Cancer Chemotherapy and Pharmacology

, Volume 81, Issue 6, pp 1007–1015 | Cite as

Combination chemotherapy with paclitaxel and oxaliplatin as first-line treatment in patients with advanced gastric cancer

  • Yan-qin Lan
  • Ling-jun Kong
  • Xiao-yan Lin
  • Qian Xu
  • Xin-yan Gao
  • Ri-ping Wu
  • Xin-li Wang
  • Dong-ta Zhong
Original Article



This study is a retrospective analysis evaluating the efficacy and toxicity of combination chemotherapy with Paclitaxel (PTX) and Oxaliplatin (OXA) as first-line treatment for patients with advanced gastric cancer (AGC).


One hundred and seven patients with locally advanced or metastatic gastric adenocarcinoma received intravenous infusions of PTX at 135 mg/m2 and OXA at 85 mg/m2 on day 1 every 14 days.


Among 107 patients enrolled, 9 patients could not be evaluated for a response because of the absence of any measurable lesions. Assessment of the response of 98 patients was made. The overall objective response rate was 42.9% (95% CI 32.9–52.8%), with two complete responses and 40 partial responses. The disease control was 79.6% (95% CI 71.5–87.7%). With 29 months of the median time of follow-up, the median progression-free survival was 5.8 months (95% CI 4.30–7.30 months) and the median overall survival was 11.5 months (95% CI 9.08–13.9 months). The 1-year survival rate was 48.0%. The most common grades 3 and 4 toxicities included neutropenia (32.7%), leucopenia (17.8%), fatigue (5.61%), and anemia (4.67%). Peripheral neuropathy occurred in 23.4% patients and grade 2 or higher peripheral neuropathy occurred in 12.1% of the patients.


Combination chemotherapy with PTX and OXA offers a new, effective and safe regimen for patients with advanced gastric cancer.


Advanced gastric cancer Paclitaxel Oxaliplatin Combination chemotherapy 



We wish to thank all the patients who volunteered for this study and the staff of Fujian Medical University Tumor Research Center who contributed to it. We also thank Mr. Cai Dingnan for his assistance in the statistical analysis.


This study was funded by the Foundation of Medical Innovation Project in Fujian Province (Grant no. 2016-CX-26).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Siegel R, Ma J, Zou Z, Jemal A (2014) Cancer statistics, 2014. CA Cancer J Clin 64 (1):9–29. CrossRefPubMedGoogle Scholar
  2. 2.
    Zhao P, Dai M, Chen W, Li N (2010) Cancer trends in China. Jpn J Clin Oncol 40 (4):281–285. CrossRefPubMedGoogle Scholar
  3. 3.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59(4):225–249. CrossRefPubMedGoogle Scholar
  4. 4.
    Glimelius B, Ekstrom K, Hoffman K, Graf W, Sjoden PO, Haglund U, Svensson C, Enander LK, Linne T, Sellstrom H, Heuman R (1997) Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol 8(2):163–168CrossRefPubMedGoogle Scholar
  5. 5.
    Imamura Y, Yoshimi I (2005) Comparison of cancer mortality (stomach cancer) in five countries: France, Italy, Japan, UK and USA from the WHO mortality database (1960–2000). Jpn J Clin Oncol 35(2):103–105. CrossRefPubMedGoogle Scholar
  6. 6.
    Van Cutsem E, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, Rodrigues A, Fodor M, Chao Y, Voznyi E, Risse ML, Ajani JA (2006) Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol 24(31):4991–4997. CrossRefPubMedGoogle Scholar
  7. 7.
    Cunningham D, Starling N, Rao S, Iveson T, Nicolson M, Coxon F, Middleton G, Daniel F, Oates J, Norman AR (2008) Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 358(1):36–46. CrossRefPubMedGoogle Scholar
  8. 8.
    Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, Miyashita K, Nishizaki T, Kobayashi O, Takiyama W, Toh Y, Nagaie T, Takagi S, Yamamura Y, Yanaoka K, Orita H, Takeuchi M (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9(3):215–221. CrossRefPubMedGoogle Scholar
  9. 9.
    Ganansia-Leymarie V, Bischoff P, Bergerat JP, Holl V (2003) Signal transduction pathways of taxanes-induced apoptosis. Curr Med Chem Anticancer Agents 3(4):291–306CrossRefPubMedGoogle Scholar
  10. 10.
    Ohtsu A, Boku N, Tamura F, Muro K, Shimada Y, Saigenji K, Akazawa S, Kitajima M, Kanamaru R, Taguchi T (1998) An early phase II study of a 3-hour infusion of paclitaxel for advanced gastric cancer. Am J Clin Oncol 21(4):416–419CrossRefPubMedGoogle Scholar
  11. 11.
    Yamada Y, Shirao K, Ohtsu A, Boku N, Hyodo I, Saitoh H, Miyata Y, Taguchi T (2001) Phase II trial of paclitaxel by three-hour infusion for advanced gastric cancer with short premedication for prophylaxis against paclitaxel-associated hypersensitivity reactions. Ann Oncol 12(8):1133–1137CrossRefPubMedGoogle Scholar
  12. 12.
    Qi WX, Shen Z, Lin F, Sun YJ, Min DL, Tang LN, He AN, Yao Y (2013) Paclitaxel-based versus docetaxel-based regimens in metastatic breast cancer: a systematic review and meta-analysis of randomized controlled trials. Curr Med Res Opin 29(2):117–125. CrossRefPubMedGoogle Scholar
  13. 13.
    Eriguchi M, Nonaka Y, Yanagie H, Yoshizaki I, Takeda Y, Sekiguchi M (2003) A molecular biological study of anti-tumor mechanisms of an anti-cancer agent Oxaliplatin against established human gastric cancer cell lines. Biomed Pharmacother 57(9):412–415CrossRefPubMedGoogle Scholar
  14. 14.
    Al-Batran SE, Hartmann JT, Probst S, Schmalenberg H, Hollerbach S, Hofheinz R, Rethwisch V, Seipelt G, Homann N, Wilhelm G, Schuch G, Stoehlmacher J, Derigs HG, Hegewisch-Becker S, Grossmann J, Pauligk C, Atmaca A, Bokemeyer C, Knuth A, Jager E (2008) Phase III trial in metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: a study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol 26(9):1435–1442. CrossRefPubMedGoogle Scholar
  15. 15.
    Sumpter K, Harper-Wynne C, Cunningham D, Rao S, Tebbutt N, Norman AR, Ward C, Iveson T, Nicolson M, Hickish T, Hill M, Oates J (2005) Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF. Br J Cancer 92 (11):1976–1983. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Gu J, Yamamoto H, Lu X, Ngan CY, Tsujino T, Konishi K, Takemasa I, Ikeda M, Nagata H, Hashimoto S, Matsuzaki T, Sekimoto M, Takagi A, Monden M (2006) Low-dose oxaliplatin enhances the antitumor efficacy of paclitaxel in human gastric cancer cell lines. Digestion 74(1):19–27. CrossRefPubMedGoogle Scholar
  17. 17.
    Guo Z, Wang X, Lin R, Chen L, Fan N, Chen Y, Lin J, Yu J (2015) Paclitaxel-based regimens as first-line treatment in advanced gastric cancer. J Chemother 27(2):94–98. CrossRefPubMedGoogle Scholar
  18. 18.
    Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A, Fleig WE (2006) Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol Off J Am Soc Clin Oncol 24(18):2903–2909. CrossRefGoogle Scholar
  19. 19.
    Lv F, Liu X, Wang B, Guo H, Li J, Shen L, Jin M (2014) S-1 monotherapy as second line chemotherapy in advanced gastric cancer patients previously treated with cisplatin/infusional fluorouracil. Int J Clin Exp Pathol 7(7):4274–4279PubMedPubMedCentralGoogle Scholar
  20. 20.
    Kim JG, Sohn SK, Song HS, Kwon KY, Do YR, Lee KH, Hyun MS, Ryoo HM, Bae SH, Park KU, Baek JH, Lee WS, Chung JS, Cho GJ, Sohn CH, Jang JS, Chung HY, Yu W (2007) Multicenter phase II study of weekly paclitaxel plus cisplatin combination chemotherapy in patients with advanced gastric cancer. Cancer Chemother Pharmacol 60(6):863–869. CrossRefPubMedGoogle Scholar
  21. 21.
    Honecker F, Kollmannsberger C, Quietzsch D, Haag C, Schroeder M, Spott C, Hartmann JT, Baronius W, Hempel V, Kanz L, Bokemeyer C (2002) Phase II study of weekly paclitaxel plus 24-h continuous infusion 5-fluorouracil, folinic acid and 3-weekly cisplatin for the treatment of patients with advanced gastric cancer. Anticancer Drugs 13(5):497–503CrossRefPubMedGoogle Scholar
  22. 22.
    Lokich JJ, Sonneborn H, Anderson NR, Bern MM, Coco FV, Dow E, Oliynyk P (1999) Combined paclitaxel, cisplatin, and etoposide for patients with previously untreated esophageal and gastroesophageal carcinomas. Cancer 85(11):2347–2351CrossRefPubMedGoogle Scholar
  23. 23.
    Sakamoto J, Matsui T, Kodera Y (2009) Paclitaxel chemotherapy for the treatment of gastric cancer. Gastric Cancer 12(2):69–78. CrossRefPubMedGoogle Scholar
  24. 24.
    Koizumi W, Akiya T, Sato A, Yamaguchi K, Sakuyama T, Nakayama N, Tanabe S, Higuchi K, Sasaki T, Sekikawa T (2009) Second-line chemotherapy with biweekly paclitaxel after failure of fluoropyrimidine-based treatment in patients with advanced or recurrent gastric cancer: a report from the gastrointestinal oncology group of the Tokyo cooperative oncology group, TCOG GC-0501 trial. Jpn J Clin Oncol 39(11):713–719. CrossRefPubMedGoogle Scholar
  25. 25.
    Yamada Y, Higuchi K, Nishikawa K, Gotoh M, Fuse N, Sugimoto N, Nishina T, Amagai K, Chin K, Niwa Y, Tsuji A, Imamura H, Tsuda M, Yasui H, Fujii H, Yamaguchi K, Yasui H, Hironaka S, Shimada K, Miwa H, Hamada C, Hyodo I (2015) Phase III study comparing oxaliplatin plus S-1 with cisplatin plus S-1 in chemotherapy-naive patients with advanced gastric cancer. Ann Oncol Off J Eur Soc Med Oncol 26(1):141–148. CrossRefGoogle Scholar
  26. 26.
    Lee HH, Hur H, Kim SH, Park AR, Kim W, Jeon HM (2010) Outcomes of modified FOLFOX-6 as first line treatment in patients with advanced gastric cancer in a single institution; retrospective analysis. Cancer Res Treat 42(1):18–23. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Kim HS, Kim JH, Kim HJ, Jang HJ, Kim JB, Kim JW, Jung SY, Kim BC, Yang DH, Park S, Kim KJ, Lee SI, Zang DY (2012) Oxaliplatin, 5-fluorouracil and leucovorin (modified FOLFOX-6) as first-line chemotherapy for advanced gastric cancer patients with poor performance status. Oncol Lett 3(2):425–428. CrossRefPubMedGoogle Scholar
  28. 28.
    Shi C, Chen Q, Shen S, Wu R, Yang B, Liu Q, Xu Q (2015) Paclitaxel combined with oxaliplatin as first-line chemotherapy for locally advanced or metastatic gastric cancer. Expert Rev Anticancer Ther 15(5):595–601. CrossRefPubMedGoogle Scholar
  29. 29.
    Cunningham D, Okines AF, Ashley S (2010) Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 362 (9):858–859. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yan-qin Lan
    • 1
    • 2
    • 3
  • Ling-jun Kong
    • 4
  • Xiao-yan Lin
    • 1
    • 2
    • 3
  • Qian Xu
    • 1
    • 2
    • 3
  • Xin-yan Gao
    • 1
    • 2
    • 3
  • Ri-ping Wu
    • 1
    • 2
    • 3
  • Xin-li Wang
    • 1
    • 2
    • 3
  • Dong-ta Zhong
    • 1
    • 2
    • 3
  1. 1.Department of Medical OncologyFujian Medical University Union HospitalFuzhouPeople’s Republic of China
  2. 2.Fujian Key Laboratory of Translational Cancer MedicineFuzhouPeople’s Republic of China
  3. 3.Fujian Medical University Stem Cell Research InstituteFuzhouPeople’s Republic of China
  4. 4.Department of Thyroid and Breast SurgeryFirst Affiliated Hospital of Fujian Medical UniversityFuzhouPeople’s Republic of China

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