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XELOX + SOX is a combination chemotherapy regimen being investigated in the ROSETTE trial for the treatment of limited-metastatic gastric or gastroesophageal junction adenocarcinoma. This regimen combines the components of two standard chemotherapy protocols: XELOX (oxaliplatin and capecitabine) and SOX (oxaliplatin and S-1), effectively utilizing oxaliplatin, capecitabine, and the multi-component agent S-1 (a combination of tegafur, gimeracil, and oteracil). Oxaliplatin functions as a DNA-alkylating agent that induces cross-links, while capecitabine and S-1 are fluoropyrimidine prodrugs that inhibit thymidylate synthase, thereby disrupting DNA synthesis. Developed and studied by Shanghai Zhongshan Hospital, this intensive cytotoxic backbone is often paired with immunotherapy (PD-1 antibodies) and targeted therapies (such as trastuzumab or zolbetuximab) to maximize pathological response before surgery-centric local treatments.
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