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 .
Sequential and combination chemotherapy of advanced gastric cancer
One hundred and forty‐six previously untreated patients with advanced gastric cancer were assigned at r and om to therapy with the following regimens : 1 ) Methyl CCNU alone ; 2 ) Methyl CCNU with cyclophosphamide induction ; 3 ) 5‐fluorouracil ( 5‐FU ) + methyl CCNU ; and 4 ) 5‐FU + methyl CCNU with cyclophosphamide induction . Cyclophosphamide induction produced an objective response rate of only 8 % . In addition , it added to hematologic toxicity and detracted from the therapeutic activity of subsequent treatment . Methyl CCNU was relatively ineffective therapy with an overall objective response rate of 8 % . The response rate  to 5‐FU + methyl CCNU without cyclophosphamide induction was 40 % and this was significantly superior to all other regimens . The survival time of all patients treated with 5‐FU + methyl CCNU was significantly superior to that of all patients treated with methyl CCNU alone
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 .