Does resection after neoadjuvant chemotherapy of Docetaxel, oxaliplatin, and S-1 (DOS regimen) benefit for gastric cancer patients with single non-curable factor? A multicenter, prospective cohort study (Neo-REGATTA)

Abstract

Abstract Background The Neo-REGATTA study evaluated the effectiveness and safety of Docetaxel, oxaliplatin, and S-1 (DOS regimen) followed by radical resection vs. chemotherapy in advanced gastric adenocarcinoma patients with single non-curable factor. Methods This cohort study prospectively enrolled advanced gastric adenocarcinoma patients with single non-curable factor between November 2017 and June 2021. Patients without progression after four cycles of DOS were divided into resection group and chemotherapy group. The outcomes included overall survival (OS), progression-free survival (PFS) and safety. Effectiveness analysis was also performed by propensity score matching (PSM). Results A total of 73 patients were enrolled and 13 patients were withdrawn due to disease progression after 4 cycles of DOS. Afterwards, 35 and 25 participants were in the resection and chemotherapy groups, respectively. After a median follow-up time of 19.5 months (5–48 months), the median PFS and OS were 9.0 months, and 18.0 months for the chemotherapy group, but not reached in the resection group. After PSM, 19 matched participants were in each group. The OS was longer in resection group than that in chemotherapy group (HR = 0.19, 95% CI: 0.05–0.70, P = 0.013). The PFS was longer in resection group than that in chemotherapy group (HR = 0.22, 95% CI: 0.07–0.68, P = 0.009). The most common grade 3 or 4 adverse events in both groups were neutropenia (5.7%, 8.0%) and leukopenia (5.7%, 8.0%), respectively. Conclusions Radical resection might provide survival benefit compared with continuous chemotherapy alone in advanced gastric adenocarcinoma patients who had a disease control after DOS, with a good safety profile. Trial registration: The study protocol was registered on ClinicalTrial.gov (NCT03001726, 23/12/2016).