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 .
Randomized phase III trial of fluorouracil alone versus fluorouracil plus cisplatin versus uracil and tegafur plus mitomycin in patients with unresectable, advanced gastric cancer: The Japan Clinical Oncology Group Study (JCOG9205).
PURPOSE To compare fluorouracil ( FU ) alone with FU plus cisplatin ( FP ) and with uracil and tegafur plus mitomycin ( UFTM ) for patients with advanced gastric cancer in a prospect i ve , r and omized , controlled trial . PATIENTS AND METHODS A total of 280 patients with advanced gastric cancer were r and omly allocated and analyzed for survival , response , and toxicity . The survival curves were compared between groups by log-rank test on an intent-to-treat basis . RESULTS At the interim analysis , the UFTM arm showed a significantly inferior survival with higher incidences of hematologic toxic effects than did control arm FU alone , and the registration to UFTM was terminated . Both investigational regimens , FP and UFTM , had a significantly higher incidence of hematologic toxic effects than FU alone , although the effects were manageable . The overall response rates of the FU-alone , FP , and UFTM arms were 11 % , 34 % , and 9 % , respectively . The median progression-free survival was 1.9 months with FU alone , 3.9 months with FP , and 2.4 months with UFTM , respectively . Although FP demonstrated a higher response rate ( P < .001 ) and longer progression-free survival than did FU alone ( P < .001 ) , no differences in overall survival were observed between the arms . The median survival times and 1-year survival rates were 7.1 months and 28 % with FU , 7.3 months and 29 % with FP , and 6.0 months and 16 % with UFTM , respectively . CONCLUSION Neither investigational regimen , FP nor UFTM , showed a survival advantage as compared with FU alone . FU alone will remain a reference arm in our future trial for advanced gastric 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 .