0-1.6]; P = 0.02) in patients treated with DCF than with CF. Despite its promising results, V-325 (11) was severely

criticized for its moderate toxicity; patients treated with DCF experienced more neutropenia (82% vs. 57%) and febrile neutropenia (29% vs. 12%) than those treated with CF. An ad hoc comparison of patients’ benefits in terms of quality of life between the two arms concluded that DCF significantly prolonged time to definitive worsening of performance status versus CF (median, 6.1 vs. 4.8 months; Inhibitors,research,lifescience,medical HR = 1.38 [95% CI, 1.08-1.76]; P = 0.009) (62),(63). The results of this study led to FDA approval of docetaxel for gastric and GEJ cancers, but every-3-weeks DCF should be reserved for highly selected groups of patients. Because docetaxel was found to be an active agent in GECs, many subsequent studies have offered modified and alternative docetaxel combinations in order

to reduce toxicity and improve tolerance. In a randomized phase II study (64), Shah et al. observed moderate hematologic toxicity with DCF despite primary prophylaxis with growth colony-stimulating factor. Inhibitors,research,lifescience,medical Despite dose changes, modified DCF was noted to be much better tolerated while maintaining the same efficacy as its parent DCF. In addition to dose and schedule modification of DCF regimens, many other docetaxel-based chemotherapy regimens have been evaluated. For instance, Inhibitors,research,lifescience,medical docetaxel has been combined with irinotecan, oxaliplatin, and S-1. S-1 is not currently available outside of clinical trials in the United States. The use of S-1 in advanced GECs in Western countries had been tempered by the negative results of the FLAGS (First Line therapy in Advanced Gastric cancer Study) study (65), comparing cisplatin plus 5-FU to cisplatin plus S-1. Selecting between paclitaxel and docetaxel remains an art Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical rather than science. Though commonly practiced, there are no convincing data in the medical literature on GEC to support the interchangeability between docetaxel and paclitaxel. In two randomized phase II studies (66),(67) from Asia comparing 5-FU combined with either paclitaxel or docetaxel, no statistically significant difference in therapeutic efficacy or survival outcomes was observed. It remains unclear if

there is a significant difference between DCF (11) and ECF (68) or other standard regimens, or between docetaxel triplet and doublets. Table 2 summarizes selected randomized phase II or III studies with taxane-based chemotherapy regimens as first-line therapy for metastatic GECs. Table 2 Taxane-based Carnitine palmitoyltransferase II chemotherapy regimens: comparative phase II/III Conclusion and future direction Taxanes are a class of cytotoxic selleck compound agents commonly administered in patients with breast and lung cancers. Both paclitaxel and docetaxel, two commonly used taxanes, have many indications as both single agents as well as in combination therapy for many solid tumors. They have also been shown to contribute significantly to the management of patients with both localized and advanced GECs.

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