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 .
Multicenter phase III comparison of cisplatin/S-1 with cisplatin/infusional fluorouracil in advanced gastric or gastroesophageal adenocarcinoma study: the FLAGS trial.
PURPOSE Patients with advanced gastric or gastroesophageal adenocarcinoma need more efficacious and safer treatments than established today . S-1 , a contemporary oral fluoropyrimidine , can provide that advantage . PATIENTS AND METHODS This study was conducted in 24 countries and 146 centers . One thous and fifty-three patients were stratified ( center , number of metastatic sites , prior adjuvant therapy , and measurable cancer ) and r and omly assigned . Patients received either S-1 at 50 mg/m(2 ) divided in two daily doses for 21 days and cisplatin at 75 mg/m(2 ) intravenously on day 1 , repeated every 28 days ( 527 patients ) or infusional fluorouracil at 1,000 mg/m(2)/24 hours for 120 hours and cisplatin at 100 mg/m(2 ) intravenously on day 1 , repeated every 28 days ( 526 patients ) . The primary end point was superiority in overall survival ( OS ) from cisplatin/S-1 compared with cisplatin/infusional fluorouracil in patients with advanced , untreated gastric , or gastroesophageal adenocarcinoma . The secondary end points were response rate , progression-free survival , time to treatment failure , and safety . RESULTS The median OS was 8.6 months in the cisplatin/S-1 arm and 7.9 months in the cisplatin/infusional fluorouracil arm ( HR , 0.92 ; 95 % CI , 0.80 to 1.05 ; P = .20 ) . Significant safety advantages were observed in the cisplatin/S-1 arm compared with the cisplatin/infusional fluorouracil arm for the rates of grade 3/4 neutropenia ( 32.3 % v 63.6 % ) , complicated neutropenia ( 5.0 % v 14.4 % ) , stomatitis ( 1.3 % v 13.6 % ) , hypokalemia ( 3.6 % v 10.8 % ) , and treatment-related deaths ( 2.5 % v 4.9 % ; P < .05 ) . CONCLUSION Cisplatin/S-1 did not prolong OS of patients with advanced gastric or gastroesophageal adenocarcinoma compared with cisplatin/infusional fluorouracil , but it did result in a significantly improved safety profile
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 .