Gastric Cancer

, Volume 21, Issue 6, pp 1050–1057 | Cite as

Salvage chemotherapy with the combination of oxaliplatin, leucovorin, and 5-fluorouracil in advanced gastric cancer refractory or intolerant to fluoropyrimidines, platinum, taxanes, and irinotecan

  • Chihiro Kondoh
  • Shigenori KadowakiEmail author
  • Azusa Komori
  • Yukiya Narita
  • Hiroya Taniguchi
  • Takashi Ura
  • Masashi Ando
  • Kei Muro
Original Article



Although nivolumab showed survival benefit in patients with advanced gastric cancer (AGC) progressing after standard chemotherapy, there is a lack of data regarding oxaliplatin-based chemotherapy in this clinical setting.


We retrospectively evaluated the efficacy and safety of oxaliplatin with l-leucovorin and bolus/continuous infusion of 5-fluorouracil as salvage treatment in patients with AGC refractory or intolerant to fluoropyrimidines, cisplatin, taxanes, and irinotecan.


Overall, 50 patients treated between December 2009 and December 2013 were included in this analysis. The overall response rate (ORR) was 21.2% among 33 patients with measurable disease. The median time to treatment failure (TTF) and overall survival (OS) were 2.4 and 4.2 months. In multivariate analysis, factors associated with OS included poor performance status [hazard ratio (HR) 3.20; 95% confidence interval (CI) 1.55–6.60], shorter time from the start of first-line therapy (HR 2.20; 95% CI 1.18–4.12), and higher neutrophil/lymphocyte ratio value (HR 4.87; 95% CI 2.32–10.25). In patients (n = 35) with at most one risk factor, the ORR, median TTF, and OS were 26.1%, 3.6, and 6.7 months, respectively. The most common grade 3 or 4 adverse events were neutropenia (30%), anemia (22%), febrile neutropenia (8%), and peripheral neuropathy (8%). Initial and subsequent dose reduction was performed in 18 (36%) and 23 (46%) patients. There was one treatment-related death caused by septic infection.


Salvage chemotherapy with the combination of oxaliplatin, leucovorin, and 5-fluorouracil has a potential activity and is tolerable for heavily treated AGC with appropriate dose modification and patient selection.


Gastric cancer Oxaliplatin Salvage therapy Prognostic factor 



The authors would like to thank Enago ( for the English language review.

Compliance with ethical standards

Conflict of interest

None of the authors have financial or personal conflicts of interest to disclose.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or a substitute for it was obtained from all patients for being included in the study.


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Chihiro Kondoh
    • 1
    • 2
  • Shigenori Kadowaki
    • 1
    Email author
  • Azusa Komori
    • 1
  • Yukiya Narita
    • 1
  • Hiroya Taniguchi
    • 1
  • Takashi Ura
    • 1
  • Masashi Ando
    • 1
  • Kei Muro
    • 1
  1. 1.Department of Clinical OncologyAichi Cancer Center HospitalNagoyaJapan
  2. 2.Department of Medical OncologyToranomon HospitalTokyoJapan

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