Clinical Research Papers:

Clinical efficacy of neoadjuvant chemotherapy regimens FLEEOX vs. XELOX in patients with initially unresectable advanced gastric cancer: a propensity score analysis

Yang Li, Jun Chen, Qi He, Xiang Ji, Xulin Wang, Chaogang Fan and Guoli Li _

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Oncotarget. 2017; 8:86886-86896. https://doi.org/10.18632/oncotarget.19004

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Yang Li1,2,*, Jun Chen2,*, Qi He2, Xiang Ji2, Xulin Wang2, Chaogang Fan2 and Guoli Li2

1Division of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, 710032, Xi’an, Shaanxi, China

2Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China

*These authors have contributed equally to this work

Correspondence to:

Guoli Li, email: [email protected]

Keywords: initially unresectable advanced gastric cancer, neoadjuvant chemotherapy, tumor response rate, overall survival, chemotherapy-related toxicity

Received: February 23, 2017    Accepted: May 15, 2017    Published: June 28, 2017


Purpose: This study was designed to assess the effectiveness of FLEEOX (5-Fu, leucovorin, etoposide, oxaliplatin, and epirubicin) compared with XELOX (capecitabine and oxaliplatin) as neoadjuvant chemotherapy (NAC) for initially unresectable advanced gastric cancer (AGC).

Methods: This study reviewed patients who underwent FLEEOX or XELOX for initially unresectable AGC. To reduce the bias in patient selection, we conducted propensity score match (PSM) with 1:1 ratio. Tumor and pathological response, surgical characteristics, chemotherapy-related toxicity and overall survival (OS) were analyzed.

Results: From January 2004 to December 2012, 436 patients were enrolled; 99 pairs of patients were generated after PSM. The tumor response rates were 80.8% and 68.7% in FLEEOX and XELOX (P=0.018). 80 patients (80.8%) in FLEEOX and 63 (63.6%) in XELOX received radical resection (P<0.001). The pathological complete response rate and R0 rate were 11.1% and 69.7% in FLEEOX, respectively, while 4.8% and 38.4% in XELOX (P<0.001). Median OS time was longer in FLEEOX (30.0 vs. 25.1 months, P<0.001). In addition, more toxicities occurred in FLEEOX, including leukocytopenia (17.2% vs. 7.1%, P=0.024), nausea (17.2% vs. 6.1%, P=0.012) and vomiting (22.2% vs. 10.1%, P=0.016). The overall toxicity rate was higher in FLEEOX (71.7% vs. 35.4%, P<0.001).

Conclusion: The FLEEOX regimen as NAC for patients with initially unresectable AGC can improve tumor response rate, radical resection rate, R0 rate, and OS as compared to XELOX regimen. More chemotherapy-related toxicity was observed in FLEEOX group, although no chemotherapy-related deaths and aborting were observed. Further randomized clinical trials on the FLEEOX regimen are necessary.

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