Docetaxel-based perioperative chemotherapy in gastric and gastroesophageal (GEJ) adenocarcinomas – a real world experience from a tertiary cancer centre in India

Locally advanced gastric and gastroesophageal adenocarcinomas constitute an important cause of cancer related mortality in India. Complete curative resection with D2 lymphadenectomy is the definitive treatment modality. Perioperative docetaxel based chemotherapy has a significant impact on the survival outcomes of these patients. In this institutional retrospective audit we report the feasibility and safety of two different docetaxel based regimens viz DOX and FLOT.

We analysed our database of 45 patients diagnosed with locally advanced gastric and GEJ adenocarcinoma who received treatment at our centre from January 2021 to December 2022. 17 patients were diagnosed with gastroesophageal junction (GEJ) and 28 patients had gastric adenocarcinoma. 42(93%) patients received perioperative chemotherapy with either DOX or FLOT regimens. FLOT was administered with docetaxel (60 mg/m2), oxaliplatin (85 mg/m2), leucovorin (200 mg/m2), and 5-fluorouracil (2,600 mg/m2 as a 24 hr infusion), given on day 1 every 2 weeks. DOX constituted docetaxel (50 mg/m2),oxaliplatin (85 mg/m2),capecitabine (1000 mg/m2 twice daily continuously ) given every 2 weeks. The details of the patients including diagnosis, imaging, tumor board plan, chemotherapy and toxicities were retrieved from our electronic medical records and analysed retrospectively.

The patients were aged 34 to 70 years (median 56 years) and 12 (26%) were women. 25(59%) patients received FLOT regimen and 17 (40 %) patients received DOX. 14(82%) patients on DOX underwent curative resection with gastrectomy and D2 lymphadenectomy among whom 6 (42%) had pathological Tumour Regression score (TRS) of 0 or 1. 21 (84%) patients in FLOT group have undergone curative resection of whom 7 (33%) had TRS of 0 or 1. 7 (16%) out of the total patients who received either DOX or FLOT had progressive disease and were inoperable on table due to peritoneal disease. The number of patients who completed the entire planned course of chemotherapy cycles in the DOX and FLOT groups are 12(85%) and 17(80% ) respectively. One patient in DOX group and 2 in the FLOT group had grade 3 and 4 neutropenia. Grade 3 Hand foot syndrome was noticed in 2 patients with DOX chemotherapy. The subsequent chemotherapy was changed to S1 plus Oxaliplatin in both of them. The incidence of grade 1/2 mucositis and diarrhea was similar in both the groups. 2 patients died due to chemotherapy related febrile neutropenia and septic shock. Dose reduction was required in 1(4%) of patients in DOX and 4(16%) patients in the FLOT groups. Four patients in the FLOT group received FOLFOX/CAPEOX subsequently due to poor performance status post operatively.

DOX and FLOT chemotherapy regimens are well tolerated with similar responses in the perioperative setting in Indian patients with gastric and GEJ adenocarcinoma. The patients in both the groups are currently under follow up to capture the recurrence patterns, overall and relapse free survival duration. Limited by its size and retrospective nature, our audit points towards the need for a prospective well conducted study to compare these two regimens.

The authors.

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All authors have declared no conflicts of interest.