Recurrent Gastric Cancer
Standard treatment options:
- Palliative chemotherapy with:
- Fluorouracil (5-FU).[1,2,3]
- Epirubicin, cisplatin, and 5-FU (ECF).[4,5]
- Cisplatin and 5-FU (CF).[6,3]
- Etoposide, leucovorin, and 5-FU (ELF).[7]
- 5-FU, doxorubicin, and methotrexate (FAMTX).[6]
- Endoluminal laser therapy or endoluminal stent placement may be helpful to patients whose tumors have occluded the gastric inlet or outlet.[8]
- Palliative radiation therapy may alleviate bleeding, pain, and obstruction.
- Palliative resection should be reserved for patients with continued bleeding or obstruction.
Standard chemotherapy versus best supportive care for patients with metastatic gastric cancer has been tested in several clinical trials, and there is general agreement that patients who receive chemotherapy live for several months longer on average than patients who receive supportive care.[9,10,11][Level of evidence: 1iiA] During the last 20 years, multiple randomized studies evaluating different treatment regimens (monotherapy vs. combination chemotherapy) have been performed in patients with metastatic gastric cancer with no clear consensus emerging as to the best management approach. A meta-analysis of these studies demonstrated an HR of 0.83 for OS (95% CI, 0.74-0.93) in favor of combination chemotherapy.[12]
Little documentation exists regarding the development of 714-X and its mechanism of action. It appears to have been developed in the 1960s on the basis of earlier studies that used a high-magnification, dark-field microscope called a somatoscope. Reviewed in [1,2] With the somatoscope, researchers were able to examine living cells in samples of fresh blood and tissue taken from healthy individuals and individuals with serious diseases, including cancer. The study of living cells (as opposed to...
Of all the combination regimens, ECF is often considered the reference standard in the United States and Europe. In one European trial, 274 patients with metastatic esophagogastric cancer were randomly assigned to receive either ECF or FAMTX.[13] The group who received ECF had a significantly longer median survival (8.9 vs. 5.7 months, P = .0009) than the FAMTX group.[13][Level of evidence: 1iiA] In a second trial that compared ECF with mitomycin, cisplatin, and 5FU (MCF), there was no statistically significant difference in median survival (9.4 vs. 8.7 months, P = .315).[5][Level of evidence: 1iiA]
An international collaboration of investigators randomly assigned 445 patients with metastatic gastric cancer to receive docetaxel, cisplatin, and 5-FU (DCF) or CF.[14] Time-to-treatment progression (TTP) was the primary endpoint. Patients who received DCF experienced a significantly longer TTP (5.6 months; 95% CI, 4.9-5.9; vs. 3.7 months; 95% CI, 3.4-4.5; HR, 1.47; 95% CI, 1.19-1.82; log-rank P < .001; risk reduction 32%). The median OS was significantly longer for patients who received DCF versus patients who received CF (9.2 months; 95% CI, 8.4-10.6; vs. 8.6 months; 95% CI, 7.2-9.5; HR, 1.29; 95% CI, 1.0-1.6; log-rank P = .02; risk reduction = 23%).[14][Level of evidence: 1iiA] There were high toxicity rates in both arms.[15] Febrile neutropenia was more common in patients who received DCF (29% vs. 12%), and the death rate on the study was 10.4% for patients on the DCF arm and 9.4% for patients on the CF arm.
WebMD Public Information from the National Cancer Institute
Today in Cancer
WebMD Special Sections
Health Solutions From Our Sponsors
©2005-2012 WebMD, LLC. All rights reserved.
WebMD does not provide medical advice, diagnosis or treatment. See additional information.