ETOPOSIDE, DOXORUBICIN AND CISPLATIN (EAP REGIMEN) IN ADVANCED GASTRIC-CANCER

The treatment of advanced gastric cancer is unsatisfactory. The respon se rates for single chemotherapy agents: 5-fluorouracil, mitomycin-c, methotrexate, cisplatin, adriamycin, nitrosoureas and etoposide are ap proximately 10-25% and response duration ranges from 3 to 6 months. Co mplete responses with single agents are rare. Combination chemotherapy produces higher response rates, but these responses are short. Recent ly the combination of etoposide, adriamycin and cisplatin (EAP regimen ) has been reported to produce results superior to what have been prev iously reported with other regimens. Twenty-four consecutive patients with locally advanced or metastatic gastric cancer (stage III-IV) were treated between June 1990 and December 1992 with the EAP regimen at o ur Department. Twenty-two patients were evaluable for response and tox icity. Objective responses were observed in 8 of 22 patients (response rate 36%; 95% confidence interval 17% to 59%). No clinical complete r esponse was found. The median duration of the response was 7 months (r ange 2 to 22). Myelosuppression represented the primary toxicity assoc iated with the EAP regimen. Grade 4 leukopenia was observed in 4 patie nts (18%). Grade 3-4 thrombocytopenia was registered in two patients, and grade 3 anemia was detected in 4 patients (18%). The median surviv al for all patients was 8 months and 12 months for the 8 responding pa tients. The EAP regimen seems to be an effective chemotherapeutic regi men, but cannot be considered the standard therapy for patients with l ocally advanced or metastatic gastric cancer, because of the high inci dence of moderate to severe myelotoxicity and a response rate and dura tion of survival similar, but not superior, to those obtained using a less toxic schedule.