Efficacy of Docetaxel, Capecitabine, Cisplatin, and Bevacizumab in Patients With Unresectable Advanced Gastric Cancer

Inclusion Criteria:

• Histologically documented adenocarcinoma of the stomach or gastroesophageal junction.
• Invasion to adjacent organ (T4) proven by endoscopic ultrasonography (EUS) or presence of paraaortic lymph node metastasis by CT and PET(short-axis diameter > 1 cm showing hot uptake in PET scan).
• Age 18-70 years old
• ECOG performance status 0-2
• Adequate hepatic function(serum bilirubin <1.5mg/dl, AST (SGOT) and ALT (SGPT) < 2.5 x UNL, alkaline phosphatase < 5 x UNL)
• Adequate renal function(serum creatinine <1.5mg/dl)
• Adequate bone marrow function (WBC ≥4000 cell/㎕ with ANC ≥1500 cell/㎕, platelet count ≥100,000 cell/㎕)
• HER2 negative (HER2 immunohistochemistry 0 or 1+, immunohistochemistry 2+ but FISH negative)
• Informed consent

Exclusion Criteria:

• Other histologic type than adenocarcinoma
• Metastasis in other sites than paraaortic lymph nodes, like in liver or peritoneum.
• Presence or history of other cancers
• History of prior chemotherapy, antiangiogenic agents, or radiation.
• Patients with definite ascites in abdomen CT scan
• Presence of not adequately controlled CNS metastasis
• Bowel obstruction
• Evidence of gastrointestinal bleeding
• Other serious illness or medical conditions including hypertension uncontrolled by medication.
• Pregnant or lactating women