CURRENT STATUS OF THERAPY FOR ADVANCED GASTRIC-CARCINOMA

Advanced gastric carcinoma remains an incurable disease with a median survival of 6 to 9 months, and available therapeutic approaches are pr edominantly palliative. In small controlled trials, systemic chemother apy has improved survival and quality of life of patients with advance d gastric carcinoma when compared with best supportive care. Patients with good performance status (Zubrod less than or equal to 2), low tum or bulk, and good organ function ape most likely to benefit from chemo therapy or combined-modality therapy. There is no generally accepted s tandard chemotherapy for advanced gastric carcinoma. Fluorouracil- and /or cisplatin-based combinations are often employed. Recently, several new classes of drugs have demonstrated activity against advanced dise ase. These include the taxanes (paclitaxel [Taxol] and docetaxel [Taxo tere], camptothecins (irinotecan [Camptosar]), and fluorouracil prodru gs (second- and third-generation agents, such as UFT [uracil and tegaf ur] and S-1). Early results with either single-agent therapy or combin ations of new agent (irinotecan, paclitaxel, and docetaxel) and more c onventional agents (cisplatin [Platinol] and fluorouracil) are encoura ging. Several of these results need to be confirmed and eventually stu died in well-designed, phase III trials. Similarly, a number of new co mbinations may be used in the future as preoperative therapies for gas tric carcinoma. Nearly all of the new agents have radiosensitizing pro perties. This affords another opportunity to investigate new chemother apeutic agents in conjunction with radiation therapy in patients with locoregional gastric carcinoma.