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 .
FAMTX versus etoposide, doxorubicin, and cisplatin: a random assignment trial in gastric cancer.
PURPOSE The chemotherapy regimens of high-dose methotrexate , high-dose fluorouracil ( FU ) , Adriamycin ( doxorubicin ; Adria Laboratories , Columbus , OH ) , and leucovorin ( FAMTX ) and etoposide , Adriamycin , and cisplatin ( EAP ) have both been reported in nonr and om assignment trials to have high overall response rates and substantial complete response rates in patients with gastric cancer , as well as major toxicities of myelosuppression . Here we report a prospect i ve , stratified , r and om-assignment comparison of the two combinations in previously untreated patients with advanced gastric cancer . PATIENTS AND METHODS Sixty patients were entered onto the trial , 30 receiving EAP and 30 FAMTX . All patients had measurable or assessable tumor masses . Patient entry was stopped at the point when significant toxicity differences were seen at interim analysis . RESULTS Response rates were similar between the two arms ( FAMTX , 33 % [ 95 % confidence interval ( CI ) , 16 % to 50 % ] ; EAP , 20 % [ 95 % Cl , 6 % to 34 % ] ) . Three FAMTX and no EAP patients had complete remissions . The median survival for the two arms were similar ( EAP , 6.1 months ; FAMTX , 7.3 months ) . At 1 year , 7 % of EAP and 17 % of FAMTX patients were alive . EAP caused significantly more myelosuppression ( leukopenia , P = .002 ; anemia , P = .03 ; thrombocytopenia , P = .0001 ) than did FAMTX . EAP also result ed in significantly longer hospitalizations per study month ( 8 v 5 days ) . Four EAP patients died of lethal toxicity , whereas no FAMTX patients died of treatment-related causes ( P = .04 ) . CONCLUSIONS FAMTX is at least as active as EAP and is significantly less toxic . Although both regimens remain investigational , the toxicities of FAMTX are more manageable . Further studies involving FAMTX in both the adjuvant and advanced disease setting are underway
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 .