Neoadjuvant therapy of high-risk gastric cancer: a phase II trial of preoperative FAMTX and postoperative intraperitoneal fluorouracil-cisplatin plus intravenous fluorouracil.

Abstract

Chemotherapy with the FAMTX regimen is tolerable in patients with locally advanced gastric cancer, without an increase in operative morbidity or mortality. IP therapy can be successfully delivered to most resected patients. The intraabdominal failure pattern appears to be decreased compared with expected. This approach is an appropriate investigational arm to pursue in future studies.

High curative resection rate with weekly cisplatin, 5-fluorouracil, epidoxorubicin, 6S-leucovorin, glutathione, and filgastrim in patients with locally advanced, unresectable gastric cancer: a report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD)

“…Interesting results have been initially reported with the use of the FAMTX regimen (5-FU, doxorubicin and methotrexate). In patients with high risk, but potentially curable, gastric tumours, 34 of 56 patients (61%) received a curative resection, but at the cost of substantial toxicity (mainly neutropenic fever) with one chemotherapy-related death (Kelsen et al, 1996). Nevertheless, data from a small randomised trial that compared the use of FAMTX as preoperative therapy before surgery vs surgery alone in operable gastric cancer could not demonstrate that the FAMTX regimen was suitable as neoadjuvant chemotherapy, and the authors concluded that more active regimens should be tested in further randomised studies (Songun et al, 1999).…”

“…Particularly promising seemed data with regard to the use of EUS in preoperative staging of stomach tumours (Lightdale et al, 1989;Botet et al, 1991). Endoscopy and endoscopic ultrasonography showed an accuracy of 75 -85% in predicting tumour stage before surgery, but its use in the evaluation of response to treatment in patients, who received preoperative chemotherapy, was disappointing and unreliable probably due to chemotherapy-induced changes in the physical pattern of the tumour (Kelsen et al, 1996;Ajani et al, 1999). Nevertheless, before a more widely diffusion of these methods occur, traditional procedures are to be applied in order to define surgical resectability.…”

“…Since screening for early detection is not performed in Western Countries, in approximately 50% of newly diagnosed cases, the tumour is beyond its local -regional margins (Kelsen, 1996;Karpeh et al, 2001). Surgery remains the mainstay of any curative treatment, but only when a radical resection is feasible (removal of all gross cancer cells at the resection margins as determined by histopathological examination).…”

“…Only a few studies have focused on the role of preoperative chemotherapy in unresectable gastric cancer. Comprehensively, these trials suggested that chemotherapy could allow radical surgery in approximately 40% of all cases not amenable of curative resection at presentation, but at the cost of severe toxicity (Kelsen, 1996). In a pilot trial, we observed that a preoperative chemotherapy with weekly cisplatin (CDDP), epidoxorubicin (epi-ADR), 5-FU, 6S-leucovorin, glutathione and bone marrow support (filgastrim) could allow a radical resection in 13 out of 32 (41%) patients previously considered unresectable (Cascinu et al, 1998).…”

A Systematic Overview of Chemotherapy Effects in Gastric Cancer

“…Treatment regimens and results are detailed in Table 4. In two studies, intraperitoneal chemotherapy was added postoperatively to eligible patients (4,67,74). Inclusion criteria were not uniform and the preoperative staging used many different imaging techniques.…”