Can Capecitabine be used Instead of Concurrent Bolus 5-FU in Postoperative Chemoradiotherapy for Gastric Adenocarcinoma?

Abstract

Background: 5-fluoro-uracil (FU) is a common agent in postoperative chemoradiation in gastric adenocarcinoma. However, FU is not well tolerated in a significant proportion of patients. Capecitabine (CA) is an orally administered fluoropyrimidine carbamate which is preferentially converted to active 5-FU and is one of the agents used instead of FU in such cases. We compared the toxicity, local and distant control and survival rates with FU or oral CA during the course of concurrent radiotherapy to assess the role of CA used instead of FU. Materials and Methods: We conducted an analysis of survival, disease control and toxicity data in 46 patients treated with postoperative chemoradiation following total or subtotal gastrectomy for gastric adenocarcinoma with either FU or CA between January 2008 and December 2012. Results: Median follow-up was 19 months (range: 3-59), median survival time was 23 (±6.08) months and 1-3 years overall survival (OS) rates were 64.9-39% for all patients. Compared with the CA regimen, the incidence of treatment interruption was higher with FU (p=0.023), but no significant differences were seen in local control (p=0.510), distant recurrences (p=0.721) and survival rates (p=0.866) among patients. Conclusions: Concurrent CA with radiotherapy seems to be a more tolerable and an equally effective regimen for the postoperative treatment of gastric adenocarcinoma when compared to FU.

Clinical research of intraperitoneal implantation of sustained-release 5-fluorouracil in advanced colorectal cancer

“…The literature has revealed that 5-Fu wrapped with adjuvant has a good effect in intraperitoneal chemotherapy of gastric cancer [ 17 ]. Besides, the efficacy of 5-Fu is positively associated with its action duration [ 18 , 19 ]. In general, the release time of 5-Fu wrapped with adjuvant does not exceed 1 day, whereas that of sustained-release 5-Fu implantation lasts more than 10 days, which overcomes the disadvantage of conventional chemotherapeutic drugs with a short action duration [ 20 , 21 ].…”

Experimental Study on Sustained-release 5-Fluorouracil Implantation in Canine Peritoneum and Para-aortic Abdominalis

“…The literature has revealed that 5-Fu wrapped with adjuvant has a good effect in intraperitoneal chemotherapy of gastric cancer (Yoshimura et al, 2011). Besides, the efficacy of 5-Fu is positively associated with its action duration (Hu et al, 2013;Yoney et al, 2013). In general, the release time of 5-Fu wrapped with adjuvant is not more than 1 day, whereas that of sustained-release 5-Fu implantation is more than 10 days, which overcomes the disadvantage of conventional chemotherapeutic drugs with short action duration Zhang et al, 2013) .…”

Modified Docetaxel and Cisplatin in Combination with Capecitabine (DCX) as a First-Line Treatment in HER2-Negative Advanced Gastric Cancer

“…As the DCF regimen has been associated with high toxicity profiles, several clinical trials have tested modifications of the DCF regimen utilizing capecitabine and dose modifications , with the aim of reducing toxicity and improving tolerability (Koizumi et al, 2003;Ozdemir et al, 2010;Kang et al, 2011;Kos et al, 2011;Polyzos et al, 2012;Alici et al, 2013). In addition, substitution of capecitabine, an orally administered fluoropyrimidine, for the continuous infusion of fluorouracil prevents the inconvenience of additional cost and morbidity with no negative impact on efficacy and safety in both early and advanced gastric cancer (Hong et al, 2004;Kang et al, 2009: Yoney andIsikli, 2013). Kang et al (2009) compared the combination of cisplatin and capecitabine (CX) with CF in AGC patients in the first-line setting in ML17032 trial.…”