A review of chemotherapy in gastric cancer

Comis, Robert L.; Carter, Stephen K.

doi:10.1002/1097-0142(197411)34:5<1576::aid-cncr2820340503>3.0.co;2-0

Cited by 89 publications

(30 citation statements)

References 34 publications

(2 reference statements)

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“…Response rates of 5% -21% have been reported for single-agent chemotherapy, with 5-fluorouracil (5-FU), in chemonaive patients (Wils and Bleiberg, 1989;Loehrer et al, 1994). Other agents, when used as monotherapy, have produced response rates as follows: paclitaxel 20% ), adriamycin 24% (O'Connell, 1985, docetaxel 25% (Sulkes et al, 1994), cisplatin 25% (O'Connell, 1985), UFT 28% (Takiuchi and Ajani, 1998) and mitomycin C 30% (Comis and Carter, 1974).…”

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Irinotecan is active in chemonaive patients with metastatic gastric cancer: a phase II multicentric trial

et al. 2003

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To assess the response rate and the tolerance of irinotecan as first-line therapy, 40 patients with metastatic gastric cancer received irinotecan 350 mg m À2 every 3 weeks administered as a 30 min infusion. Among the 35 patients evaluable for response, two complete and five partial responses were recorded (response rate: 20.0% (95% CI:8.4 -36.9%)). In total, 16 patients achieved stable disease and 12 progressive disease. In all, 66 percent of the patients benefited from tumour growth control. The median time to progression was 3.0 months (95% CI: 2.3 -4.4%). The median overall survival was 7.1 months (95% CI: 5.2 -9.0%). The probability of being alive at 6 months and 9 months was 61.0 and 32.4%, respectively. The median number of cycles per patient was 3 (range 1 -14), and the relative dose intensity was 0.98. The most common grade 3 -4 toxicities by patients were diarrhoea 20%, asthenia 10%, nausea 7.5%, vomiting 5.0%, abdominal pain 5%, neutropenia 38.5%, leucopenia 28.2%, anaemia 12.8% and thrombocytopenia 5.1%. Febrile neutropenia occurred in 12.5% of patients. These findings indicate that irinotecan is active and well tolerated in patients with metastatic gastric adenocarcinoma and warrants further evaluation in this clinical setting.

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Irinotecan is active in chemonaive patients with metastatic gastric cancer: a phase II multicentric trial

et al. 2003

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“…40% of patients diagnosed with gastric cancer are inoperable at the time of diagnosis (13), and 30～40% of those curative resected patients experience recurrence of tumor (14). These are the patients that are suitable for chemotherapy.…”

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confidence: 99%

Randomized Phase III Trial of Cisplatin, Epirubicin, Leucovorin, 5-Fluorouracil (PELF) Combination versus 5-fluorouracil Alone as Adjuvant Chemotherapy in Curative Resected Stage III Gastric Cancer

et al. 2004

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Purpose:The combination of cisplatin, epirubicin, leucovorin and 5-fluorouracil (PELF) administration, as adjuvant chemotherapy after curative resection for gastirc cancer, was compared with 5-fluorouracil (5-FU) administration alone. This paper reports the results of a prospective randomized comparison of the two regimens, PELF and 5-FU.Methods: From August 1996 to July 1999, 54 patients were selected subsequent to being diagnosed with stage III cancer after a curative resection for gastric cancer. The patients were stratified according to stage IIIA/IIIB and subtotal/total gastrectomy, and then they were randomized into each treatment group, i.e. the PELF or 5-FU alone groups.Results: 54 assessable patients were enrolled in this study: 28 received PELF and 26 received 5-FU alone. 12 patients relapsed in each group and the median follow-up duration was 42 months (range: 10～77 months). The overall survival rate and disease-free survival rate (DFS) were not significantly different between two groups, (5-year survival of PELF vs. 5-FU: 57% vs. 64% , 5-year DFS: 54% vs. 51% ). The PELF combination was more toxic in terms of anemia, anorexia, nausea and diarrhea than the 5-FU.Conclusions: This study showed that the PELF combination, as an adjuvant therapy for gastric cancer after a curative resection, was a less effective treatment, and it had more toxic effects than the

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“…7 ' 8 Combination chemotherapy studies in advanced-stage gastric cancer, initially most often incorporating 5-fluorouracil (5-FU), mitomycin C, or a nitrosourea and subsequently adding doxorubicin, have reported response rates in excess of 40% and on occasion > 50%.9-12 However, there have only been a limited number of randomized studies comparing these various combinations with individual drugs, and more recent studies have compared different drug combinations. 9,10,[13][14][15][16] An initial pilot study by Levi et al using the three-drug combination of 5-FU, doxorubicin paring this three-drug combination to the apparently most active single agent available, doxorubicin, based on the results of single-agent data published up to the time of initiation of the study.…”

confidence: 99%

“…In view of the fact that the largest studies evaluating 5-FU as a single agent have included 54 to 72 patients in each study and obtained response rates of 20% to 27%, this drug must still be considered the most active single agent and the standard for comparison of any drug combinations.1' 2 , 7 In this context, it is pertinent to note that no studies reported have demonstrated a significant survival advantage for combination chemotherapy when compared with 5-FU, and when such advantages for drug combinations were reported the single-agent comparison has been either a nitrosourea or doxorubicin.…”

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Analysis of a prospectively randomized comparison of doxorubicin versus 5-fluorouracil, doxorubicin, and BCNU in advanced gastric cancer: implications for future studies.

Levi¹,

Fox²,

Tattersall³

et al. 1986

JCO

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A multi-institutional cooperative study of patients with locally advanced, recurrent, or metastatic gastric adenocarcinoma who had not previously received chemotherapy was conducted, prospectively randomizing patients to receive either doxorubicin or the three-drug combination, 5-fluorouracil (5-FU), doxorubicin (Adriamycin; Adria Laboratories, Columbus, Ohio), and BCNU (FAB). The 187 evaluable patients were initially stratified according to the presence of measurable or evaluable disease and performance status. There was a significantly higher response rate observed for FAB (40%) compared with doxorubicin (13%) among the 145 measurable-disease patients. Duration of response and survival were significantly longer for FAB in the measurable-disease group, but for the total patient population an early advantage for FAB in time to disease progression and survival was lost with continued follow-up. Median survival was 33 weeks for patients receiving FAB and 19 weeks for those receiving doxorubicin. Significant pretreatment factors adversely affecting survival included poor performance status, weight loss of greater than 10%, and more than two sites of metastases. Toxicity was not severe in either treatment arm, and only thrombocytopenia occurred significantly more often with FAB. It is contended that in the treatment of advanced gastric cancer, chemotherapy only exerts a relatively short-term and modest beneficial effect, most apparent in patients with intermediate tumor bulk. 5-FU remains the most active single agent, and combination chemotherapy has not yet proven its overall worth. Further studies are indicated comparing the most active combinations with 5-FU using optimal doses and schedules, and consideration must be given to the incorporation of no-treatment controls.

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A review of chemotherapy in gastric cancer

Cited by 89 publications

References 34 publications

Irinotecan is active in chemonaive patients with metastatic gastric cancer: a phase II multicentric trial

Irinotecan is active in chemonaive patients with metastatic gastric cancer: a phase II multicentric trial

Randomized Phase III Trial of Cisplatin, Epirubicin, Leucovorin, 5-Fluorouracil (PELF) Combination versus 5-fluorouracil Alone as Adjuvant Chemotherapy in Curative Resected Stage III Gastric Cancer

Analysis of a prospectively randomized comparison of doxorubicin versus 5-fluorouracil, doxorubicin, and BCNU in advanced gastric cancer: implications for future studies.

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