Comparison of ECF, DCF, FOLFOX and FLOT regimens as perioperative treatment among patient with resectable signet ring cell gastric cancer

Introduction: signet-ring cell carcinoma (SRCC) is considered as a poor prognosis and chemoresistance type of gastric cancer. Although SRCC has a low survival rate, perioperative chemotherapy has shown advantages on overall and progression-free survival and progression-free survivalof the patient with resectable SRCC gastric cancer. However, the best chemotherapy approach in this setting is not established yet. We aim to evaluate the effect of 4 common perioperative chemotherapy regimens which use in SRCC gastric cancer treatment. Method: A total of 41 patients from July 2015 until 2019 were enrolled in this retrospective study. Patients had documented evidence of signet-ring cell carcinoma gastriccancer and received one of the perioperative chemotherapy regimens including FOLFOX (n=7), DCF (13), ECF (n=9) and FLOT (12). The primary endpoints were overall response rate based on RECIST criteria and R0 resection rate. In addition, overall survival and progression-free survival, and toxicity were considered as a secondary endpoint, which was estimated by Kaplan-Meier curves and Cox regression formultivariate analysis. Toxicity was evaluated according to CTCAE v4. 0 criteria. Result: mean age of patients was 55.37±11.64. The Overall response rate were shown 44.4% for ECF, 61.5% for DCF, 42.9% for FOLFOX and 83.3% for FLOT regimen (p=0.137). The R0 resection rate was 55.6%, 62.9%, 57.1% and 75% for ECF, DCF, FOLFOX and FLOT regimen, respectively (P=0.579). The median PFS which were obtained from KM curve showed 7, 10, 14 and 18 months in ECF, DCF, FOLFOX, and FLOT groups, respectively (log-rank=0.387). The median overall survival was 15 months for the ECF regimen, 22 months for DCF regimen, 15 months for FOLFOX regimen and 26 months for FLOT regimen which was significantly higher in comparison to other regimens (log-rank=0.43). All groups showed acceptable toxicity, grade 3-4 neutropenia were 20.4%, 30.8%, and 14.3% in ECF, DCF, FOLOFX, and FLOT groups and mucositis22. 2%, 15,4%, 0%, 8.3% in ECF, DCF, FOLOFX and FLOT groups, respectively. Toxicityhad no significant differences in both grades 3-4 neutropenia and Mucositis (P=0.303, P=0.461807). In multivariate analysis, the response rate was found to be an independent predictor of survival. Conclusion: all chemotherapy regimens were comparable in R0 resection rate, ORR, PFS, and toxicity. although, FLOT regimen associated with higher overall survival in SRCC gastric cancer. Therefore, we deduced FLOTregimen seems to be effective and safe as a preparative regimen in a patient with signet-ring cell carcinoma gastric cancer

Keywords:

gastriccancer , signetring