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 .
Phase II multi-institutional randomized trial of docetaxel plus cisplatin with or without fluorouracil in patients with untreated, advanced gastric, or gastroesophageal adenocarcinoma.
PURPOSE The purpose of this study was to define the contribution of docetaxel to combination chemotherapy in the outcome of patients with advanced gastric or gastroesophageal adenocarcinoma . We compared the overall response rate ( ORR ) and safety of docetaxel plus cisplatin ( DC ) with DC plus fluorouracil ( DCF ) to select either DC or DCF as the experimental treatment in the ensuing phase III part of trial V-325 . PATIENTS AND METHODS In this phase II r and omized study , untreated patients with confirmed advanced gastric or gastroesophageal adenocarcinoma received either DCF ( docetaxel 75 mg/m2 , cisplatin 75 mg/m2 on day 1 , and fluorouracil 750 mg/m2/d as continuous infusion on days 1 to 5 ) or DC ( docetaxel 85 mg/m2 and cisplatin 75 mg/m2 on day 1 ) every 3 weeks . An independent data monitoring committee ( IDMC ) was to select one of the two regimens based primarily on ORR and safety profile . RESULTS Of 158 r and omly assigned patients , 155 ( DCF , n = 79 ; DC , n = 76 ) received treatment . The confirmed ORR was 43 % for DCF ( n = 79 ) and 26 % for DC ( n = 76 ) . Median time to progression was 5.9 months for DCF and 5.0 months for DC .  Median overall survival time was 9.6 months for DCF and 10.5 months for DC . The most frequent grade 3 and 4 events per patient included neutropenia  ( DCF = 86 % ; DC = 87 % ) and GI ( DCF = 56 % ; DC = 30 % ) . CONCLUSION Both regimens were active , but DCF produced a higher confirmed ORR than DC .  Toxicity profiles of DCF were considered manageable . The IDMC chose DCF for the phase III part of V-325 , which compares DCF with cisplatin plus fluorouracil
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 .