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 .
Fluorouracil, doxorubicin, and mitomycin combination versus PELF chemotherapy in advanced gastric cancer: a prospective randomized trial of the Italian Oncology Group for Clinical Research.
PURPOSE The combination of cisplatin , epirubicin , and leucovorin preceding fluorouracil ( PELF ) includes three novel agents compared with the st and ard combination of fluorouracil , doxorubicin , and mitomycin ( FAM ) in the treatment of advanced gastric carcinoma . We report the results of a prospect i ve r and omized comparison of the two combinations in previously untreated patients . PATIENTS AND METHODS One hundred thirty assessable patients were entered onto the trial ; 52 received FAM and 85 PELF . A 1:2 unbalanced r and omization in favor of the experimental treatment was chosen . Approximately 90 % of patients had measurable tumor masses . RESULTS The overall response rates ( complete responses [ CRs ] and partial responses [ PRs ] ) were 15 % and 43 % for the FAM and the PELF regimens , respectively , with a statistically significant advantage for the experimental treatment ( P = .001 ) . Time to progression ( median , 2.6 and 4.7 months ) , duration of response ( median , 10.7 and 10.2 months ) , and survival duration s ( median , 5.6 and 8.1 months ) were not significantly different between the FAM and PELF regimens , respectively . The PELF combination was more toxic compared with FAM , but generally tolerable . CONCLUSION This study showed that the PELF combination is about three times more effective than the FAM combination in inducing objective responses . Due to tolerability , it is not recommended for routine clinical use . However , it should be considered , among other second-generation chemotherapy combinations , in future r and omized studies aim ed to improve the therapeutic outcome in gastric carcinoma
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 .