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 .
Weekly infusional high-dose fluorouracil (HD-FU), HD-FU plus folinic acid (HD-FU/FA), or HD-FU/FA plus biweekly cisplatin in advanced gastric cancer: randomized phase II trial 40953 of the European Organisation for Research and Treatment of Cancer Gastrointestinal Group and the Arbeitsgemeinschaft I
PURPOSE This multicentric , r and omized , two-stage phase II trial evaluated three simplified weekly infusional regimens of fluorouracil ( FU ) or FU plus folinic acid ( FA ) and cisplatin ( Cis ) with the aim to select a regimen for future phase III trials . PATIENTS AND METHODS A total of 145 patients with advanced gastric cancer where r and omly assigned to weekly  FU 3,000 mg/m2/24 hours ( HD-FU ) , FU 2,600 mg/m2/24 hours plus dl-FA 500 mg/m2 or l-FA 250 mg/m2 ( HD-FU/FA ) , or FU 2000 mg/m2/24 hours plus FA plus biweekly Cis 50 mg/m2 , each administered for 6 weeks with a 1-week rest . The primary end point was the response rate . RESULTS Confirmed responses were observed in 6.1 % ( two of 33 ) of the eligible patients treated with HD-FU , in 25 % ( 12 of 48 , including one complete remission [ CR ] ) with HD-FU/FA , and in 45.7 % ( 21 of 46 , including four CRs ) with HD-FU/FA/Cis . The HD-FU arm was closed after stage 1 because the required minimum number of responses was not met . The median progression-free survival of all patients in the HD-FU , HD-FU/FA , and HD-FU/FA/Cis arm was 1.9 , 4.0 , and 6.1 months , respectively . The median overall survival was 7.1 , 8.9 , and 9.7 months , and the survival rate at 1 year was 24.3 % , 30.3 % , and 45.3 % , respectively . Grade 4 toxicities were rare . The most relevant grade 3/4 toxicities were neutropenia in 1.9 % , 5.4 % , and 19.6 % , and diarrhea in 2.7 % , 1.9 % , and 3.9 % of the cycles in the HD-FU , HD-FU/FA , and HD-/FU/Cis arms , respectively . CONCLUSION Weekly infusional FU/FA plus biweekly Cis is effective and safe in patients with gastric 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 .