Chemotherapy for advanced gastric cancer

Abstract

Chemotherapy significantly improves survival in comparison to best supportive care. In addition, combination chemotherapy improves survival compared to single-agent 5-FU, but the effect size is much smaller. Among the combination chemotherapy regimens studied, best survival results are achieved with regimens containing 5-FU, anthracyclines and cisplatin. In this category, ECF (epirubicin, cisplatin and continuous infusion 5-FU) is tolerated best.

Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: a meta-analysis and meta-regression

“…Another important issue in clinical trial design is the selection of the optimal regimen as control. Our metaregression models indicate that no specific types of chemotherapeutic agents are clearly superior to others in terms of improvement in PFS, consistent with previous metaanalyses [1,10,60]. While multi-drug combinations produce higher PFS, the selection of chemotherapeutic regimens should also take into account treatment safety and impact on the patients' quality of life.…”

“…Trials published before 2005 have been summarized in previous meta-analyses [1,10]. In addition, the standard of supportive care may change over the years, and this change may confound the interpretation of the meta-analysis results.…”

“…Many studies were done to compare the efficacy, safety, and pharmacological characteristics of different fluoropyrimidine regimens, but the optimal regimen remains undetermined [5][6][7][8]. Addition of epirubicin or docetaxel to the platinum-fluoropyrimidine combination is common in Europe and the USA because of the survival benefit demonstrated by randomized clinical trials [9][10][11], but it is still under debate whether the survival benefit justifies the additional toxicity of these threedrug combinations.…”

The Changing Use of Palliative Chemotherapy for Recurrent Esophagogastric Cancer: A Single Center Retrospective 15-Year Review

“…Palliative chemotherapy, however, is more commonly used for esophageal and gastric cancers that are locally advanced or have distant metastatic spread at initial presentation, thus being deemed as incurable. There is some evidence of the value of palliative chemotherapy as primary treatment in advanced gastric cancer [1,2]. There is no good evidence to support use of palliative chemotherapy in advanced or metastatic esophageal cancer [3,4].…”

“…Sparse literature exists exclusively for patients with recurrent EG disease. More often, patients with recurrent disease are studied as a heterogeneous group among those who present with locally advanced or metastatic disease [1][2][3][4]. Such studies have included patients with recurrent EG cancer, though have not specifically subanalyzed their outcome after treatment.…”