Docetaxel in advanced gastric cancer - Review of the main clinical trials

The aim was to investigate the activity of docetaxel in advanced gastric cancer either as single agent or in combination with other drugs. A systematic review was carried out using the databases of Medline, Embase and CancerLit. Results from ASCO and ESMO meetings during 2002 were also included. Eight phase II trials focused on docetaxel as a single agent. Considering collectively the 262 evaluable patients enrolled in these studies, the mean response rate (RR) was 19% (CI 95% 14 - 24%). Docetaxel was well tolerated with a dose-limiting myelosuppression (grade 3 - 4 neutropenia in 36 - 95% of cases). Adding fluorouracil, an RR ranging from 22% to 86% was registered, due to differences in populations studied (young vs. elderly) and modalities of drug administration (continuous vs. bolus infusion). RRs for docetaxel - cisplatin combination were 56%, 37% and 36% in three phase II trials and 35% in a phase III trial. The addition of both cisplatin and fluorouracil to docetaxel did not increase toxicity. Randomized trials comparing docetaxel - cisplatin - fluorouracil with ciplatin - fluorouoracil or epirubicin - cisplatin - fluorouracil, the most commonly used regimens, are ongoing. The future results of the above phase III studies could indicate docetaxel as a key drug to improve treatment of patients with advanced gastric cancer.