ETOPOSIDE, DOXORUBICIN (ADRIAMYCIN) AND CISPLATIN CHEMOTHERAPY (EAP) FOR ADVANCED GASTRIC CANCER - RESULTS OF A PHASE-II STUDY AND FINAL REVIEW

Background. A phase II, single centre study was performed to evaluate the efficacy and toxicity of a combination of etoposide, doxorubicin ( Adriamycin) and cisplatin in the treatment of advanced adenocarcinoma of the stomach or gastro-eosophageal junction, Methods. 71 patients wi th inoperable or recurrent, histologically proven gastric or gastro-oe sophageal adenocarcinoma were treated with doxorubicin 20 mg/m(2) intr avenous (IV) bolus an days 1 and 8, cisplatin 40 mg/m(2) TV infusion o n days 1 and 8 and etoposide 200 mg/m(2) orally on days 4, 5 and 6 eve ry 28 days for up to six cycles, Results. Objective responses were ach ieved in 14 of the 71 patients (19.7%), All of these were partial resp onses, no complete responses were seen. Of the remaining 57 patients, 29 (40.8%) had stable disease. Median duration of response was 135 day s and median overall survival for all patients was 156 days (5 months) . Toxicity was predominantly haematologic with 45 (63%) patients devel oping at least one infective episode, Non-haematologic toxicity of WHO grade 3 or greater included nausea and vomiting in 36%, mucositis in 6% and alopecia in 45%, Chemotherapy was delayed in 45 out of a total number of 257 cycles given (17.5%) due to toxicity or inadequate bone marrow recovery. 1 death due to toxicity occured. Conclusions. The EAP chemotherapeutic regimen appears to have only modest efficacy. Given the high incidence of moderate to severe myelotoxicity and poor tolera bility in this and other studies, it cannot be considered as a standar d therapy for patients with advanced gastric or gastro-oesophageal ade nocarcinoma.