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

Abstract

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.

A phase I/II study of S-1 plus cisplatin in patients with advanced gastric cancer: 2-week S-1 administration regimen

“…[2][3][4] The response rates of various single agents such as 5-FU, cisplatin (CDDP), doxorubicin, and mitomycin-C are all less than 20%. [5][6][7] Therefore, with no standard regimen as yet established, there is a real and immediate need to develop new agents with improved antitumor effect, which could be added to the chemotherapy armamentarium for gastric cancers.…”

Gastric cancer – the recognition of a chemosensitive tumour

“…Levi et al treated 35 evaluable patients with the combination of 5-FU adriamycin and BCNU (FAB) and found 18 (51%) patients responded with a median duration of response of 10 months. However, a subsequent randomised study from this group showed no difference in the survival of patients treated with single agent adriamycin compared with FAB (Levi et al, 1986). Until recently, the most widely used regimen in gastric cancer was the combination of 5-FU, adriamycin and mitomycin-C (FAM) (MacDonald et al, 1979).…”

Chemotherapy in metastatic gastric cancer: population-based perceptions and practice patterns of medical oncologists

“…This led to the development of combination chemotherapy such as 5-FU, doxorubicin and mitomycin C (FAM) and 5-FU, doxorubicin and carmustine (FAB). Comparative studies of these combinations to single agents did not show an improvement in RR or survival (Cullinan et al 1985; Levi et al, 1986).…”