Within a combination chemotherapy regimen , oral capecitabine is preferred over intravenous 5-fluorouracil (5fu)-that is , epirubicin-cisplatin-capecitabine is preferred over the prior st and ard regimen , epirubicin-cisplatin-5fu (ecf).Epirubicin-oxaliplatin-capecitabine ( eox ) is a reasonable alternative to ecf .
QUESTION What is the optimal chemotherapy regimen in advanced gastric cancer ?
PERSPECTIVES Gastric cancer is the second leading cause of cancer mortality worldwide .
Despite low incidence rates for gastric cancer in Ontario , the overall prognosis is bleak , with 5-year survival rates of approximately 23 % in Canada .
Even with the considerable body of research available on chemotherapy for advanced gastric cancer , uncertainty remains .
There is no recognized st and ard treatment , and there appears to be geographic variation in practice .
Cisplatin, epirubicin, leucovorin and 5-fluorouracil (PELF) is more active than 5-fluorouracil, doxorubicin and methotrexate (FAMTX) in advanced gastric carcinoma.
BACKGROUND 5-Fluorouracil ( 5-FU ) , doxorubicin and methotrexate ( FAMTX ) and cisplatin , epirubicin , leucovorin and 5-FU ( PELF ) have both been reported to be superior to the combination 5-FU , doxorubicin and mitomycin C ( FAM ) in advanced gastric carcinoma . On the basis of the presence and dose intensity of the included agents , we hypothesised that PELF would be superior to FAMTX . PATIENTS AND METHODS Two hundred patients with untreated advanced gastric carcinoma were r and omised to receive PELF or FAMTX for a maximum of six cycles or until disease progression . RESULTS The complete response ( CR ) rates to PELF and FAMTX were , respectively , 13 % [ 95 % confidence intervals ( CI ) 6 % to 20 % ] and 2 % ( 95 % CI 0 % to 5 % ; P = 0.003 ) , and the objective response rates [ CR plus partial response ( PR ) rates ] 39 % ( 95 % CI 29 % to 49 % ) and 22 % ( 95 % CI 13 % to 30 % ; P = 0.009 ) , thus significantly favouring the PELF combination . The survival rates after 12 months ( 30.8 % versus 22.4 % ) and 24 months ( 15.7 % versus 9.5 % ) were also higher among patients receiving PELF , but these differences were not statistically significant . The toxicities were qualitatively different but quantitatively similar . Both regimens seem to be feasible provided that careful patient monitoring is assured . CONCLUSIONS PELF is significantly more active than FAMTX and deserves further research in the adjuvant setting
Within a combination chemotherapy regimen , oral capecitabine is preferred over intravenous 5-fluorouracil (5fu)-that is , epirubicin-cisplatin-capecitabine is preferred over the prior st and ard regimen , epirubicin-cisplatin-5fu (ecf).Epirubicin-oxaliplatin-capecitabine ( eox ) is a reasonable alternative to ecf .
QUESTION What is the optimal chemotherapy regimen in advanced gastric cancer ?
PERSPECTIVES Gastric cancer is the second leading cause of cancer mortality worldwide .
Despite low incidence rates for gastric cancer in Ontario , the overall prognosis is bleak , with 5-year survival rates of approximately 23 % in Canada .
Even with the considerable body of research available on chemotherapy for advanced gastric cancer , uncertainty remains .
There is no recognized st and ard treatment , and there appears to be geographic variation in practice .