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 .
High Doses of 5-Fluorouracil and Epirubicin with or without Cisplatin in Advanced Gastric Cancer: A Randomized Study
Background A prospect i ve r and omized clinical study was performed in patients with locally advanced or metastatic gastric cancer . The purpose of the study was to determine the activity of high doses of 5-fluorouracil and epirubicin ( FE ) vs the same combination + cisplatin ( FEP ) , and particularly the value of cisplatin in the combination . Patients and Methods A total of 122 patients was included in the study ; 110 of them were assessable . In the FE arm , the treatment involved 1000 mg/m2 in a 6-hr infusion of 5-fluorouracil on days 1 , 2 , 3 , 4 and 5 and 120 mg/m2 of epirubicin iv on day 1 . In the FEP arm , the same combination of cytostatics + cisplatin ( 30 mg/m2 ) was administered on days 2 and 4 . The cycles were repeated after 4 weeks . Altogether , 468 cycles of chemotherapy were given ( FE , 240 ; FEP , 228 ) . Results In the FE arm , 56 patients were assessable , with 2 complete and 14 partial remissions ( 28.6 % ) ; in the FEP arm , 4 complete and 19 partial remissions ( 42.6 % ) were observed in 54 assessable patients . Median survival in the FE group was 7.1 months and in the FEP group 9.6 months . The survival difference was statistically significant ( Cox 's test , P<0.05 ) . The most frequent side effects included grade 2 and 3 alopecia ( FE , 93 % ; FEP , 94 % ) and grade 2 and 3 vomiting ( FE , 20 % ; FEP , 35 % ) . Grade 3 and 4 leukopenia was observed in 9 % of patients in the FE group and in 13 % of patients in the FEP group , with 6 cases of febrile neutropenia ( FE , 4 % ; FEP , 7 % ) . Stenocardia was registered in 1 patient in the FE group and in 2 patients in the FEP group . No treatment-related death was registered . Conclusions The addition of cisplatin to high doses of 5-fluorouracil and epirubicin result ed in a statistically significant better survival of treated patients
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 .