Hormonal and genetic factors prognosis in gastric cancer.
Аннотация
e15029 Background: Improve the efficiency of treatment for locally advanced gastric cancer (LAGC) by designing new methods of treatment, taking into account the status of molecular markers of sensitivity and resistance to cytotoxic drugs and hormonal status. Methods: The control group consisted of 30 patients with LAGC, whom in the first stage of treatment was performed operation. In the second stage of treatment, after 3-5 weeks after surgery patients received 2-4 cycles of postoperative (adjuvant) therapy by DCF regime (Docetaxel, Cisplatin, 5-FU) - 10 and CF (Cisplatin, 5-FU) - 20 patients. A study group comprised 27 patients with LAGC. In the study group were determined mutations of BRCA 1 and 2 genes, expression of ER and PR. In the study group patients underwent 2-4 cycles of neoadjuvant chemotherapy (NAC) by DCF regimen. In 8 (30%) of the main group were observed mutation of BRCA genes, and increased expression of ER and PR. In this group of patients in addition to chemotherapy there was used Tamoxifen 20 mg/day. Results: Patients who received NAC, after 2-4 cycles in 25% of hormone positive (HP) patients treated with Tamoxifen was observed complete regression (CR). In hormone negative (HN) patients CR was observed only in 16% cases. In HP patients disease progression (DP) cases were not observed, whereas in 2 HN cases there were noted DP. In general, the number of positive responses to NAC in both subgroups was approximately equal, about 50%. In 4 (21%) of HN patients there was observed DP during the adjuvant chemotherapy. In HP patients had 100% one-year survival rate, whereas in HN patients this figure was 94.7%. Significant superiority was noted in terms of disease free survival (DFS) in patients receiving NAC. In the main group 1 year DFS was above 25% and 2 year higher than 30% than in the group of patients treated with only adjuvant chemotherapy. Conclusions: Conducting of 2-4 cycles of preoperative (neoadjuvant) chemotherapy by DCF regimen in LAGC led to reduce the stage of the process in 48%, to perform radical surgery in 56% of patients and achieved 52% 2 years of DFS. Overcoming tumor resistance to treatment through the use of hormonal drugs will provide an opportunity to increase overall survival and progression-free survival, improve the quality of patient’s life.