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

Abstract

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.

Adjuvant chemoradiation using 5-fluorouracil/folinic acid/cisplatin with or without paclitaxel and radiation in patients with completely resected high-risk gastric cancer: two cooperative phase II studies of the AIO/ARO/ACO

“…In addition, improved radiation techniques, in particular the use of 3D radiation treatment planning resulting in four or more field techniques in the majority of patients compared with simple AP-PA portals in the INT 0116 trial, and the application of 5-FU as continuous infusion during radiotherapy as well as improved supportive measures, may all have contributed to the apparently better tolerability. Similar conclusions have been drawn by other recent studies [26,27]. Weight loss and anorexia represent particular problems in this patient group.…”

Four consecutive multicenter phase II trials of adjuvant chemoradiation in patients with completely resected high-risk gastric cancer: the experience of the German AIO/ARO/CAO group

“…CTX 90 -92 3 100 -60 Therefore, with the use of more eVective chemotherapy regimens than bolus 5-FU/leucovorin according to the Mayo-protocol, which was used in the US Intergroup Study, the eYcacy of adjuvant chemoradiotherapy might be improved. Leong et al 2003 demonstrated feasibility and tolerability of a combination chemotherapy in the adjuvant setting after completely resected gastric cancer, applying one cycle of combination chemotherapy of epirubicin, cisplatin and 5-FU each before and after chemoradiation in 26 patients with an acceptable toxicity proWle (Leong et al 2003). Recently, these results were conWrmed by a pilot study of Lee et al, who evaluated a combination regimen of 5-FU and cisplatin before and after chemoradiation including capecitabine.…”

Adjuvant Chemoradiotherapy in Patients With Stage III or IV Radically Resected Gastric Cancer

“…On the contrary, postoperative fluorouracil-based CT-RT is the recommended standard of care for pT3 and Nϩ gastric cancers in the United States, 9 and several phase 2 studies exploring substitution of bolus fluorouracil with the better-tolerated continuous infusion of fluorouracil and the addition of cisplatin or paclitaxel as a second drug were recently published. [10][11][12] Overall, all of these studies were characterized by difficulty in completing the planned treatment in more than 80% of patients. However, CT-RT is not considered the standard of care in Europe for patients with radically resected gastric cancer.…”