CHEMOTHERAPY OF GASTRIC-CANCER

Patients with gastric adenocarcinomas have a poor prognosis. Because c urative surgery is often impossible (metastatic disease) or extremely difficult (locally advanced tumors), and the majority of patients unde rgoing curative resection relapse, chemotherapy has been actively stud ied in gastric cancer. Many drugs have shown activity; however, single -agent chemotherapy failed to demonstrate increased survival benefit. Several combination regimens have been developed with high activity in locally advanced and metastatic disease. Among them are B-fluorouraci l (5-FU) plus high dose methotrexate plus doxorubicin (FAMTX), etoposi de plus doxorubicin plus cisplatin (EAP), etoposide plus leucovorin pl us 5-FU (ELF), and epirubicin plus cisplatin plus 5-FU (ECF). Although the response rates of these schedules are encouraging, the toxicity i s considerable. Randomized trials comparing chemotherapy with best sup portive care showed an increase in overall survival and in quality-of- life. Up to now adjuvant chemotherapy in curatively resected gastric c ancer patients has failed to improve survival as compared with surgica l controls. Phase II trials with preoperative chemotherapy have shown very promising results, but results of randomized trials should be awa ited to judge the real value of this approach. At this moment it canno t yet be estimated whether preoperative chemotherapy does positively i nfluence the resection rate and survival of patients with clinically r esectable tumors.