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 .
A randomized phase II trial of irinotecan plus oxaliplatin versus oxaliplatin, fluorouracil (5 FU), leukovorin (LV) as first-line treatment in advanced gastric cancer.
4536 Background : To compare the efficacy and tolerance of two oxaliplatin-based regimens as first-line treatment of advanced gastric cancer . METHODS Chemotherapy-naïve patients with measurable recurrent or metastatic gastric adenocarcinoma , PS ( ECOG ) 0 - 2 and adequate organ functions were r and omly assigned to receive either irinotecan 200mg/m2 and oxaliplatin 80mg/m2 ( IO ) , every 21 days or oxaliplatin 85mg/m2 on day 1 , 5-FU 400 mg/m2 ( over 1 hour infusion ) + 600mg/m2 ( over 22 hours infusion ) on days 1 and 2 , leucovorin ( LV ) 200mg/m2 on days 1 and 2 ( FOLFOX4 ) every 2 weeks . Study endpoints : Overall Response Rate ( ORR ) , Toxicity Time to Progression ( TTP ) and Survival ( S ) . RESULTS 138 patients were enrolled and all were evaluable for response . Median number of cycles administered was 5.5 ( range 1 - 10 ) for IO and 7 ( range 1 - 18 ) for FOLFOX4 . In an intent-to treat analysis the ORR ( RR+CR ) was 29.4 % for IO arm and 34.3 % for FOLFOX4 arm ( p= 0.587 ) . The median response duration was 5.63 months ( mo ) for IO arm and 6,6mo for FOLFOX4 arm . Median TTP was 4.2mo and 6,1mo for IO and FOLFOX4 arm respectively ( p= 0.012 ) . Median OS was 9.4mo for IO and 11.97mo for FOLFOX4 ( p= 0.456 ) . Toxicity was acceptable , with one toxic death in each arm . Grade 3 - 4 vomiting ( 7.3 % ) , diarrhea ( 11.8 % ) , neutropenia ( 22 % ) and febrile neutropenia ( 5.9 % ) occurred more frequently in IO arm , while anaemia ( 4.3 % ) and grade II neurotoxicity ( 11.4 % ) was more frequent in FOLFOX4 arm . CONCLUSIONS Both regimens are well tolerated and active in advanced gastric cancer . Based on the TTP and toxicity profile , the FOLFOX4 regimen merits to be further evaluated in prospect i ve phase III trials . No significant financial relationships to disclose
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 .