Presenter: G. Cocconi Affiliation: Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy
Most patients with gastric cancer in the United States are found at the time of diagnosis to have advanced disease. The prognosis of these patients is extremely poor. Various treatment regimens have been explored.
Materials and Methods:
A total of 195 patients with metastatic gastric carcinoma (MGC) were included in this randomized study Patients received 6 cycles of either PELF (Cisplatin, epirubicin, Leucovorin, and 5-FU) (98 patients) or FAMTX (methotrexate, 5-FU, and adriamycin) (97 patients).
PELF treated patients achieved much higher response rate (39% vs. 22%, p=0.009).
The one-year and two-year survival rates were not significantly higher statistically in the PELF group than FAMTX group (30.8% vs 22.4% and 15.7% vs 9.5%, p=0.19).
PELF was associated with more significant nausea/vomiting and diarrhea.
Mucositis was significantly more severe in FAMTX group.
PELF appeared to be more significantly active in patients with MGC.
Survival was better at one and two years with PELF, but not statistically significant.
The two treatment regimens were tolerable, although different in spectrum. FAMTX should no longer be considered as an active new-generation regimen for patients with MGC.
PELF deserves further study in adjuvant settings.
Regimens involving biochemical modulation of 5-FU such as the FAMTX and PELF regimens are one major focus of investigation in patients with MGC. The development of new active agents is equally important.
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