Successful initial treatment with weekly etoposide, epirubicin, cisplatin,5-fluorouracil and leucovorin chemotherapy in advanced gastric cancer patients with disseminated intravascular coagulation

Background: Acute disseminated intravascular coagulation (DIC) is a rare bu t severe complication of gastric adenocarcinoma. Conventional treatments, s uch as fresh frozen plasma, platelet replacement and heparin injections, ar e disappointing. The only way to correct this fatal condition is to control the underlying cancer promptly by effective chemotherapy. Here the success ful initial control of acute DIC in gastric cancer patients with weekly EEP FL chemotherapy is reported. Methods: Advanced gastric cancer patients complicated with acute DIC were e ligible. Patients were treated with weekly EEPFL therapy (etoposide 40, epi rubicin 10, cisplatin 25, Ei-fluorouracil 2200 and leucovorin 120 mg/m(2)). Response, survival and toxicity were evaluated. Results: From April 1997 to April 1999, six patients were included in this study. All patients received EEPFL chemotherapy. Clinical and laboratory ev idence of acute DIC stabilized quickly after starting chemotherapy. Four pa tients showed a partial response, one stable disease and one progressive di sease. The toxicity was mild and well tolerated, Median survival was 28 wee ks (12, 14, 26, 30, 30 and 32 weeks). All patients suffered from a relapse of DIC after initial successful control and died within 30 days of clinical and laboratory evidence of acute DIC relapse. Conclusion: EEPFL therapy is an effective chemotherapy regimen for patients with advanced gastric cancer associated with acute DIG. The prognosis is p oor if the DIC relapses after the initial successful control.