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 .
Irinotecan in combination with 5-fluorouracil and folinic acid or with cisplatin in patients with advanced gastric or esophageal-gastric junction adenocarcinoma: results of a randomized phase II study.
BACKGROUND To identify the most effective of two combinations , irinotecan/5-fluorouracil (5-FU)/folinic acid ( FA ) and irinotecan/cisplatin , in the treatment of advanced gastric cancer , for investigation in a phase III trial . PATIENTS AND METHODS Patients were r and omized to receive irinotecan [ 80 mg/m2 intravenously ( i.v . ) ] , FA ( 500 mg/m2 i.v . ) and a 22-h infusion of 5-FU ( 2000 mg/m2 i.v . ) , weekly for 6 weeks with a 1-week rest , or  irinotecan ( 200 mg/m2 i.v . ) and  cisplatin ( 60 mg/m2 i.v . ) , on day 1 for 3 weeks . RESULTS A total of 115 patients were eligible for analysis in the per- protocol population . The overall response rate in the irinotecan/5-FU/FA arm ( n=59 ) was 42.4 % , with a complete response rate of 5.1 % . Corresponding figures for the irinotecan/cisplatin arm ( n=56 ) were 32.1 % and 1.8 % , respectively . The median time to progression was 6.5 months ( irinotecan/5-FU/FA ) and 4.2 months ( irinotecan/cisplatin ) ( P < 0.0001 ) , with median survival times of 10.7 and 6.9 months , respectively ( P=0.0018 ) . The major toxicity was grade 3/4 neutropenia , which was more pronounced with irinotecan/cisplatin than with irinotecan/5-FU/FA ( 65.7 % versus 27 % ) . Diarrhea was the main grade 3/4 non-hematological toxicity with both irinotecan/5-FU/FA ( 27.0 % ) and irinotecan/cisplatin ( 18.1 % ) . CONCLUSIONS Both combinations were active , with acceptable safety profiles . Irinotecan/5-FU/FA was selected as the most effective combination for investigation in a phase III trial in advanced gastric cancer
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 .