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 .
Sequence-dependence of cisplatin and 5-fluorouracil in advanced and recurrent gastric cancer.
This r and omized controlled clinical trial was design ed to compare the safety and effectiveness of different sequences of treatment with cisplatin ( CDDP ) and 5-fluorouracil ( 5-FU ) in patients with unresectable advanced and post-operative recurrent gastric cancer . Patients with unresectable advanced or post-operative recurrent gastric cancer were r and omly assigned by a registration center to group A or B. Group A received CDDP ( 80 mg/m(2 ) ) as a continuous 2-h intravenous infusion on day 1 and 5-FU ( 700 mg/m(2 ) ) as a continuous intravenous infusion on days 2 - 5 . Group B was given 5-FU ( 700 mg/m(2 ) ) as a continuous intravenous infusion on days 1 - 4 , followed by CDDP ( 80 mg/m(2 ) ) as a continuous 2-h intravenous infusion on day 5 . Each course of chemotherapy was repeated every 28 days . A total of 74 patients were enrolled . One patient died accidentally , and 5 could not be evaluated . Response was assessable in 68 patients . The response rate was 31.3 % ( 10/32 ) in group A as compared with 13.9 % ( 5/36 ) in group B. Although the response rate was higher in Group A , the difference was not significant ( p=0.085 ) . The response rate in  patients with diffuse type tumors was significantly lower in group B. There was no difference between the groups in response among patients with intestinal type tumors . The median overall survival was 239 and 174 days and time to progression was 175 and 140 days in group A and group B , respectively . Although there were trends toward longer survival and time to progression in group A , the differences between the groups were not statistically significant . There was also no difference in the type or incidence of adverse reactions . The results of this controlled study indicate that the overall response rate was slightly but not significantly higher in patients who received CDDP before 5-FU . Among patients with diffuse type tumors , the response rate was significantly lower when 5-FU was administered before CDDP . Our results suggest that CDDP should be given before 5-FU in patients with gastric cancer when treated with a combination of CDDP and 5-FU
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 .