CHEMOTHERAPY FOR GASTRIC-CARCINOMA - NEW AND OLD OPTIONS

Although gastric carcinoma is an uncommon disease in North America, it s incidence is alarmingly high in Asia, South America, Eastern Europe, and countries of the former Soviet Union, Screening for gastric carci noma is performed only on a limited basis in Japan; in the rest of the world, therefore, patients often present with advanced disease at the time of diagnosis, Chemotherapy, radiotherapy, or both rarely cure pa tients with unresectable or metastatic carcinoma; therapy thus remains palliative for such patients. Chemotherapy seems to be beneficial, ho wever, and continues to evolve in the treatment of patients with advan ced gastric carcinoma. Four small randomized trials demonstrated survi val and quality-of-life benefits for patients who received chemotherap y compared with those who received best supportive care. in the past 2 0 years, several ''old'' drugs have been studied either alone or in co mbination to treat this disease; and new active drugs have been identi fied. Recently, quality of life, convenience, and cost-containment hav e been emphasized in the treatment of cancer, This has increased inter est in oral agents. At present, several promising oral 5-fluorouracil prodrugs are being studied in clinical trials, This article summarizes current developments in the treatment of advanced gastric carcinoma.