Palliative chemotherapy for advanced gastric cancer
- 1 November 2004
- journal article
- research article
- Published by Elsevier in Annals of Oncology
- Vol. 15 (11) , 1585-1595
- https://doi.org/10.1093/annonc/mdh422
Abstract
Background: More than two-thirds of patients diagnosed with gastric cancer will have unresectable disease. They present a difficult problem to clinicians as to whether to choose a strictly supportive approach or expose patients to the side-effects of a potentially ineffective treatment. The objective of this article is to review the clinical trials utilizing cytotoxic chemotherapy in patients with advanced gastric cancer. Methods: A computerized (Medline) search was carried out to identify papers published on this topic between 1966 and 2003. Only articles with an English abstract were reviewed, and studies only presented in abstract form were not included in the analysis. Results: A total of 101 trials were subsequently identified. Four randomized trials compared palliative chemotherapy with best supportive care in 174 patients with advanced gastric cancer. Effectiveness and side-effects were evaluated in 73 phase II studies and 24 randomized phase III trials. Conclusion: Analysis of results shows chemotherapy to be superior to best supportive care alone. Combination chemotherapy compared with monochemotherapy is associated with significantly higher overall (complete plus partial) response rates but nevertheless results in similar survival. ECF (epirubicin, cisplatin and 5-fluorouracil) currently represents one of the most effective regimens for advanced gastric cancer, whereas among the newer combinations, irinotecan- or taxane-based regimens have also given promising results. In patients with a poor performance status, consideration could be given to leucovorin-modulated 5-fluorouracil alone. Prognosis for the majority of patients, however, remains poor, as increases in survival were moderate at best.Keywords
This publication has 99 references indexed in Scilit:
- Docetaxel as salvage chemotherapy in advanced gastric cancer patients (AGC): a phase II study of the Southern Italy oncology group (GOIM)European Journal Of Cancer, 1999
- Phase II study of docetaxel (D) as salvage chemotherapy in patients with advanced gastric cancerEuropean Journal Of Cancer, 1999
- Late phase II study of novel oral fluoropyrimidine anticancer drug S-1 (1M tegafur–0.4M gimestat–1M otastat potassium) in advanced gastric cancer patientsEuropean Journal Of Cancer, 1998
- Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancerBritish Journal of Cancer, 1995
- Etoposide, doxorubicin and cisplatin (EAP) treatment in advanced gastric carcinoma: a multicentre study of the Italian Trials in Medical Oncology (I.T.M.O.) GroupEuropean Journal Of Cancer, 1994
- Efficacy of combined 5-fluorouracil and cisplatinum in advanced gastric carcinomas. A phase II trial with prognostic factor analysisEuropean Journal Of Cancer, 1994
- Association of Epirubicin, Etoposide and Cisplatin in Gastric CancerOncology, 1991
- Phase II study of carboplatin in untreated inoperable advanced stomach cancerEuropean Journal of Cancer and Clinical Oncology, 1990
- Ergebnisse eines modifizierten FAMeth-Chemotherapieprotokolls beim metastasierten MagenkarzinomDeutsche Medizinische Wochenschrift (1946), 1989
- Cis-platinum as second-line chemotherapy in advanced gastric adenocarcinoma. A phase II study of the EORTC gastrointestinal tract cancer cooperative groupEuropean Journal of Cancer and Clinical Oncology, 1985