Docetaxel delivers new management opportunities for gastrointestinal carcinomas

The results of four phase II studies of docetaxel in cancers of the gastrointestinal tract are summarized. No prior chemotherapy was permitted except for adjuvant chemotherapy completed at least 1 year before entering the present study. In all studies, docetaxel was administered at a dose of 100 mg/m2 given by intravenous infusion over 1 h once every 3 weeks, adjusted according to toxicity. Routine premedication for hypersensitivity reactions was given to most patients in the US study in colorectal cancer but not to patients in the three European studies in gastric, pancreatic and colorectal cancers. In a European Organization for Research on Treatment of Cancer--Early Clinical Trials Group (EORTC-ECTG) study in gastric cancer, 8 (24%) of 33 evaluable patients achieved partial remissions lasting for a median of 7.5 months. Responses occurred in a variety of metastatic sites. Forty-two patients were evaluable in a French study of docetaxel in pancreatic cancer. Partial responses were achieved in 6 (20%) of 30 patients with metastatic disease and 3 of 12 patients with loco-regional disease showed some improvement. Two studies in colorectal cancer--one European and one US--found that docetaxel had little or no activity in these patients. Three (9%) of 33 evaluable patients in the European study achieved responses (one complete and two partial) and none of 19 patients in the US study. Hematological toxicity was the dose-limiting adverse effect. Acute hypersensitivity reactions and fluid retention also occurred in some patients. In conclusion, docetaxel appears to be as effective as standard single-agent therapies for gastric and pancreatic cancers but to have minimal effect in colorectal carcinoma. Toxicities were generally manageable; premedication with corticosteroids may reduce the incidence and severity of acute hypersensitivity reactions and delay the onset of fluid retention.