Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Choice of Capecitabine or S1 in Combination with Oxaliplatin based on Thymidine Phosphorylase and Dihydropyrimidine Dehydrogenase Expression Status in Patients with Advanced Gastric Cancer

  • Xu, Rong (Department of Oncology, People's Hospital of Xinjiang Uygur Autonomous Region) ;
  • He, Xiaolei (Department of Hepatopathy, The First Affiliated Hospital of Xinjiang Medical University) ;
  • Wufuli, Reyina (Department of Oncology, People's Hospital of Xinjiang Uygur Autonomous Region) ;
  • Su, Ying (Department of Oncology, People's Hospital of Xinjiang Uygur Autonomous Region) ;
  • Ma, Lili (Department of Oncology, People's Hospital of Xinjiang Uygur Autonomous Region) ;
  • Chen, Ru (Department of Oncology, People's Hospital of Xinjiang Uygur Autonomous Region) ;
  • Han, Zhongcheng (Department of Oncology, People's Hospital of Xinjiang Uygur Autonomous Region) ;
  • Wang, Fang (Department of Oncology, People's Hospital of Xinjiang Uygur Autonomous Region) ;
  • Liu, Jiang (Department of Oncology, People's Hospital of Xinjiang Uygur Autonomous Region)
  • Received : 2019.03.05
  • Accepted : 2019.10.03
  • Published : 2019.12.31
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Abstract

Purpose: To study the efficacy of capecitabine or S-1 plus oxaliplatin (CAPOX or SOX) for treating thymidine phosphorylase (TP)- or dihydropyrimidine dehydrogenase (DPD)-positive advanced gastric cancer. Materials and Methods: Eighty-six patients with stage IIIC to IV gastric cancer were assessed for TP and DPD expression by immunohistochemistry. The association between CAPOX or SOX efficacy and TP/DPD expression was retrospectively analyzed. Results: There were no significant differences in the objective remission rate (ORR, 52.27% vs. 47.62%; P>0.05), disease control rate (72.73% vs. 73.81%, P>0.05), progression-free survival (hazard ratio [HR], 1.119; 95% confidence interval [CI], 0.739-1.741; P=0.586), and overall survival (OS; HR, 0.855; 95% CI, 0.481-1.511; P=0.588) between CAPOX and SOX. A higher number of stage IV patients showed TP positivity, while DPD-positive patients predominantly showed intestinal type of gastric cancer. In TP-positive patients, the ORRs associated with CAPOX and SOX treatments were 57.14% and 38.10%, respectively; OS was better with CAPOX than with SOX (HR, 0.447; 95% CI, 0.179-0.978; P=0.046). Among DPD-positive patients, the SOX treatment-associated ORR (60.87%) was significantly higher than the CAPOX treatment-associated ORR (43.48%). Furthermore, SOX treatment resulted in better OS than did CAPOX treatment (HR, 2.020; 95% CI, 1.019-4.837; P=0.049). Conclusions: No significant difference in clinical efficacy was found between CAPOX and SOX. TP-positive patients might respond better to CAPOX while DPD-positive patients may respond better to SOX. Our findings might serve as a guide for personalized chemotherapy for gastric cancer.

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References

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