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 .
Final results of a randomized phase III trial of sequential high-dose methotrexate, fluorouracil, and doxorubicin versus etoposide, leucovorin, and fluorouracil versus infusional fluorouracil and cisplatin in advanced gastric cancer: A trial of the European Organization for Research and Treatment of
PURPOSE To compare the efficacy and tolerability of etoposide , leucovorin , and bolus fluorouracil ( ELF ) or infusional fluorouracil plus cisplatin ( FUP ) with that of the reference protocol of fluorouracil , doxorubicin , and methotrexate ( FAMTX ) in advanced gastric cancer . PATIENTS AND METHODS A total of 399 patients with advanced adenocarcinoma of the stomach were r and omized and analyzed for toxicity , tumor response , and progression-free and overall survival . Only review ed and confirmed responses were considered . The analysis of remission was based on assessable patients with documented measurable lesions . The intent-to-treat principle , log-rank test , and Cox regression model were used for the statistical analysis of time-to-event end points . RESULTS The overall response rate for 245 eligible patients with measurable disease was 9 % with ELF , 20 % with FUP , and 12 % with FAMTX , with no significant differences . One hundred twelve patients were eligible for efficacy  in assessable , nonmeasurable disease . No change was observed in 66 % of patients treated with ELF , 56 % with FUP , and 55 % with FAMTX . Two patients achieved a complete tumor regression ( one each for ELF and FAMTX ) . With a median follow-up time of 4.5 years , the median survival times were 7.2 months with ELF , 7.2 months with FUP , and 6.7 months with FAMTX , respectively , with no significant differences . Nonhematologic and hematologic toxicities of ELF , FUP , and FAMTX were acceptable , with neutropenia being the major toxicity for all three regimens . Seven treatment-related deaths occurred ( two with FUP and five with FAMTX ) . CONCLUSION All three investigated regimens demonstrate modest clinical efficacy and should not be regarded as st and ard treatment for advanced gastric cancer . New strategies should be considered to achieve a better clinical efficacy in the treatment 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 .