Perioperative Docetaxel, Cisplatin, and 5-Fluorouracil Compared to Standard Chemotherapy for Resectable Gastroesophageal Adenocarcinoma

• Published in: European journal of surgical oncology 2017-01, Vol.43 (1), p.218-225
• Main Authors: Kim, Stefano, Paget-Bailly, Sophie, Messager, Mathieu, Nguyen, Thierry, Mathieu, Pierre, Lamfichekh, Najib, Fein, Francine, Fratté, Serge, Cléau, Denis, Lakkis, Zaher, Jary, Marine, Sakek, Nacera, Jacquin, Marion, Foubert, Audrey, Bonnetain, Franck, Mariette, Christophe, Fiteni, Frederic, Borg, Christophe
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - surgery; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cisplatin - administration & dosage; Combined Modality Therapy; Docetaxel; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - surgery; Female; Fluorouracil - administration & dosage; France; Gastric cancer; Gastroesophageal cancer; Hematology, Oncology and Palliative Medicine; Humans; Male; Middle Aged; Neoadjuvant; Preoperative; Propensity Score; Retrospective Studies; Stomach Neoplasms - drug therapy; Stomach Neoplasms - surgery; Surgery; Survival Analysis; Taxane; Taxoids - administration & dosage; Treatment Outcome
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2016.06.395

Abstract Background Even though the perioperative chemotherapy improves the overall survival (OS) compared to surgery alone in patients with a resectable gastroesophageal adenocarcinoma (GEA), prognosis of these patients remains poor. Docetaxel (D), cisplatin (C), and 5-fluorouracil (F) regimen improves OS compared to CF among patients with advanced GEA. We evaluated the potential interest of a perioperative DCF regimen, compared to standard (S) regimens, in resectable GEA patients. Methods We identified 459 patients treated with preoperative DCF or S regimens among patients with resectable GEA between 2006 and 2012 based in two French retrospective databases. The primary endpoint was OS. Propensity scores were estimated with a logistic regression model in which all baseline covariates were included. We then used two methods to take PS into account and thus make DCF and S patients comparable. OS analyses were performed with Kaplan-Meier and Cox models in propensity score matched samples, and inverse probability of treatment weighted (IPTW) samples. Results In the propensity score matched sample (58 patients for each group), the p-value from the log rank test for OS was equal to 0.0961, and the 3-year OS rate was 73% and 55% in DCF and S groups, respectively. The multivariate Cox regression underlined a Hazard Ratio (HR) of 0.55 (95% CI 0.27-1.13) for DCF patients compared to S patients. The results from IPTW analyses showed that DCF was significantly and independently associated with OS (HR=0.52; 95% CI 0.40-0.69). Conclusions In this retrospective multicenter, hypothesis-generating study, the propensity score analyses underlined encouraging results in favor of DCF compared to standard regimens regarding OS. This promising result should be validated in a phase-3 trial.