The role of docetaxel in gastric cancer

To date, there has been no global standard chemotherapy for advanced gastric cancer and patient outcomes remain poor. This has led to a concerted effort to find more active treatments. Single-agent docetaxel has shown encouraging clinical activity, and Phase II studies have established docetaxel-cisplatin-5-fluorouracil (DCF) as the most promising docetaxel-containing regimen for further evaluation. TAX 325, the largest Phase III trial to date of patients with advanced gastric adenocarcinoma (n = 445), has demonstrated a significant survival advantage, higher overall response rate, improved clinical benefit and better preservation of quality of life for DCF vs. cisplatin-5-fluorouracil (CF) - a previous reference regimen. Although haematological toxicity was higher with DCF, prophylaxis with granulocyte colony-stimulating factor, awareness of the risk of neutropenic complications and early intervention can all help to manage the toxicity. Addition of docetaxel to CF or other active agent(s) represents an important new front-line option for patients with advanced gastric or gastro-oesophageal cancer and should be a new reference regimen for further clinical studies.