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 .
A comparative clinical assessment of combination chemotherapy in the management of advanced gastric carcinoma
This report summarizes the results of a r and omized multi‐institutional clinical trial in advanced gastric carcinoma comparing four combination chemotherapy regimens : 5‐FU , Adriamycin + mitomycin C ( FAMi ) ; 5‐FU , Adriamycin + methyl‐CCNU ( FAMe ) ; 5‐FU , ICRF‐159 + methyl‐CCNU ( FIMe ) ; and 5‐FU + methyl‐CCNU ( FMe ) .  One‐hundred‐eighty‐one evaluable patients received chemotherapy . These objective tumor response rates were observed among the 59 patients with measurable indicator lesions : FAMi , 3/12 ( 25 % ) ; FAMe , 3/10 ( 30 % ) ; FIMe , 4/19 ( 21 % ) ; FMe , 1/18 ( 6 % ) . The survival distributions for the four treatment groups were significantly different ( P < 0.05 ) , with these median survivals observed ( in weeks from the onset of chemotherapy ) : FAMi , 29.6 ; FAMe , 34.4 ; FMe , 22.9 ; FIMe , 17.4 . Two nontreatment variables were found to be significantly associated with survival when analyzed using the Cox covariate model : pretreatment performance status ( P < 0.0001 ) , and presence or absence of measurable metastatic disease ( P < 0.001 ) . After adjustments for the effects of these and other clinical variables , two treatment regimens were found to be associated with improved survival  : FAMi therapy ( P < 0.01 ) , and FAMe therapy ( P = 0.07 ) . Toxicity was , in general , moderate and consisted primarily of gastrointestinal side effects and myelosuppression . We conclude that the FAMi and FAMe regimens are superior to the FIMe and FMe regimens in the management of 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 .