Thirty-four patients with locally advanced, nonresectable gastric cancer (staged by laparotomy) received etoposide, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and cisplatin (EAP). Thirty-three patients were evaluable for response and toxicity. Second-look surgery with removal of residual tumor by gastrectomy and lymphadenectomy was performed in case of complete/partial remission (CR/PR) after EAP. After successful resection (R0- and R1-resection), two cycles of EAP were administered for consolidation therapy. Patients refusing reoperation received up to six cycles of EAP. The response rate (CR/PR) after EAP was 70% (23/33), including a 21% (7/33) rate of clinical CRs (CCRs). Two patients had minor remission (MR)/no change and seven had progressive disease. There was one early death. Nineteen of 23 responders (5 CCRs, 14 clinical PRs [CPRs]) and one patient with MR underwent second-look surgery. Five CCRs were pathologically confirmed; 10 patients with CPR were without evidence of disease (NED) after resection. In three patients (CPR), R1-resections (microscopically tumor-cell positive proximal margin) were performed; two patients are disease-free, 22+ and 33+ months after consolidation chemotherapy. In two patients, the tumor was again considered nonresectable. Twenty patients were disease-free after EAP +/- surgery +/- consolidation chemotherapy. Toxicity was primarily hematologic. Leukopenia and thrombocytopenia of World Health Organization (WHO) grade 3 occurred in 30% and 9%, respectively and grade 4 in 18% and 9% of the patients, respectively. There was no increased peri- or postoperative morbidity. After a median follow-up of 20 months for disease-free patients, the relapse rate is 60% (12/20). The median survival time for all patients is 18 months and for disease-free patients 24 months. EAP is highly effective in locally advanced gastric cancer, and offers a chance for surgery with curative intention in patients with an otherwise fatal prognosis.

major shift in management strategy for breast cancer patients and has been taken one step further in a research paper published on behalf of the Arimidex, Tamoxifen, Alone or in Combination (ATAC) Trials Group. 2 This paper advocates that not only should 5 years of an aromatase inhibitor be the preferred hormonal option for these women, but that anastrozole is the agent of choice. Such conviction may not be fully justified at the present time and in the face of alternative (and potentially interchangeable) aromatase inhibitors and a continued price differential with tamoxifen, which inevitably influences any cost-benefit analysis. The most recent ATAC data at 68 months follow-up shows a continuing divergence of the curves for disease-free survival with evidence of a carry-over effect and a reduction in time to distant recurrence in favor of anastrozole. 2 However, there is no difference in overall survival [hazard ratio (HR) 0.97; P ϭ .7] and the relatively good prognostic parameters of patients (61% node-negative) may ultimately obscure translation into a statistically significant benefit for this end point. Furthermore, non-breast cancer-related deaths could be higher in the anastrozole group as effects of aromatase inhibitors on the cardiovascular system and lipid profile remain unclear.These data must be placed in context with those from other adjuvant trials of aromatase inhibitors such as the Intergroup Exemestane (IES), the Italian (ITA), and the Austrian (ABCSG/ARNO) studies, which collectively involve a large number of patients. At a median follow-up of 37 months, the IES trial yields a HR of 0.83 for exemestane with a P value approaching significance (P ϭ .08). 3 This trial could be the first to eventually show a gain in overall survival for use of an aromatase inhibitor within the conventional hormonal treatment span of 5 years. Definitive results are awaited of the BIG-FEMTA trial, which incorporates both a direct comparison of letrozole and tamoxifen (5 years treatment duration) together with sequential regimes of tamoxifen (2 to 3 years) followed by letrozole (2 to 3 years) and vice versa.It seems likely that any blanket policy for adjuvant hormonal therapy in postmenopausal women with early breast cancer is no longer appropriate. A selective strategy based on risk of relapse may prove optimal; there is evidence that patients with estrogen receptor positive but progesterone receptor negative tumors and those with over-expression of HER-2 neu may derive proportionately more benefit from aromatase inhibition (HR 0.48). 4 These patients could receive an aromatase inhibitor at the outset that may suppress the amplitude of the hazard peak for recurrence, which is of greater magnitude in those at higher risk of relapse. 5 For those patients with lower hazard rates for relapse in the first 2 to 3 years, sequential therapy with tamoxifen (2 to 3 years) followed by an aromatase inhibitor may be more appropriate. Finally, it should be noted that a group of patients may exist for whom the standard 5 years of t...

A total of 26 evaluable patients presenting with advanced or metastatic squamous-cell carcinoma of the esophagus were entered in a phase II trial to assess the single-agent activity of etoposide. Etoposide was given at a dose of 200 mg/m2 on 3 consecutive days every 3 weeks. Five patients (19%) achieved a partial response and seven (27%) experienced stabilisation of their disease. The median duration of response was 4 months (range 3-8 months). The major toxicity was leukopenia, which reached WHO grade 3 in 46% of patients and grade 4 in 11% of cases, with five instances of leukopenic fever and one therapy-associated death being recorded. Etoposide given at this dose and on this schedule seems to have considerable activity against non-pretreated metastatic esophageal carcinoma.

No abstract