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 .
Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer.
PURPOSE We report the results of a prospect ively r and omized study that compared the combination of epirubicin , cisplatin , and protracted venous infusion fluorouracil ( 5-FU ) ( ECF regimen ) with the st and ard combination of 5-FU , doxorubicin , and methotrexate ( FAMTX ) in previously untreated patients with advanced esophagogastric cancer . PATIENTS AND METHODS Two hundred seventy-four patients with adenocarcinoma or undifferentiated carcinoma were r and omized and analyzed for survival , tumor response , toxicity , and quality of life ( QL ) . RESULTS The overall response rate was 45 % ( 95 % confidence interval [ CI ] , 36 % to 54 % ) with ECF and 21 % ( 95 % CI , 13 % to 29 % ) with FAMTX ( P = .0002 ) . Toxicity was tolerable and there were only three toxic deaths . The FAMTX regimen caused more hematologic toxicity and serious infections , but ECF caused more emesis and alopecia . The median survival duration was 8.9 months with ECF and 5.7 months with FAMTX ( P = .0009 ) ; at 1 year , 36 % ( 95 % CI , 27 % to 45 % ) of ECF and 21 % ( 95 % CI , 14 % to 29 % ) of FAMTX patients were alive . The median failure-free survival duration was 7.4 months with ECF and 3.4 months with FAMTX ( P = .00006 ) . The global QL scores were better for ECF at 24 weeks , but the remaining QL data showed no differences between either arm of the study . Hospital-based cost analysis on a subset of patients was similar for each arm and translated into an increment cost of $ 975 per life-year gained . CONCLUSION The ECF regimen results in a survival and response advantage , tolerable toxicity , better QL and cost-effectiveness compared with FAMTX chemotherapy . This regimen should now be considered the st and ard treatment for advanced esophagogastric 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 .