Pilot Study Comparing Epirubicin, Oxaliplatin, Capecitabine (EOX) and Docetaxel, Cisplatin, and 5-Fluorouracil (TCF) Regimens in Neoadjuvant Chemotherapy for Gastric Cancer Patients

Abstract

Background: Neoadjuvant chemotherapy (NACT) can improve quality of life and reduce symptoms in patients with inoperable gastric cancer (GC). Despite several evaluations, a single standard regimen for NACT in patients with advanced GC has not yet been established. Objectives: This study aimed to compare the response rate and side effects of the epirubicin, oxaliplatin, and capecitabine (EOX) chemotherapy regimen with those of the docetaxel, cisplatin, and 5-fluorouracil (TCF) regimen in the NACT of GC patients. Methods: This randomized, pilot, double-blind clinical trial was conducted on patients with GC referred to Velayat Educational and Therapeutic Hospital, Qazvin, Iran, in 2023 - 2024. Forty patients were divided into two intervention groups. The first group received the EOX treatment regimen (epirubicin 50 mg/m2 on day 1, oxaliplatin 130 mg/m2 on day 1, and capecitabine 625 mg/m2, BD, from day 1 through day 21) for three weeks, and the second group received the TCF treatment regimen (docetaxel 75 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1, and 5-fluorouracil 750 mg/m2 from day 1 through day 5) for three courses. Demographic and laboratory data were recorded in a checklist, and the response to chemotherapy was compared between the two groups. Results: The results showed that before the intervention, there was a significant difference between the two groups in terms of TNM classification and disease stage; however, after the intervention, no significant difference was observed. The EOX regimen impacted disease stages T3N1M0, T3N2M0, and IIIA, while the TCF regimen had a greater effect on stages T3N2M0, T4N2M0, IIIC, and IIIB. In addition, no significant difference was observed between the two groups regarding the degree of differentiation before and after the intervention, although the TCF regimen had a greater effect on poorly differentiated tumors, while the EOX regimen had a greater effect on moderately differentiated tumors. Overall, complications following chemotherapy, particularly nausea and vomiting, were less frequent in the EOX regimen; however, the difference was not statistically significant. Conclusions: The TCF and EOX regimens yield similar outcomes in terms of efficacy, although the incidence of side effects was lower with the EOX regimen. Both regimens are recommended as first-line treatments for patients with advanced GC.