DCF vs ECF in gastric cancer

Advanced Gastric Adenocarcinoma in Jordan: Epidemiology and Efficacy of two different regimens
Salah .Y Abbasi , MD., Adnan M Saad ,MD., Ahmed .M. Badheeb, MD.
Medical Oncology Department, King Hussein Cancer Centre, Amman, Jordan.
Tables and Figures
Purpose
The goal of our study is to evaluate the epidemiological and the
clinico-pathological features of gastric cancer in Jordan, and to
report the treatment outcomes of advanced gastric cancer at a
single institution; King Hussein Cancer Center (KHCC), where
approximately 70% of Jordanian oncology patients are treated.
Also we aimed to retrospectively compare the outcome of two
different regimens (ECF and DCF) in the treatment of non
resectable gastric cancer. The choice of chemotherapy regimen
was according to KHCC clinical practice guidelines which were
changed on January 2008 from ECF to DCF as first line therapy
for advanced gastric cancer.
Introduction
Gastric cancer (GC) is the fourth most common cancer worldwide
and the second most common cancer-related death in the world.
The incidence in the Middle East countries is relatively low with
rates 5 to 15 times lower than in Japan. Major risk factors for
stomach cancer are hypothesized to be nutritional and
environmental, including Helicobacter Pylori (H. pylori) infection, the
prevalence of which ranges from 25% in the developed countries to
80-90% in the developing countries. Advanced gastric cancer
patients have poor prognosis with a median survival of 3 to 5
months if untreated. Although, we have increasing armamentarium
of chemotherapy agents in gastric cancer, there is no consensus
about the optimal palliative chemotherapy for advanced disease or
whether triplet regimens are superior to doublet regimens. The
combination of Epirubicin, Cisplatin, and infusioanl Fluorouracil
(ECF) was shown by Webb et al to result in a median survival of 8-
9 months, with higher response rates, a tolerable toxicity, and a
better quality of life (QOL) compared with fluorouracil, doxorubicin
and Methotrexate (FAMTX). Van Cutsem et al showed that
docetaxel, cisplatin, and fluorouracil (DCF) regimen is superior to
(CF) in terms of response rate, time to tumor progression, and
median survival. Gastric cancer epidemiology and treatment
outcomes are not well characterized in the Middle Eastern
population. Gastric cancer in Jordan constitutes 3.2% of new
cancer cases; one study from Jordan showed an age adjusted
incidence of 5.82/100,000 population/year.
Conclusions:
• Some epidemiological features of GC in Jordan mimic those of
high risk areas.
• Our outcomes of chemotherapy are comparable to the
internationally reported data, and suggest superiority of the DCF
regimen over ECF in terms of RR and TTP but not MS.
The authors acknowledge Mohammad R. Al-Qudimat, RN, MSN, for his valuable
contribution in poster and figures design
Total DCF
(N=30)
Count (%)
ECF
(N=113)
Count (%)
p-value
Age (years) Median (range) 143 58 (22-75) 59 (20-76) 0.40
Gender
Female 50 11(36.7%) 39(34.5%) 0.83
Male 93 19(63.3%) 74(65.5%)
Performance status (ECOG)

0 121 27(90.0%) 94(83.2%) 0.46
1 17 3(10.0%) 14(12.4%)
2 5 5(4.4%)
Stage at diagnosis
locally
advanced
46 8(26.7%) 38(33.6%) 0.47
Metastatic 97 22(73.3%) 75(66.4%)
Site of primary tumor
Stomach 113 23(76.7%) 90(79.6%) 0.75
Lower
esophageal
7 1(3.3%) 6(5.3%)
GEJ 23 6(20.0%) 17(15.0%)
Presence of H.pylroi at presentation
Yes 111 23(76.7%) 88(77.9%) 0.85
No 11 3(10.0%) 8(7.1%)
Non-available 21 4(13.3%) 17(15.0%)
Time between first symptoms and diagnosis
(months)
Median (range) 143 6.0 (2-12) 6.0 (1-12) 0.27
Number of chemotherapy cycles Median (range) 143 6 (1-8) 6 (1-8) 0.56
Fig 2: Kaplan-Meier estimate of time to tumor progression among advanced
gastric cancer patients treated with DCF or ECF.
Table1: Characteristics of treated patients (N=143)
Fig 1: Kaplan-Meier estimate of overall survival among advanced gastric
cancer patients treated with DCF or ECF.
Results
The median age at presentation was 59 years with male: female
ratio of 1.8:1. Lymph nodes (67.9%) and liver (49.4%) were the
most common sites of metastasis. 78.4% had stomach as the
primary site versus 16.7% for gastroesophageal junction and
4.9% for lower esophageal tumor. Poorly differentiated histology
was predominant (46.9%). Anemia (53.7%), pain (48.1%), and
reflux (44.4%) were the most common presenting symptoms.
79% had helicobacter pylori infection at presentation. Average
time between initial symptom and diagnosis was 6.0 months.
Characteristics of the treated patients (Table 1) were well
balanced between the DCF and the ECF groups.
The overall response rate (RR) was 59.3% with DCF and 32.6%
with ECF (p=0.01). Time to tumor progression (TTP) was 6.9
months with DCF and 5.9 months with ECF (p=0.005). Median
survival (MS) was 11.0 months with DCF and 10.2 months with
ECF (p=0.17) (Figures 1 and 2).
Multivariate analysis showed that the patient characteristics
including gender, performance status, stage, site of primary
tumor and histology have no impact on survival or response to
chemotherapy.
Methods
Charts of patients with gastric malignancies, who were seen and
treated at KHCC in Jordan between January, 2004 and
December, 2008 were reviewed. 294 patients were identified ;
26 of them had histology other than adenocarcinoma and were
excluded. Of the remaining 268 cases , only 162 were
inoperable adenocarcinoma or undifferentiated carcinoma of the
lower esophagus , gastroesophageal junction (GEJ) or stomach.
Data was retrospectively collected for those 162 cases and was
included in our analysis. 143 patients were treated with either
DCF (30) or ECF (113).
The primary tumor was classified as inoperable on the basis of
either the findings on laparotomy or computerized tomography
(CT) scan and the endoscopic results.

DCF vs ECF in gastric cancer

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