Sequential and combination chemotherapy of advanced gastric cancer

Moertel, Charles G.; Mittelman, James A.; Bakemeier, Richard F.; Engstrom, Paul F.; Hanley, James A.

doi:10.1002/1097-0142(197608)38:2<678::aid-cncr2820380209>3.0.co;2-s

Cited by 91 publications

(11 citation statements)

References 3 publications

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“…In one study patients were randomly allocated to 5-FU and methyl-CCNU or methyl-CCNU alone. Response to the combination was 40% and the patients survived significantly longer following treatment with 5-FU but a subsequent study failed to confirm these results (Moertel et al, 1976;Baker et al, 1976). Adriamycin has been added to the combination of 5-FU and methyl-CCNU (The Gastrointestinal Tumour Study Group (GITSG), 1979;.…”

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confidence: 99%

Gastric cancer – the recognition of a chemosensitive tumour

Cunningham

1988

Br J Cancer

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confidence: 99%

Gastric cancer – the recognition of a chemosensitive tumour

Cunningham

1988

Br J Cancer

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“…Given the large numbers of trials and the many different comparisons in the trials retrieved, the gi dsg made an a posteriori decision to focus on the individual contributions of fluoropyrimidines 20,24,25,28,[32][33][34][35][36][37][38][39][40] , platinum agents 9,23,26,30,36,[41][42][43][44][45] , anthracyclines 34,46 -50,79 , taxanes 22,51,52 , and irinotecan 9,53 . The dsg also decided to determine whether the available evidence supports the regimens that are currently in common use in Ontario 21,24,25,36,48,[55][56][57][58] and to determine the contribution of targeted therapies 59,80 .…”

Section: Resultsmentioning

confidence: 99%

Systemic Therapy for Advanced Gastric Cancer: A Clinical Practice Guideline

2011

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• Within a combination chemotherapy regimen, oral capecitabine is preferred over intravenous 5-fluorouracil (5fu)-that is, epirubicin-cisplatincapecitabine is preferred over the prior standard regimen, epirubicin-cisplatin-5fu (ecf).• Epirubicin-oxaliplatin-capecitabine (eox) is a reasonable alternative to ecf. The choice between ecf and eox should be based on patient preference.• Trastuzumab in combination with cisplatin and a fluoropyrimidine (5fu or oral capecitabine) is recommended for advanced gastric cancer positive for the human epidermal growth factor receptor 2 (her2/neu). KEY WORDSAdvanced gastric cancer, systemic therapy, practice guideline QUESTIONWhat is the optimal chemotherapy regimen in advanced gastric cancer? Outcomes of interest were overall survival (os), objective response rate (complete plus partial responses), time to disease progression, adverse effects, and quality of life. INTRODUCTIONGastric cancer is a virulent disease that is the second leading cause of cancer mortality worldwide 1 . There is significant geographic variation in the incidence of gastric cancer, with incidence and mortality being particularly high in Japan, China, Korea, Chile, and Costa Rica 2 . Even though the incidence rate for gastric cancer in Ontario is one of the lowest worldwide 3 , overall prognosis is bleak, with 5-year survival rates of approximately 23% in Canada 4 and 23%-25% in the United States for all stages combined 5 .Despite the considerable body of research available on chemotherapy for advanced gastric cancer, ABSTRACT QuestionWhat is the optimal chemotherapy regimen in advanced gastric cancer? PerspectivesGastric cancer is the second leading cause of cancer mortality worldwide. Despite low incidence rates for gastric cancer in Ontario, the overall prognosis is bleak, with 5-year survival rates of approximately 23% in Canada. Even with the considerable body of research available on chemotherapy for advanced gastric cancer, uncertainty remains. There is no recognized standard treatment, and there appears to be geographic variation in practice. OutcomesOutcomes of interest were overall survival, objective response rate (complete plus partial responses), time to disease progression, adverse effects, and quality of life. MethodologyAfter a systematic review, a practice guideline containing clinical recommendations relevant to patients in Ontario was drafted. The practice guideline was reviewed and approved by the Gastrointestinal Disease Site Group (gi dsg) and the Report Approval Panel of the Program in Evidence-Based Care. External review by Ontario practitioners was obtained through a survey, the results of which were incorporated into the practice guideline. Practice GuidelineThe gi dsg makes the following recommendations:• To improve survival, a platinum agent should be included in any combination chemotherapy regimen.

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“…This study shows a better 5-year survival rate in the postoperative immunochemotherapy group than in the surgery alone group. The MFC [ll] and FME [12] regimens for which good response rates in advanced gastric cancer had been reported previously were utilized in this study. After the completion of ten cycles of MFC therapy, we continued the chemotherapy with oral 5-FU [37] for 18 months.…”

Section: Discussionmentioning

confidence: 99%

Immunochemosurgery for gastric cancer

Kim

1985

Seminars in Surgical Oncology

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The effects of immunochemosurgery on 73 patients with stage III gastric cancer who were treated with radical subtotal gastrectomy followed by immunochemotherapy for 18 months during the 5-year period between 1975 and 1980 were compared to the effects of therapy on 64 patients with stage III gastric cancer treated with radical subtotal gastrectomy alone during the period between 1970 and 1980. For immunotherapy, picibanil (streptococcus pyogenes preparation) was intramuscularly given weekly, and for chemotherapy, either MFC (mitomycin-C, 5-FU, and cytosine arabinoside) regimen I.V. ten times followed by oral 5-FU or FME (5-FU and methyl-CCNU) regimen was given. The percentage of survivors who received postoperative immunochemotherapy compared to that of survivors who received surgery alone differed by approximately 15%. This difference was rather constant with more than 5 years of follow-up. The 5-year survival rate in the immunochemosurgery group was 38.1%, whereas that in the surgery alone group was 24.8%, which was statistically significant (p less than 0.01). Various immune parameter studies such as 1-chloro-2, 4-dinitrobenzene (DNCB) test, T lymphocyte count and percent, PHA- and concanavalin-A-stimulated lymphoblastogenesis, and antibody dependent cellular cytotoxicity (ADCC) activity showed more favorable data in the immunochemosurgery group than in the surgery alone group. The effects of early postoperative immunochemotherapy (immunotherapy from the fourth to fifth postoperative day, and chemotherapy from the eighth to tenth postoperative day) after radical gastrectomy seems to be superior to that of surgery alone for stage III gastric cancer. For stage I and II gastric cancer, radical gastrectomy and postoperative immunotherapy for 3 months would be the best treatment.

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Sequential and combination chemotherapy of advanced gastric cancer

Cited by 91 publications

References 3 publications

Gastric cancer – the recognition of a chemosensitive tumour

Gastric cancer – the recognition of a chemosensitive tumour

Systemic Therapy for Advanced Gastric Cancer: A Clinical Practice Guideline

Immunochemosurgery for gastric cancer

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