DOXIFLURIDINE AS PALLIATIVE TREATMENT IN ADVANCED GASTRIC AND PANCREATIC-CANCER PATIENTS

Background: The association of 5-fluorouracil (5-FU) and leucovorin is currently the most used combination in the treatment of advanced gast rointestinal neoplasms. Doxifluridine (d-FUR) is a fluoropyrimidine de rivative that is converted into 5-FU inside tumor cells, where it is s electively cytotoxic. The oral administration of dFUR has been extensi vely investigated in colorectal carcinoma, and has been proven to be a ctive and well tolerated. The purpose of this study was to test the ef fectiveness of the oral combination with dFUR plus l-leucovorin in gas tric and pancreatic cancer patients. Methods: A total of 50 cases were treated with l-leucovorin 25 mg, followed 2 h later by d-FUR 1,200 mg /m(2) for 5 days; the cycles were repeated every 10 days. The regimen was given for a maximum of 36 cycles or until disease progression. Twe nty-six patients had gastric cancer (all of whom were pretreated with polychemotherapy) and 24 had advanced pancreatic carcinoma. Results: O bjective responses were obtained in 4 (15%; 95% Cl 1-29) patients with gastric cancer, and in 1 (4%) with pancreatic cancer. The median resp onse duration was 4 months. All of the responses were seen in patients previously treated with 5-FU-containing regimens. The median survival in gastric cancer patients was 7 months. Toxicity was moderate: WHO g rade III and IV diarrhea was observed in 14% of the cases. Conclusions : This study indicates the efficacy of oral d-FUR plus l-leucovorin as palliative treatment in gastric cancer patients. The results in pancr eatic carcinoma are disappointing but are in line with the published d ata relating to fluoropyrimidines.