Clinical efficacy and safety of standard versus modified DCF regimens in treatment of advanced gastric cancer

Docetaxel and cisplatin plus fluorouracil (DCF) is one standard regimen in the treatment of advanced gastric cancer (AGC). Due to substantial toxicity of DCF, modified DCF regimens have been developed to improve efficacy and safety. This study aimed to compare the clinical efficacy and safety between the standard DCF regimen and three common modified DCF regimens. A total of 97 consecutive AGC patients were admitted. Patients are divided into the standard DCF group (n=53) and three modified DCF groups with regimen of docetaxel, oxaliplatin and capecitabine (DOX, n=14), regimen of docetaxel, oxaliplatin and 5-fluorouracil (DOF, n=13), and regimen of paclitaxel, docetaxel and 5-fluorouracil (PDF, n=17), respectively. The efficacy and associated adverse reactions were compared between groups with different DCF regimens. The overall response rates were 37.2% (DCF), 42.9% (DOX), 33.3% (DOF) and 35.3% (PDF), respectively, and DOX group showed relatively higher efficacy than those in the other three groups. The median progression-free survival (PFS) was 4.8, 6.0, 4.7 and 4.0 month, and median overall survival (OS) was 9.3, 11.8, 9.0 and 8.0 month in DCF, DOX, DOF and PDF groups, respectively. There were no statistical differences among groups in PFS and OS (P>0.05). The incidence of hematological toxic reactions was relatively lower in the modified DCF groups than in the standard DCF group. The hand-foot syndrome was most common in the DOX group and neurotoxic reactions in the DOX and DOF groups. All adverse reactions were mild (Degree I-II), and there were no statistically significant differences in incidence of adverse reactions among groups (P>0.05). In conclusion, three modified DCF regimens are not inferior options for AGC treatment compared with the standard DCF. DOX regimen can be considered as is a superior alternative regimen for first-line treatment of AGC, which demonstrates moderately increased efficacy and significantly reduced adverse reactions.