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 .
Bimonthly 24 h Infusion of High-Dose 5-Fluorouracil vs EAP Regimen in Patients with Advanced Gastric Cancer
Abstract Background : To investigate the activity and toxicity of high dose ( HD ) infusional 5-FU in comparison to EAP regimen as first-line chemotherapy in patients with advanced gastric cancer . Patients and methods : Histologically confirmed measurable advanced gastric cancer , age < 72 yr , ECOG performance status 0–2 , no prior chemo- and radiotherapy , adequate organ functions . Treatment : EAP arm : doxorubicin ( 40 mg/m2 ) , etoposide ( 360 mg/m2 ) , and cisplatin ( 80 mg/m2 ) every 28 d ; HD 5-FU arm : 5-FU 2.6 g/m2 24 h infusion , biweekly . Results : Sixty patients were r and omized . Patient characteristics ( arms EAP/HD 5-FU ) : Median age 57/55 yr , median PS 1/1 , LAD ( patients ) 3/8 , M1 ( patients ) 27/22 .  Median number of cycles ( range ) : EAP arm 4 ( 2–8 ) , HD 5-FU arm 2 ( 1–8 ) . Worst toxicity per cycle ( grade 3 and 4 in% ) : Neutropenia 20/3 , thrombocytopenia 9/0 , anemia 9/13 , diarrhea 3/10 , nausea 17/7 , vomiting 10/0 for EAP and HD 5-FU arms , respectively . All patients were eligible for response in both arms .  Confirmed response rate ( 95%CI ) : EAP arm 34 % [16–50%]/HD 5-FU arm 10 % ( 0–21 % ) , no change : 46/40 % , progression of disease : 20/50 , respectively . Overall survival ( range ) : EAP arm A 7 mo [ 3–27 ] , HD 5-FU arm 6 mo ( 4–25 ) . Conclusions : Infusional HD 5-FU showed a low incidence of severe toxicity . But given the low efficacy of 5-FU in the dosage we applied in the study , it can not be recommended as a single treatment for further studies . Assessment of higher dose intensity and /or dose density of 5-FU , with introduction of other active drugs in combination , could be an option for further studies
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 .