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 .
Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) With epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer.
PURPOSE We report the results of a prospect ively r and omized study that compared the combination of epirubicin , cisplatin , and protracted venous-infusion fluorouracil ( PVI 5-FU ) ( ECF ) with the combination of mitomycin , cisplatin , and PVI 5-FU ( MCF ) in previously untreated patients with advanced esophagogastric cancer . PATIENTS AND METHODS Five hundred eighty patients with adenocarcinoma , squamous carcinoma , or undifferentiated carcinoma were r and omized to receive either ECF ( epirubicin 50 mg/m(2 ) every 3 weeks , cisplatin 60 mg/m(2 ) every 3 weeks and PVI 5-FU 200 mg/m(2)/d ) or MCF ( mitomycin 7 mg/m(2 ) every 6 weeks , cisplatin 60 mg/m(2 ) every 3 weeks , and PVI 5-FU 300 mg/m(2)/d ) and analyzed for survival , response , toxicity , and quality of life ( QOL ) . RESULTS The overall response rate was 42.4 % ( 95 % confidence interval [ CI ] , 37 % to 48 % ) with ECF and 44.1 % ( 95 % CI , 38 % to 50 % ) with MCF ( P = .692 ) . Toxicity was tolerable , and there were only two toxic deaths .  ECF result ed in more grade 3/4 neutropenia and grade 2 alopecia , but MCF caused more thrombocytopenia and plantar-palmar erythema . Median survival was 9.4 months with ECF and 8.7 months with MCF ( P = .315 ) ; at 1 year , 40.2 % ( 95 % CI , 34 % to 46 % ) of ECF and 32.7 % ( 95 % CI , 27 % to 38 % ) of MCF patients were alive . Median failure-free survival was 7 months with both regimens . Global QOL scores were better with ECF at 3 and 6 months . CONCLUSION This study confirms response , survival , and QOL benefits of ECF observed in a previous r and omized study . The equivalent efficacy of MCF was demonstrated , but QOL was superior with ECF . ECF remains one of the reference treatments for advanced esophagogastric 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 .