Clinical Observation Of FOLFOX4 Regimen Versus ECF Regiment In Treatment Of Advanced Gastric Carcinoma

Background Gastric cancer currently ranks second in global cancer mortal。80 to 90% of all patients are either diagnosed at an advanced stage when the tumour is inoperable, or develop a recurrence within five years. Chemotherapy clearly improves survival in comparison to best supportive care only. In addition, combination chemotherapy further improves survival compared to single-agent chemotherapy. Among the combination chemotherapy regimens studied, best survival results are achieved with regimens containing 5-FU, anthracyclines and cisplatin. Among these, ECF (epirubicin, cisplatin and continuous infusion 5-FU) is tolerated best.However, ECF has higher rates of adverse effects, and their impact on the patients quality of life has been adequately studied. Oxaliplatin is third generation of platinum compound, and the mechanism of antineoplastic activity is inhibiting DNA synthesis.Clinial evidences supported Oxaliplatinwith high tumor reponse rate and prolong progression free survival in gastrocolic cancer and without cross resistance to ather platimum agents.The most popular regimen is infusion leucovorin and 5-fluourouracil (FOLFOX) for advanced gastric cancer. Objective To compare the curative effect and the side effects of the regimen of FOLFOX4 (Leucovorin , 5-Fluorouracil and Oxaliplatin) with the regimen of ECF ( Epirubicin , Cisplatin ,5-FU and Leucovorin).Methods: analyze the clinical data of 293 patints with advanced gastric cancer treated by FOLFOX4 or ECF in our hospital during Jan 1997and Dem 2008, to compare the curative effect and the side effects of the two regimens. FOLFOX4 regimen: L-OHP (85mg/m2 ivd2h d1) were given first, CF (200mg/m2 ivd2h d1, d2) followed by 5-FU (200mg/m2 ivd d1-d5 ) were given. FOLFOX4 regimen was repearted every 14 days. ECF regimen: EPI (50mg/m2 iv d1), 5-FU (400mg/m2 ivd96h) and DDP (20mg/m2 ivd d1-d5) were given. ECF regimen was repeated every 21 days.Result:①FOLFOX4 group MST 23.8 mouths, mPFS 13.8 months.3 year survival 39.7%, 5 year 27.9%.ECF group MST 18.3 months, mPFS 10.49 months.3 year survival 30.8%, 5 year 22.1%, P=0.161,0.195.②For patients without complete exairesis, FOLFOX4 RR 51.3%, RR+SD 82.1%, ECF group RR 46.7%, RR+SD 77.8%, P>0.05. For old patients, RR and RR+SD in FOLFOX4 are higher than ECF, <0.05. FOLFOX4 group MST 10.76 mouths, PFS 6.87months, 1 year survival 48.7%, 2 year OS 11.5%. ECF group MST 9.8 mouths, PFS 6.11months, 1 year survival 44.4%, 2 year OS 8.9%. P=0.361,0.405.③For patient with complete exairesis, FOLFOX4 group MST 41.0 mouths, mPFS 32.0 months.3 year survival 56.8%, 5 year 35.1%.ECF group MST 39.0 months,3 year survival 52.5%,5 year 23.7%, P=0.806.④The main side effects were in ECF group is grade III and IV leucopenia,vomiting, cardiotoxic,alopecie in EPLF group P<0.05. The main side effect of FOLFOX4 is neuritis P<0.05, The toxicity is mild and tolerable.Conclusions:The regimens of FOLFOX4 and ECF are both effective as the first-line treatment of advanced gastric carcinoma. FOLFOX4 regimen is better suitable for the patients who are elder and weaker or with leucepenia after chemotherapies.