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 .
Analysis of a prospectively randomized comparison of doxorubicin versus 5-fluorouracil, doxorubicin, and BCNU in advanced gastric cancer: implications for future studies.
A multi-institutional cooperative study of patients with locally advanced , recurrent , or metastatic gastric adenocarcinoma who had not previously received chemotherapy  was conducted , prospect ively r and omizing patients to receive either doxorubicin or the three-drug combination , 5-fluorouracil ( 5-FU ) , doxorubicin ( Adriamycin ; Adria Laboratories , Columbus , Ohio ) , and BCNU ( FAB ) . The 187 evaluable patients were initially stratified according to the presence of measurable or evaluable disease and performance status . There was a significantly higher response rate observed for FAB ( 40 % ) compared with doxorubicin ( 13 % ) among the 145 measurable-disease patients . Duration of response and survival were significantly longer for FAB in the measurable-disease group , but for the total patient population an early advantage for FAB in time to disease progression and survival was lost with continued follow-up . Median survival was 33 weeks for patients receiving FAB and 19 weeks for those receiving doxorubicin . Significant pretreatment factors adversely affecting survival included poor performance status , weight loss of greater than 10 % , and more than two sites of metastases . Toxicity was not severe in either treatment arm , and only thrombocytopenia occurred significantly more often with FAB . It is contended that in the treatment of advanced gastric cancer , chemotherapy only exerts a relatively short-term and modest beneficial effect , most apparent in patients with intermediate tumor bulk . 5-FU remains the most active single agent , and combination chemotherapy has not yet proven its overall worth . Further studies are indicated comparing the most active combinations with 5-FU using optimal doses and schedules , and consideration must be given to the incorporation of no-treatment controls
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 .