Combination chemotherapy (CT) has, in some groups of patients with gastric cancer (GC), who are at a high risk for relapse, resulted in a small but measurable improvement in palliation and patient survival not reaching statistical significance and therefore remaining applicable in an investigational setting. Based on the above data, we studied adjuvant CT with FEM (5-fluorouracil (5-FU), epirubicin, mitomycin C) in a randomized study of patients with completely resected stage III GC and patients with stages T_1–3 with a low histologic grade. CT was started 2–3 weeks after surgery. From August 1988 until February 1994, 84 patients with completely resected tumors and lymph nodes were randomized to either group A (FEM) or group B (no treatment). Patients were eligible for randomization if they had a Karnofsky score > 60, no postoperative evidence of residual tumor, and normal cardiac, hepatic and renal functions. Forty-two patients were randomized to each group, with no significant differences regarding: age distribution, group A 53 years (41–65), group B 57 years (35–66); sex, group A 32/10, group B 25/17 (men/women); site of primary tumor, group A 22/20, group B 25/ 17 (pylorus/antrum); histologic grade, group A 0/19/23, group B 0/ 25/17 (grades I/II/III); lymph node metastases, group A 30, group B 32, and surgical procedure, group A 33/9/6, group B 35/7/9 (total gastrectomy/partial gastrectomy/splenectomy). Group A received 5-FU 600 mg/m²/day i.v. on days 1, 8, 29 and 36, epirubicin 45 mg/m²/day i.v. on days 1 and 29, and mitomycin C 10 mg/m² i.v. on day 1. The schedule was repeated every 56 days for 3 cycles. Group B received no treatment odd was only subjected to the regular follow-up. At the last follow-up at 66 months, 27/42 patients in group A (64%) had relapsed or died, compared to 34/42 patients in group B (81 %). The differences in the relapse and the disease-free and the overall survival rates were not statistically significant. Only the subgroup of patients with histologic grade III tumors receiving adjuvant FEM demonstrated a trend towards improved survival (p = 0.085). Main therapy-related toxicities for the treatment group were grade I–II anemia, neutropenia, and throbocytopenia in 16, 45, and 22% of patients, respectively, and grade I–II nausea and vomiting in 29% of patients. Based on the present findings and those of previous studies, even if one considers the difference reaching statistical significance in the latter for histologic grade III tumors, it becomes evident that with current therapeutic modalities adjuvant therapy has no established role in the management of resectable GC. Studies of new-generation regimens, such as FAMTX (5-FU, Adriamycin and methotrexate) as well as ELF (etoposide, Leucover-in, and 5-FU), should be conducted in the adjuvant therapy setting with a nontherapy control group, in order to clarify the issue of adjuvant CT in resectable GC.

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Background: The study evaluated the effects of cefepime and meropenem on the gastrointestinal (GI) colonization of surgical patients by Candida albicans. Patients and Methods: Twenty adult surgical patients who received intravenously either of these antibiotics as monotherapy for the treatment of an existing infection were studied prospectively. Ten patients received cefepime (2.0 g twice a day), and another ten meropenem (1.0 g every 8 h) for 7 days. Quantitative stool cultures for C. albicans were performed immediately before, at the end, and 1 week after the end of antibiotic treatment. Results: Both antibiotics increased the GI colonization of patients by Candida. Meropenem caused a higher increase (2.0 log₁₀ CFU/g of stool) as compared to cefepime (1.7 log₁₀ CFU/g of stool). However, these increases were statistically not significant. Conclusion: Cefepime and meropenem when given to sensitive patients do not increase significantly the risk of Candida infection originating in the GI tract.