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 .
Paclitaxel versus docetaxel for advanced gastric cancer: a randomized phase II trial in combination with infusional 5-fluorouracil
Taxanes have clearly demonstrated activities against gastric cancer . We compared the combination of paclitaxel plus 5-fluorouracil ( 5-FU ) ( PF ) with docetaxel plus 5-FU ( DF ) as first-line chemotherapy in patients with measurable metastatic gastric cancer . Seventy-seven patients were r and omly assigned to receive paclitaxel 175 mg/m2 or docetaxel 75 mg/m2 on day 1 , in combination with 5-FU 500 mg/m2 continuous infusion on days 1–5 . Treatment was repeated every 3 weeks . Of 314 chemotherapy cycles delivered ( median 5 in both groups ) , dose reduction was required more frequently in the DF group , being 9 and 19 % , respectively ( P<0.01 ) . PF was associated with , although statistically insignificant , substantially less grade 3 or 4 toxicities than DF ( 68 versus 85 % ; P=0.09 ) . Global quality of life was similar in both groups , but substantive differences in many symptom scores including pain , dyspnea , constipation and diarrhea favored PF . There were no significant differences in therapeutic efficacy between PF and DF with respect to response rate ( 42 versus 33 % , respectively ; P=0.53 ) , and failure-free ( 3.6 versus 4.2 months ; P=0.92 ) and overall survival ( 9.9 versus 9.3 months ; P=0.42 ) . Both PF and DF appear to have efficacy against metastatic gastric cancer , with different , but acceptable , safety profiles
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 .