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 .
Docetaxel, cisplatin, and fluorouracil; docetaxel and cisplatin; and epirubicin, cisplatin, and fluorouracil as systemic treatment for advanced gastric carcinoma: a randomized phase II trial of the Swiss Group for Clinical Cancer Research.
PURPOSE This r and omized phase II trial evaluated two docetaxel-based regimens to see which would be most promising according to overall response rate ( ORR ) for comparison in a phase III trial with epirubicin-cisplatin-fluorouracil ( ECF ) as first-line advanced gastric cancer therapy . PATIENTS AND METHODS Chemotherapy-naïve patients with measurable unresectable and /or metastatic gastric carcinoma , a performance status < or= 1 , and adequate hematologic , hepatic , and renal function r and omly received < or= eight 3-weekly cycles of ECF ( epirubicin 50 mg/m(2 ) on day 1 , cisplatin 60 mg/m(2 ) on day 1 , and fluorouracil [ FU ] 200 mg/m(2)/d on days 1 to 21 ) , TC ( docetaxel initially 85 mg/m(2 ) on day 1 [ later reduced to 75 mg/m(2 ) as a result of toxicity ] and cisplatin 75 mg/m(2 ) on day 1 ) , or TCF ( TC plus FU 300 mg/m(2)/d on days 1 to 14 ) . Study objectives included response ( primary ) , survival , toxicity , and quality of life ( QOL ) . RESULTS ORR was 25.0 % ( 95 % CI , 13 % to 41 % ) for ECF , 18.5 % ( 95 % CI , 9 % to 34 % ) for TC , and 36.6 % ( 95 % CI , 23 % to 53 % ) for TCF ( n = 119 ) . Median overall survival times were 8.3 , 11.0 , and 10.4 months for ECF , TC , and TCF , respectively . Toxicity was acceptable , with one toxic death ( TC arm ) . Grade 3 or 4 neutropenia occurred in more treatment cycles with docetaxel ( TC , 49 % ; TCF , 57 % ; ECF , 34 % ) . Global health status/QOL substantially improved with ECF and remained similar to baseline with both docetaxel regimens . CONCLUSION Time to response and ORR favor TCF over TC for further evaluation , particularly in the neoadjuvant setting . A trend towards increased myelosuppression and infectious complications with TCF versus TC or ECF was observed
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 .