetter, Gerald K. Bayer, Mary F. Mulcahy, Al B. Benson

*Corresponding author for this work

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3 Scopus citations

Abstract

BACKGROUND: Randomized trials have shown an increase in survival with perioperative chemotherapy as well as with postoperative chemoradiation. It was hypothesized that combining induction chemotherapy with postoperative chemoradiation would be well tolerated and improve pathologic complete response. METHODS: Patients with resectable cancers of the stomach/gastroesophageal junction were eligible. Neoadjuvant chemotherapy consisted of 3 cycles of paclitaxel and cisplatin. Adjuvant therapy consisted of 1 cycle of 5-fluorouracil (FU) and leucovorin (LV) followed by chemoradiation (45 Gy with concurrent 5-FU/LV). Chemoradiation was followed by 2 additional cycles of 5-FU/LV. Response to neoadjuvant therapy was based on pathology. RESULTS: From 1999 to 2002, 38 eligible patients were enrolled; 35 completed induction chemotherapy, and 29 went on to surgery. Sixteen patients did not develop metastatic progression, 10 developed metastatic disease, and 12 were unevaluable. There were no pathologic complete responses after induction therapy. Twenty-five of 38 patients suffered grade 3-4 toxicities during induction paclitaxel/cisplatin. Six of the 7 patients who received postoperative therapy suffered grade 3-4 toxicities. Only 3 of 38 (7.9%) eligible patients completed all assigned treatment. The median overall survival was 1.6 years, and the 2-year survival was 40%. CONCLUSIONS: This regimen of neoadjuvant paclitaxel/cisplatin followed by postoperative 5-FU/LV-based chemoradiation did not have a high enough response rate and proved to be too toxic for further development.

Original languageEnglish (US)
Pages (from-to)191-197
Number of pages7
JournalGastrointestinal Cancer Research
Volume5
Issue number6
StatePublished - Nov 1 2013

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ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

Bapsi Chakravarthy, A., Catalano, P. J., Mondschein, J. K., Rosenthal, D. I., Haller, D. G., Whittington, R., Spitz, F. R., Wagner, H., Sigurdson, E. R., Tschetter, L. K., Bayer, G. K., Mulcahy, M. F., & Benson, A. B. (2013). Phase II trial of paclitaxel/cisplatin followed by surgery and adjuvant radiation therapy and 5-fluorouracil/leucovorin for gastric cancer (ECOG E7296). Gastrointestinal Cancer Research, 5(6), 191-197.