Efficacy of fluorouracil combined with paclitaxel and oxaliplatin for the treatment of advanced gastric signet ring cell carcinoma.

Background: Gastric signet ring cell carcinoma (GSRC) is a distinctive type of gastric cancer. It is a mucus-secreting adenocarcinoma that may progress to distant metastasis at an early stage. Because of poor differentiation, aggressive invasion, rapid progression, and other high-risk characteristics, early surgical intervention should be prioritized.

Aim: To explore the clinical efficacy of fluorouracil (5-FU) combined with paclitaxel and oxaliplatin for the treatment of advanced GSRC.

Methods: A total of 85 patients with advanced GSRC were selected between January 2020 and June 2021 and randomly divided into a control group (n = 42, receiving standard chemotherapy) and a treatment group (n = 43, receiving monotherapy with oxaliplatin, 5-FU, and paclitaxel). Patients in the treatment group received a 135 mg/m² infusion of paclitaxel for 3 hours, a 400 mg/m² infusion of calcium folate (or 200 mg/m² of levocalcium folate) for 2 hours, and an 85 mg/m² infusion of oxaliplatin for 2 hours. This was followed by a continuous intravenous infusion of 2200-2400 mg/m² 5-FU for 46 hours using a portable pump.

Results: The treatment group showed a median survival time of 11.7 months and an objective response rate (ORR) of 32.5%, significantly higher than the control group (P < 0.05). Serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and albumin levels were correlated with treatment effectiveness in advanced GSRC (P < 0.01), but total serum protein was not correlated (P > 0.05). Safety and survival were assessed in all patients. Short-term efficacy was evaluated in 66 patients, with a disease control rate of 89.4% and an ORR of 48.5%. Median progression-free survival was 7.0 months (95% confidence interval [CI]: 6.85-7.15), and median overall survival was 10.6 months (95%CI: 9.86-11.3). Primary grade III/IV adverse events included neutropenia (22.1%) and peripheral neurotoxicity (10.3%).

Conclusion: This treatment regimen is more effective for patients with advanced GSRC. Serum levels of CEA, CA19-9, and albumin predicted chemotherapy efficacy, while total protein concentration correlated minimally and insignificantly.