Asia-Pacific journal of clinical oncology · 2025
Effectiveness of Neoadjuvant Chemotherapy With Docetaxel, Cisplatin, and S-1 for Locoregionally Advanced Gastric Adenocarcinoma: Findings From a University Hospital in Vietnam.
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Tran Tho Vinh, Thai Truc Thanh, La Loi Ngoc, Van Dinh Ngon, Long Vo Duy, Nguyen Bac Hoang
Аннотация
AIM: To evaluate treatment results of a neoadjuvant regimen consisting of Docetaxel + Cisplatin + S-1 (DCS) in patients with locoregionally advanced unresectable gastric adenocarcinoma characterized by tumors with bulky regional lymph nodes (T1-4a, N-bulky, M0) or T4b tumors (any N, M0)).
METHODS: This study included 78 patients with locoregionally advanced gastric adenocarcinoma treated at a university hospital in Vietnam, comprising 47 retrospective and 31 prospective cases. Patients received 2 - 4 cycles of DCS chemotherapy, with each cycle comprising intravenous docetaxel (35 mg/m2) and cisplatin (35 mg/m2) on days 1 and 15, and oral S-1 (40 mg/m2/twice daily) from days 1 to 14, repeated every 4 weeks. Clinical treatment response was assessed after every three cycles and re-staging evaluation by using the RECIST criteria and contrast-enhanced CT scans after 2 - 4 cycles, depending on patient response and tolerability. Patients with a good response and down-staging were referred for gastrectomy.
RESULTS: The median age was 58 years, and 64.1% were male. Following neoadjuvant chemotherapy, the proportion of T4b tumors decreased from 78.2% to 52.6%, while T4a tumors increased from 20.5% to 43.6%. The rate of N-bulky decreased from 23.1% to 11.5%. Anemia and neutropenia were the most common hematological toxicities, predominantly grade 1-2. Gastrointestinal toxicity and hair loss were the most frequent clinical adverse events, mostly grade 1-2. Among 65 patients (83.3%) achieving an objective response to neoadjuvant chemotherapy, 42 (53.8%) underwent gastrectomy, with R0 resection achieved in 92.9%.
CONCLUSION: Neoadjuvant chemotherapy using the DCS regimen every 4 weeks demonstrated high effectiveness and safety in patients with locoregionally advanced unresectable gastric adenocarcinoma characterized by extensive regional metastases, and increased their eligibility for successful gastrectomy (R0 resection).
TRIAL REGISTRATION: This study is a retrospective and prospective cohort study, not a clinical trial.
METHODS: This study included 78 patients with locoregionally advanced gastric adenocarcinoma treated at a university hospital in Vietnam, comprising 47 retrospective and 31 prospective cases. Patients received 2 - 4 cycles of DCS chemotherapy, with each cycle comprising intravenous docetaxel (35 mg/m2) and cisplatin (35 mg/m2) on days 1 and 15, and oral S-1 (40 mg/m2/twice daily) from days 1 to 14, repeated every 4 weeks. Clinical treatment response was assessed after every three cycles and re-staging evaluation by using the RECIST criteria and contrast-enhanced CT scans after 2 - 4 cycles, depending on patient response and tolerability. Patients with a good response and down-staging were referred for gastrectomy.
RESULTS: The median age was 58 years, and 64.1% were male. Following neoadjuvant chemotherapy, the proportion of T4b tumors decreased from 78.2% to 52.6%, while T4a tumors increased from 20.5% to 43.6%. The rate of N-bulky decreased from 23.1% to 11.5%. Anemia and neutropenia were the most common hematological toxicities, predominantly grade 1-2. Gastrointestinal toxicity and hair loss were the most frequent clinical adverse events, mostly grade 1-2. Among 65 patients (83.3%) achieving an objective response to neoadjuvant chemotherapy, 42 (53.8%) underwent gastrectomy, with R0 resection achieved in 92.9%.
CONCLUSION: Neoadjuvant chemotherapy using the DCS regimen every 4 weeks demonstrated high effectiveness and safety in patients with locoregionally advanced unresectable gastric adenocarcinoma characterized by extensive regional metastases, and increased their eligibility for successful gastrectomy (R0 resection).
TRIAL REGISTRATION: This study is a retrospective and prospective cohort study, not a clinical trial.