ECF with Infusional Fluorouracil for 5 Days in Locally Advanced and Metastatic Gastric Cancer, Is It Better than the Standard?

Abstract

The ECF (Epirubcin/Cisplatin/5-fluorouracil) first therapy in metastatic gastric is the optimal therapeutic option but its complexity limits its utility in many communities. We investigated a more convenient modification of the standard approach, "5 days CIV 5-fluorouracil 1000mg/m 2 ". A total of 115 patients with advanced and metastatic adenocarcinoma of the stomach and gastroesophageal cancer were reviewed retrospectively to compare the efficacy of modified ECF N=41 with the reference protocols FAM N=32 and ELF N=42. The overall response rate was 36.5% with ECF, 16.6% with ELF, and 15.6% with FAM, with significant differences p=0.001. No one achieved a complete tumor regression. However, 4 patients with locally advanced stomach were able to have total gastrectomy in ECF arm only with p=0.000. Hematologic toxicities were more common in ECF p= 0.01. On the other hand, there was no significant difference in progression free survival or overall survival between the three regimens. Modified ECF showed significant overall response than FAM and FLF. However survival benefit is very small. So we recommend using this regimen as neoadjuvant treatment.

Modified Epirubicin, cisplatin, and 5-FU regimen as first-line chemotherapy in metastatic gastric or gastroesophageal junction adenocarcinoma: A Phase II study

“…[14] In a retrospective study, Ibrahim et al investigated a more convenient and logical modification of the standard ECF protocol. [15] They used "5-day continuous IV infusion 5-FU" at a dose of 1000 mg/m 2 /day. The ORR was 36.5%; the median PFS was 3.2 months, and the median OS was 7 months, with the modified ECF regimen (n = 41).…”

“…Grade 3-4 neutropenia, thrombocytopenia, and mucositis were seen in 39%, 34%, and 31% of patients, respectively. [15] In the present prospective study, we have used an almost similar modification of the ECF regimen as done by Ibrahim et al, to make it more convenient for our patients, using 5-day IV infusion of 5-FU at a dose of 750 mg/m 2 /day (given over 6 h through a peripheral venous line), every 3 weeks. The ORR was 32.7%; median PFS and OS were 5.9 months and 10.4 months, respectively.…”