A phase II study of cisplatin in advanced gastric cancer

Beer, M; Cocconi, Giorgio; Ceci, Guido; Varini, M.; Cavalli, F.

doi:10.1016/0277-5379(83)90003-2

Cited by 60 publications

(17 citation statements)

References 6 publications

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“…This regimen was first reported in 1991, with the three drugs being selected on the basis of their single agent activity in upper GIT tumours (Beer et al, 1983;Cersosimo and Hong, 1986;Machover et al, 1986), and on the synergy demonstrated between 5-FU and cisplatin in preclinical models (Etienne et al, 1991). ECF is associated with response rates of approximately 45% in patients with metastatic gastric cancer, although higher response rates are seen when used for locally advanced disease (Findlay et al, 1994;Waters et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

Adjuvant and neoadjuvant therapy for gastric cancer using epirubicin/cisplatin/5-fluorouracil (ECF) and alternative regimens before and after chemoradiation

et al. 2003

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Chemoradiation is now used more commonly for gastric cancer following publication of the US Intergroup trial results that demonstrate an advantage to adjuvant postoperative chemoradiotherapy. However, there remain concerns regarding the toxicity of this treatment, the optimal chemotherapy regimen and the optimal method of radiotherapy delivery. In this prospective study, we evaluated the toxicity and feasibility of an alternative chemoradiation regimen to that used in the Intergroup trial. A total of 26 patients with adenocarcinoma of the stomach were treated with 3D-conformal radiation therapy to a dose of 45 Gy in 25 fractions with concurrent continuous infusional 5-fluorouracil (5-FU). The majority of patients received epirubicin, cisplatin and 5-FU (ECF) as the systemic component given before and after concurrent chemoradiation. The overall rates of observed grade 3 and 4 toxicities were 38 and 15%, respectively. GIT grade 3 toxicity was observed in 19% of patients, while haematologic grade 3 and 4 toxicities were observed in 23%. Our results suggest that this adjuvant regimen can be delivered safely and with acceptable toxicity. This regimen forms the basis of several new studies being developed for postoperative adjuvant therapy of gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Adjuvant and neoadjuvant therapy for gastric cancer using epirubicin/cisplatin/5-fluorouracil (ECF) and alternative regimens before and after chemoradiation

et al. 2003

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“…The regimen of epirubicin, cisplatin and 5-FU (ECF) was developed at the Royal Marsden Hospital (RMH) and first reported in 1991 (Cunningham et al, 1991). The three drugs in this regimen were selected on the basis of their single agent activity in upper gastrointestinal tract tumours (Beer et al, 1983;Cersosimo and Hong, 1986;Machover et al, 1986), and on the synergy demonstrated between 5-FU and cisplatin in preclinical models (Etienne et al, 1991). The 5-FU is delivered as a protracted infusion as this schedule has produced higher response rates with less myelotoxicity compared with bolus administration in patients with colorectal cancer (Lokich et al, 1989).…”

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confidence: 99%

Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: results of a randomized trial

et al. 1999

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The value of combination chemotherapy in advanced oesophagogastric cancer has been clarified. Three randomized clinical trials have demonstrated the superiority of chemotherapy over best supportive care alone (Murad et al, 1993;Pyrhonen et al, 1995;Glimelius et al, 1997). However, the optimal regimen has not yet been established. The combination of 5-fluorouracil (5-FU), adriamycin and methotrexate (FAMTX) has been considered standard therapy, with superior response and survival rates compared with previous regimens (Wils et al, 1991;Kelsen et al, 1992). A combination of cisplatin, epirubicin, leucovorin and 5-FU (PELF) has also demonstrated impressive response rates in a randomized study (Cocconi et al, 1994). The regimen of epirubicin, cisplatin and 5-FU (ECF) was developed at the Royal Marsden Hospital (RMH) and first reported in 1991 (Cunningham et al, 1991). The three drugs in this regimen were selected on the basis of their single agent activity in upper gastrointestinal tract tumours (Beer et al, 1983;Cersosimo and Hong, 1986;Machover et al, 1986), and on the synergy demonstrated between 5-FU and cisplatin in preclinical models (Etienne et al, 1991). The 5-FU is delivered as a protracted infusion as this schedule has produced higher response rates with less myelotoxicity compared with bolus administration in patients with colorectal cancer (Lokich et al, 1989). Following the demonstration of response rates of 71% with moderate toxicity in a phase II study (Findlay et al, 1994), we undertook a multicentre randomized study comparing ECF with FAMTX in advanced oesophagogastric cancer. The initial results of this trial were reported in 1996 when recruitment was completed (Webb et al, 1997). At that stage, an advantage for ECF in response rate and survival was evident. However, median follow-up was only 6.1 months and only 75% of patients had died. We now present a final survival analysis with all patients followed up for 26.9 months or more (median 44 months), and 95% of patients having died. METHODSOur methods have been described previously (Webb et al, 1997). Briefly, patients with inoperable adenocarcinoma or undifferentiated carcinoma of the oesophagus, oesophagogastric junction, or stomach were randomized to receive ECF or FAMTX chemotherapy. ECF chemotherapy was administered through a central venous catheter placed in the subclavian vein. 5-FU was given as a continuous intravenous infusion at a dose of 200 mg m -2 day -1 for up to 6 months. Epirubicin (50 mg m -2 ) and cisplatin (60 mg m -2 ) were given every 3 weeks to a maximum of 8 cycles. FAMTX chemotherapy comprised methotrexate 1500 mg m -2 and 5-FU 1500 mg m -2 on day 1, and doxorubicin 30 mg m -2 on day 15. Cycles were repeated every 28 days to a maximum of 24 weeks. Patients were followed up with clinical and symptomatic SummaryWe report the final results of a prospectively randomized study that compared the combination of epirubicin, cisplatin and protracted venous infusion fluorouracil (5-FU) (ECF regimen) with the standard combination of 5-...

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“…Thus, there is a great need for the development of chemotherapy that will improve the prognosis of these patients. Because response rates to the major drugs used alone have been reported to be less than 25% [4][5][6], most patients with advanced gastric cancer are given combination therapies. According to a JCOG study, FP (5-FU combined with CDDP) therapy had a better response than 5-FU alone [25].…”

Section: Discussionmentioning

confidence: 99%

Combination chemotherapy of S-1 and low-dose cisplatin for advanced gastric cancer

2003

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A phase II study of cisplatin in advanced gastric cancer

Cited by 60 publications

References 6 publications

Adjuvant and neoadjuvant therapy for gastric cancer using epirubicin/cisplatin/5-fluorouracil (ECF) and alternative regimens before and after chemoradiation

Adjuvant and neoadjuvant therapy for gastric cancer using epirubicin/cisplatin/5-fluorouracil (ECF) and alternative regimens before and after chemoradiation

Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: results of a randomized trial

Combination chemotherapy of S-1 and low-dose cisplatin for advanced gastric cancer

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