Sir -Interest in enhancing the activity of by the use of prolonged infusions and/or modulation with high dose folinic acid continues. Early studies showed an increased response rate and survival benefit in colorectal adenocarcinoma (Erlichman et al., 1988), but more variable response rates of 12-48% in advanced gastric adenocarcinoma (Machover et al., 1986;Arbuck et al., 1987). Recently short infusions of high dose folinic acid and 5-FU have produced response rates of 40% and 43.5% (Johnson et al., 1991;Louvet et al., 1991).We have treated 15 patients with advanced histologically confirmed gastric and oesophageal adenocarcinoma using the regimen described by De Gramont (De Gramont et al., 1988 The treatment regimen consisted of folinic acid 200mg m-2 in 500 ml of N-saline over 2 h followed by 5-FU 400 mg m2 IV bolus then 5-FU 400 mg m-2 in 1000 ml of N-saline over 22 h. This was repeated on day 2. Oral mucositis was limited by the prophylactic use of allopurinol mouthwash, initially hourly for 4 h after the folinic acid infusion, then four hourly. Laser

Harper PG. A phase II study of ifosfamide and bleomycin in advanced or recurrent cervical carcinoma. Int J Gynecol Cancer 1996; 6: 323-327.Thirty-seven patients with advanced or recurrent cervical squamous cell carcinoma were treated with ifosfamide 1.5 gm -2 on days 1-5 (with mesna as a uroprotector), and bleomycin 30 mg on day 1, every 3 weeks. A partial response rate of 21% (95%CI: 6-36%) was obtained in patients who had not received prior chemotherapy, with a median duration of response of 5 months. No complete responses were seen. The median survival of all patients was 6 months. Nausea and vomiting, white cell suppression and encephalopathy were the main toxic effects. The results suggest that the addition of bleomycin to ifosfamide is not advantageous and increases toxicity, and that the interaction between these two agents is not contributory to the activity of the bleomycin, ifosfamide and cisplatin combination regimen (BIP). The potentially more severe toxicity of combination regimens must be considered when treating this group of patients.