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 .
Docetaxel and continuous-infusion fluorouracil versus epirubicin, cisplatin, and fluorouracil for advanced gastric adenocarcinoma: a randomized phase II study.
PURPOSE A combination of docetaxel and fluorouracil ( DF ) was evaluated in an outpatient setting and compared with epirubicin , cisplatin , and fluorouracil ( ECF ) , which served as an internal control arm to avoid selection bias . PATIENTS AND METHODS Patients with metastatic or locally advanced gastric adenocarcinoma without prior chemotherapy were r and omly assigned to receive either ECF ( epirubicin 50 mg/m(2 ) day 1 , cisplatin 60 mg/m(2 ) day 1 , and fluorouracil 200 mg/m(2 ) days 1 through 21 , every 3 weeks ) or DF ( docetaxel 75 mg/m(2 ) day 1 , and fluorouracil 200 mg/m(2 ) days 1 through 21 , every 3 weeks ) . RESULTS Ninety patients were r and omly assigned . Toxicity was rarely severe . Major toxic effects included diarrhea , stomatitis , and leukopenia in the DF arm and nausea , vomiting , and leukopenia in the ECF arm . Forty-three of 45 patients in each arm were assessable . In the DF arm , two patients ( 4.4 % , intent to treat ) experienced a confirmed complete tumor remission as best response , and 15 patients ( 33.3 % ) experienced a confirmed partial remission ( overall response rate [ ORR ] , 37.8 % ; 95 % CI , 25.9 % to 51.9 % ) . Two patients ( 4.4 % ) in the ECF arm showed confirmed complete remission , and 14 ( 31.1 % ) showed confirmed partial remission ( ORR , 35.6 % ; 95 % CI , 24.8 % to 48.7 % ) . For the DF and ECF arms , the median survival was 9.5 and 9.7 months , and the median time to tumor progression 5.5 and 5.3 months , respectively . CONCLUSION DF can be safely given in an ambulant setting . Compared with ECF , the dual combination of DF shows promising efficacy and may be an alternative treatment option that avoids cisplatin
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 .