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NCI CANCERLIT® Search: Therapy of Gastric Cancer - March 2002
National Cancer Institute®
Ultima Vez Modificado: 1 de marzo del 2002
Table of Contents
1
UI - 11760080
AU - Yoshida M; Boku N; Ohtsu A; Muto M; Nagashima F; Yoshida S
TI -
Combination chemotherapy of irinotecan plus cisplatin for advanced
gastric cancer: efficacy and feasibility in clinical practice.
SO - Gastric Cancer 2001;4(3):144-9
AD - Division of Digestive Endoscopy and Gastrointestinal Oncology, National
Cancer Center Hospital East, Kashiwa, Chiba, Japan.
BACKGROUND: A previous phase II study showed that a combination of
irinotecan (CPT-11) with cisplatin (CDDP) was effective for advanced
gastric cancers, but was associated with substantial neutropenia and
diarrhea. The aim of this retrospective study was to evaluate the
efficacy and feasibility of the combination in clinical practice.
METHODS: The subjects comprised 65 patients with advanced gastric cancer
treated with CPT-11 (70mg/m2, day 1, day 15) and CDDP (80mg/m2, day 1)
backgrounds, response rates, response durations, times to progression,
and survival rates were investigated retrospectively. RESULTS: The
overall response rate and the response rates for measurable metastatic
lesions and primary sites were 43% (28/65), 48% (31/64), and 24%
(10/42). Leucopenia of grade 4 and diarrhea of grade 3 or 4 were
observed in 6 (9%) and 5 (8%) patients, respectively. Among the 19
patients with peritoneal metastasis, leucopenia of grade 4 and diarrhea
of grade 3 or 4 were observed in only 1 of the 18 patients who received
sufficient oral intake (6%). There were no treatment-related or early
deaths within 30 days from the last treatment day. The median survival
times of all patients, patients with an intestinal type of
adenocarcinoma, and patients with a diffuse type were 365, 472, and 291
days, respectively. Multivariate analysis showed that the histological
type of cancer was a significant independent prognostic factor (P =
0.0169). CONCLUSION: This retrospective study confirmed the efficacy and
feasibility of this combination therapy in clinical practice.
2
UI - 11760082
AU - Miyoshi K; Fuchimoto S; Ohsaki T; Sakata T; Ohtsuka S; Takakura N
TI -
Long-term effects of jejunal pouch added to Roux-en-Y reconstruction
after total gastrectomy.
SO - Gastric Cancer 2001;4(3):156-61
AD - Department of Surgery, Fukuyama National Hospital, Japan.
BACKGROUND: Jejunal pouch reconstruction after total gastrectomy has
been demonstrated to ameliorate postgastrectomy symptoms, with the
process of adaptation taking several months. In contrast to the
short-term effects of pouch reconstruction, there are few reports about
the long-term consequences (more than 2 years after surgery). METHODS:
In this study, 22 patients with jejunal pouch (PRY group) and 12
patients without jejunal pouch (RY group) who survived for more than 2
years without any recurrence and were available for follow-up were
compared. Patients in the two groups were compared 2 years after surgery
in terms of postgastrectomy symptoms, and improvements in body weight
and nutritional parameters. RESULTS: Eating capacity at a single meal
compared with that in the pre-illness state was significantly better in
the PRY group than in the RY group. The total score on the
gastrointestinal symptom rating scale (GSRS) in the PRY group was less
than that in the RY group (3.17 vs 5.25). The GSRS score for reflux
syndrome in the PRY group was significantly better than that in the RY
group. Assessment according to Cuschieri's gradings revealed that the
total score in the PRY group was lower than that in the RY group (2.73
vs 5.92). Among the various symptoms examined, the incidence of dietary
restriction and that of heartburn were significantly lower in the PRY
group. CONCLUSION: We conclude that, 2 years after total gastrectomy,
the pouch reconstruction had alleviated postgastrectomy symptoms to a
greater extent than simple Roux-en-Y reconstruction, but the
effectiveness could be improved. The long-term effects of pouch
reconstruction should be examined more precisely with an adequate and
valid scoring system for determining quality of life.
3
UI - 10894862
AU - Kulke MH
TI -
The treatment of advanced gastric cancer: in search of the right
combination.
SO - J Clin Oncol 2000 Jul;18(14):2645-7
4
UI - 11078502
AU - Ross PJ; Hill ME; Norman A; Cunningham D
TI -
ECF in gastric cancer.
SO - J Clin Oncol 2000 Nov 15;18(22):3874-5
5
UI - 11822009
AU - Leiper K; Morris AI
TI -
Treatment of oesophago-gastric tumours.
SO - Endoscopy 2002 Feb;34(2):139-45
AD - Department of Gastroenterology, Royal Liverpool University Hospital,
Liverpool, United Kingdom. kleiper@liverpool.ac.uk
The incidence of oesophageal adenocarcinoma continues to rise rapidly in
the West whereas cancer of the stomach is becoming less common. Most
patients present with advanced disease that is not amenable to curative
treatment. This review focuses on recent evidence on the endoscopic
therapy of oesophago-gastric cancer. Although there are many treatment
modalities available, there is a paucity of good quality randomised
trial evidence on which to base palliative treatment decisions.
Furthermore, although palliation of dysphagia may be improved by
expandable metal stents or ablative therapy, there is no evidence that
this improves survival and each of these therapies has a high frequency
of complications particularly in longterm survivors. Exciting
developments have however been reported in the therapy of early stage
oesophago-gastric cancer. Endoscopic mucosal resection is particularly
promising with high rates of complete removal of early cancer or high
grade dysplasia. Long-term follow up of these patients is required
because of high rates of metachronous tumour formation and at present
there are no randomised trial data comparing endoscopic mucosal
resection with conventional surgery.
6
UI - 11822019
AU - Salameh FS
TI -
A promising new device for use in polypectomy.
SO - Endoscopy 2002 Feb;34(2):178
AD - Dept. or Surgery I, Tokyo Medical and Dental University, Tokyo, Japan.
salameh.srg1@tmd.ac.jp
7
UI - 11821829
AU - Kitano S; Shiraishi N; Fujii K; Yasuda K; Inomata M; Adachi Y
TI -
A randomized controlled trial comparing open vs laparoscopy-assisted
distal gastrectomy for the treatment of early gastric cancer: an interim
report.
SO - Surgery 2002 Jan;131(1 Suppl):S306-11
AD - Department of Surgery I, Oita Medical University, Oita, Japan.
BACKGROUND: The application of laparoscopy-assisted distal gastrectomy
(LADG) for early gastric cancer remains controversial among gastric
surgeons. The purpose of this study was to compare LADG with open distal
gastrectomy (ODG) regarding clinical outcome and postoperative
parameters, including postoperative pain and pulmonary function.
cancer were randomly assigned to an LADG (n = 14) or ODG group (n = 14)
with Billroth I reconstruction. Postoperative pain during resting,
coughing, and walking were evaluated by a visual analog scale (VAS).
Pulmonary functions such as forced vital capacity (FVC) and forced
expiratory volume in 1 second (FEV1) measured on the third postoperative
day were compared with preoperative functions. RESULTS: Patients in the
2 groups were comparable for age, gender, height, weight, staging, and
location of gastric cancer. The mean blood loss was significantly less
in the LADG than in the ODG group (P <.05). Histologic examinations of
resected specimens revealed that these 2 operations were identical from
the standpoint of curability. Patients in the LADG group recovered both
bowel movement and walking ability earlier than did patients in the ODG
group (P <.05). The postoperative VAS pain score during rest was lower
for 3 days after LADG than ODG (P <.05) and for 1 day during coughing or
walking (P <.05). The pulmonary functions such as FVC and FEV1 values
were reduced on the third day after LADG and ODG. However, the FVC value
on the third day after LADG was lower than after ODG (P <.05).
CONCLUSIONS: This study demonstrates that LADG has several advantages
including an earlier recovery, less pain, and less impaired pulmonary
function after gastric surgery when compared with ODG; furthermore, no
reduction in curability was observed.
8
UI - 11821787
AU - Kakeji Y; Maehara Y; Sumiyoshi Y; Oda S; Emi Y
TI -
Angiogenesis as a target for gastric cancer.
SO - Surgery 2002 Jan;131(1 Suppl):S48-54
AD - Department of Surgery and Science, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan.
BACKGROUND: The growth of solid tumors and the formation of metastases
depend on angiogenesis. Both tumor cells and host cells secrete a
variety of factors to stimulate angiogenesis. METHODS: We investigated
the expression of angiogenic factors in gastric cancer in vitro and in
vivo. RESULTS: The expression of one of the angiogenic factors, vascular
endothelial growth factor antigen, in gastric cancer cells can thus
serve as a pertinent predictive factor for hematogenous invasion or
metastasis, in addition to having prognostic value. The presence of
micrometastasis in bone marrow was closely related to vascular
endothelial growth factor positivity and microvessel density in the
primary gastric cancer. In in vivo experiments antiangiogenic agents
with cytotoxic anticancer drugs formed a highly effective modulator
combination for the treatment of the Lewis lung carcinoma against
primary and metastatic disease. CONCLUSIONS: Antiangiogenic agents may
thus be valuable for long-term administration to maintain tumor dormancy
because drug resistance does not develop, and these agents have a
sustained effect. As a target, antiangiogenic therapy may therefore be
potentially able to prolong survival time of patients with gastric
cancer.
9
UI - 11821792
AU - Maehara Y; Kakeji Y; Koga T; Emi Y; Baba H; Akazawa K; Sugimachi K
TI -
Therapeutic value of lymph node dissection and the clinical outcome for
patients with gastric cancer.
SO - Surgery 2002 Jan;131(1 Suppl):S85-91
AD - Department of Surgery and Science, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan.
BACKGROUND: While the incidence of gastric cancer differs greatly
between Japan and other countries, both diagnostic and treatment
modalities for patients with gastric cancer have improved in Japan. What
follows is an overview of the effects of lymph node dissection for such
patients. METHODS: We analyzed data on 2152 Japanese men and women with
gastric cancer who underwent surgical resection from 1965 to 1995 at
Kyushu University in Fukuoka, Japan. We focused on time trends of
surgical management, including lymph node dissection and postoperative
outcome. RESULTS: In all cases of gastric cancer, the rate of early
gastric cancer increased from 18% in the first 6-year period to 57% in
the last 5-year period. Extensive lymph node dissections (D2 and D3)
were performed more frequently in recent years. Due to early
identification of the cancer and upgraded perioperative care, both
postoperative morbidity and mortality rates 30 days after surgery have
decreased greatly, even in aged patients. CONCLUSIONS: Early tumor
detection, standardized surgical treatment, including routine lymph node
dissection, and improved perioperative management have led to increased
survival time among patients with this malignancy.
10
UI - 11821794
AU - Tsujitani S; Fukuda K; Saito H; Kondo A; Ikeguchi M; Maeta M; Kaibara N
TI -
The administration of hypotonic intraperitoneal cisplatin during
operation as a treatment for the peritoneal dissemination of gastric
cancer.
SO - Surgery 2002 Jan;131(1 Suppl):S98-104
AD - Department of Surgery I, Faculty of Medicine, Tottori University,
Yonago, Japan.
BACKGROUND: Gastric cancers with serosal invasion often spread to the
peritoneal surface. Beneficial effects of hypotonic intraperitoneal
cisplatin against peritoneal dissemination was noted in experimental
models. Prophylactic hypotonic intraperitoneal cisplatin during
operation should therefore be examined in human gastric cancer. METHODS:
Isotonic intraperitoneal cisplatin was administered immediately after
gastrectomy in increasing doses to patients with locally advanced
gastric cancer until dose-limiting toxicity (DLT) was observed in 2 or
more of 3 patients who were treated at a specific dose level. The
osmolarity reduction and dose escalation trial for hypotonic
intraperitoneal cisplatin was then performed until DLT was observed in 2
or more of 6 patients. RESULTS: The dose-escalation trial revealed the
DLT of isotonic intraperitoneal cisplatin in the form of nausea and
vomiting at a dose of 120 mg/m2. Isotonic intraperitoneal cisplatin
treatment was recommended at a dose of 100 mg/m2. Because of the
possible enhanced toxicity by hypotonic solution, hypotonic
intraperitoneal cisplatin at a dose of 70 mg/m2 in one-half normal
saline solution was injected, but no serious toxic reaction was
observed. Hypotonic intraperitoneal cisplatin at a dose of 70 mg/m2 that
had been dissolved in distilled water was then injected. It was
accompanied by serious renal toxicity in 2 of 6 patients. Dose
escalation was thus terminated, and the trial in an additional 25
patients confirmed that the toxicity of hypotonic intraperitoneal
cisplatin at a dose of 70 mg/m2 was tolerable. A pharmacokinetic study
to determine the maximum concentration and the area under the curve of
concentration versus time of platinum revealed that hypotonic
intraperitoneal cisplatin did not appear to increase the maximum
concentration or area under the curve of the total and free platinum in
the plasma in comparison with the isotonic intraperitoneal cisplatin at
the same dose. CONCLUSIONS: Hypotonic intraperitoneal cisplatin
treatment with distilled water at the time of a gastric resection is
well tolerated. Hypotonic intraperitoneal cisplatin does not increase
the plasma level of platinum at a dose of 70 mg/m2. Phase II/III studies
are still required to clarify the efficacy of hypotonic intraperitoneal
cisplatin for the treatment of the peritoneal dissemination in gastric
cancer.
11
UI - 11865630
AU - Inaba Y; Watabe S; Ohe S; Kamio Y; Koyama M; Hayashi K; Chiba M
TI -
[The clinical effect of TS-1 in advanced and recurrent gastric cancer
with peritoneal dissemination]
SO - Gan To Kagaku Ryoho 2002 Feb;29(2):239-44
AD - Dept. of Surgery, Yamagata Prefectural Kahoku Hospital.
Eighteen patients with far advanced and recurrent gastric cancer with
peritoneal dissemination were treated with a novel oral anticancer drug,
TS-1, and assessed according to clinical effect. TS-1 was administered
at a dose of 80-120 mg/day. One course consisted of consecutive
administration of TS-1 for 28 days followed by 14 days rest. The 1- and
2-year survival rates and median survival time after administration of
TS-1 were 63.2%, 23.7% and 437 days, respectively. Eight patients
(44.4%) survived for 1 year or more. Adverse reactions consisted of
reduction in hemoglobin level and hyperbilirubinemia at grades 3 and 4,
which were observed in 3 patients and 1 patient, respectively. TS-1 is a
promising drug for gastric cancer with peritoneal dissemination.
12
UI - 11823701
AU - Wang X; Pang L; Feng J
TI -
A phase II study of etoposide, doxorubicin, and carboplatin in the
treatment of advanced gastric cancer.
SO - Am J Clin Oncol 2002 Feb;25(1):71-5
AD - Department of Medical Oncology, Jiangsu Cancer Hospital, Jiangsu Cancer
Research Institute, Baiziting 42, Nanjing 210009, People's Republic of
China.
Many phase II studies have reported improved response rates with severe
toxicity of etoposide, doxorubicin (Adriamycin), and cisplatin in
advanced gastric cancer. In an attempt to obtain a better regimen with
high efficacy and less toxicity, a combination regimen of etoposide,
doxorubicin, and carboplatin (EAC) had been developed and evaluated in
this phase II study. Forty-six patients with advanced gastric cancer
were enrolled in the study. The treatment consisted of doxorubicin 20
mg/m2 given intravenously on days 1 and 7, etoposide 70 mg/m2
intravenously on days 4, 5, and 6, and carboplatin 200 mg/m2
intravenously on days 2 and 8. Therapy was repeated every 4 weeks.
Patients who had stable disease or who responded, received an additional
two to six cycles of therapy. Among 45 patients evaluable for response
and toxicity, there was a 49% objective response rate, including 7%
complete remission and 42% partial response. There was 11% stable
disease and 27% progressive disease. Among 11 patients with lymph node
metastasis only after a curative gastrectomy, there was an 82% objective
response rates with 27% having complete remission and 55% having partial
response. The median follow-up was 16 months. The median survival
duration of all 45 patients was 11 months. The median time to
progression was 5 months. The main toxicity was myelosuppression, with a
high incidence of 82% leukopenia but only 9% of grades III to IV.
Gastrointestinal toxicity was mild, with a low incidence of 42% nausea
and vomiting and only 2% of grades III to IV. There were no
chemotherapy-related deaths. With mild and tolerable toxicity, the EAC
regimen in our study has active antitumor activity in advanced gastric
cancer, which may have a positive influence on long-term survival time.
It has a high efficacy, especially in patients with lymph node
metastasis only after a curative gastrectomy. This regimen deserves
further clinical studies for testing activity and toxicity in advanced
gastric cancer.
13
UI - 11823704
AU - Green D; Ponce de Leon S; Leon-Rodriguez E; Sosa-Sanchez R
TI -
Adenocarcinoma of the stomach: univariate and multivariate analysis of
factors associated with survival.
SO - Am J Clin Oncol 2002 Feb;25(1):84-9
AD - Department of Hematology-Oncology, Instituto Nacional de Ciencias
Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga 15, Col. Seccion
16, Tlalpan, 14000 Mexico D.F., Mexico.
Gastric cancer is the most frequent tumor of the digestive tract in
Mexico. Most patients are diagnosed at advanced stages, and fatal
outcome is expected. One hundred fifty patient charts were
retrospectively reviewed. Univariate and multivariate analyses were
performed to evaluate the impact of clinicopathologic and treatment
variables on survival. Most patients (75%) were at advanced stages,
harboring poorly differentiated tumors. Surgery, mostly palliative, was
performed on 114 patients. Chemotherapy was administered to 47 patients.
On univariate analysis, significant prognostic factors were TNM stage,
chemotherapy, surgical attempt, performance status, histology, and tumor
site (p < 0.001). On multivariate analysis, independent prognostic
factors were TNM stage, histology, tumor site, surgical attempt, and
chemotherapy (p < 0.01). Median survival for patients with palliative or
adjuvant chemotherapy was 11.4 and 10.4 months, respectively, compared
with +/- 3 months for patients with no chemotherapy (p < 0.03).
Nonsurgical patients receiving chemotherapy survived 5.4 months versus
1.1 months for those without chemotherapy. The favorable influence of
chemotherapy persisted after a stratified analysis of subgroups
eliminating potential biases. We identified prognostic factors for
survival. Chemotherapy should be considered even for advanced-stage
patients with either adjuvant or palliative attempts, because we
consistently found a favorable impact on the median survival time.
However, phase III prospective randomized trials are awaited.
14
UI - 11843002
AU - Feiz HR; Mobarhan S
TI -
Does vitamin C intake slow the progression of gastric cancer in
Helicobacter pylori-infected populations?
SO - Nutr Rev 2002 Jan;60(1):34-6
AD - Department of Gastroenterology, Loyola University of Chicago, Maywood,
IL 60153, USA.
Vitamin C's role in the prevention of disease and malignancy has been
studied over the last several decades. Vitamin C intake has been shown
to have an inverse relationship with gastric cancer. Recent follow-up
studies on high-risk populations suggest that ascorbic acid, the reduced
form of vitamin C, protects against gastric cancer, for which H. pylori
is a significant risk factor. In populations infected with H. pylori,
there is a reduction in gastric juice ascorbic acid concentration. This
article reviews the risk factors for gastric cancer and the role of
vitamin C in prevention of the disease.
15
UI - 11853213
AU - Hsu P I; Lai K H; Lo G H; Lin C K; Lo C C; Wang E M; Wang Y Y; Tsai W L;
TI -
Lin C P; Tseng H H; Chen H C; Chen J L
Sequential changes of gastric hyperplastic polyps following endoscopic
ligation.
SO - Zhonghua Yi Xue Za Zhi (Taipei) 2001 Nov;64(11):609-14
AD - Department of Internal Medicine, Kaohsiung Veterans General Hospital,
Taiwan, ROC.
BACKGROUND: Endoscopic ligation has been extensively applied in the
management of esophageal and gastric varices with or without bleeding.
The varices are automatically eradicated through the use of ligation.
However, whether avascular necrosis will occur in a gastrointestinal
polyp when the base is ligated remains unclear. The aims of this pilot
study were to investigate the sequential changes of gastric hyperplastic
polyps following endoscopic detachable snare ligation and to determine
the possibility of induction of avascular necrosis in these lesions
following ligation. METHODS: Eleven patients with eighteen gastric
hyperplastic polyps were treated with endoscopic detachable-snare
ligation. The polyps were observed for 5 minutes and biopsies were then
conducted. At 14 days after endoscopic ligation, follow-up endoscopies
were performed to assess the outcome of the strangulated polyps.
RESULTS: After being strangulated by the detachable snares, a majority
of the polyps immediately congested (94%), and then developed cyanotic
change (89%) approximately 4 minutes later. Pathological examination
revealed severe venous congestion in the lamina propria of the
strangulated polyps. On follow-up endoscopy 2 weeks later, all the
snares had dropped off, and avascular necrosis occurred in sixteen
polyps (89%). All of the polyps with avascular necrosis were detected to
have developed cyanotic changes in initial endoscopy. No complications
occurred during or following the ligation procedure. CONCLUSIONS: Most
gastric hyperplastic polyps develop avascular necrosis following
ligation by detachable snare. Cyanotic change is an important predictor
of the outcomes of the lesions following endoscopic ligation. The
application of this ligation technique in treatment of bleeding or
non-bleeding gastrointestinal polyps deserves further investigation.
16
UI - 11853214
AU - Chang F Y
TI -
Endoscopic ligation for removal of stomach hyperptastic polyp: less risk
or saving money?
SO - Zhonghua Yi Xue Za Zhi (Taipei) 2001 Nov;64(11):615-6
17
UI - 11857295
AU - Ajani JA; Baker J; Pisters PW; Ho L; Mansfield PF; Feig BW;
TI -
Charnsangavej C
CPT-11 plus cisplatin in patients with advanced, untreated gastric or
gastroesophageal junction carcinoma: results of a phase II study.
SO - Cancer 2002 Feb 1;94(3):641-6
AD - Department of Gastrointestinal Medical Oncology, The University of Texas
M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
jajani@mdanderson.org
BACKGROUND: This Phase II study assessed the response rate and toxicity
profile of the combination CPT-11 and cisplatin administered weekly to
patients with untreated, advanced adenocarcinoma of the stomach or the
gastroesophageal junction. METHODS: Patients with histologic proof of
adenocarcinoma of the stomach or the gastroesophageal junction with
adequate liver, kidney, and bone marrow functions were treated with 65
mg/m(2) CPT-11 plus 30 mg/m(2) cisplatin, both administered
intravenously 1 day per week for 4 consecutive weeks, followed by a
recovery period of 2 consecutive weeks. The response rate, time to
disease progression, survival, and toxic effects were analyzed. RESULTS:
Thirty-six of 38 registered patients (95%) were assessable. The median
number of 6-week cycles per patient was 2.5 (range, 1-7 6-week cycles).
Four patients (11%) achieved a complete response, and 17 patients (47%)
had a partial response for an overall response rate of 58%. The median
time to progression of carcinoma was 24 weeks, and the median survival
was 9 months (range, 1-23+ months). There was one treatment-related
death. Major toxic effects included diarrhea, neutropenia, and fatigue.
Ninety percent of all planned doses were delivered on time; however, 53
of 79 canceled or delayed weekly doses (66%) occurred in the third or
fourth week of the therapy cycle. CONCLUSIONS: The combination of CPT-11
and cisplatin is active against gastric or gastroesophageal
adenocarcinoma and needs to be studied further. A modification in doses
and schedules may be warranted to make the regimen more tolerable to
patients. The addition of other active drugs or radiation therapy to
this regimen would be of interest. Copyright 2002 American Cancer
Society. DOI 10.1002/cncr.10279
18
UI - 11859986
AU - Pentheroudakis G; Lim K C; Dunlop D J; Soukop M; Eatock M M
TI -
Non-infusional 5-fluorouracil, doxorubicin and cisplatin in the
treatment of locally advanced or metastatic gastro-oesophageal
adenocarcinoma.
SO - Acta Oncol 2001;40(7):855-61
AD - Department of Medical Oncology, St Mungo Institute, Glasgow Royal
Infirmary, Scotland. penther@ukonline.co.uk
To reduce the Hickman line-associated morbidity of continuous infusion
5-fluorouracil combined with epirubicin and cisplatin (ECF) and to
investigate the need for infusional regimens, we conducted a
retrospective study in patients with advanced gastro-oesophageal
adenocarcinoma. Thirty-six patients, with histologically proven
irresectable gastro-oesophageal adenocarcinoma were given: 60 mg/m2
cisplatin on day 1, 35 mg/m2 doxorubicin on day 1 and 500 mg/m2
5-fluorouracil on days 1 and 8 (NIACF) every 3-weeks. A median of 3
cycles was administered. The principal toxicity was myelosuppression
with grade III/IV neutropenia in 47% of cycles. Neutropenic fever
occurred in 5% of the cycles: non-haematological toxicity was mild and
there were no treatment-related deaths. Administered dose intensity was
96.1% for doxorubicin, 93.6% for cisplatin and 90.5% for 5-fluorouracil.
There were 16 partial responses and 1 complete response (overall
response rate 47%, 95% confidence interval CI 31-63%); 8 patients had
stable disease. Median progression-free and overall survival rates were
5 months (95% CI 4-6) and 8 months (95% CI 6-10), respectively. NIACF is
a well-tolerated regimen in advanced gastro-oesophageal adenocarcinoma
that precludes the need for central venous access, with activity similar
to that observed with ECF.
19
UI - 11665720
AU - Dunbier A; Guilford P
TI -
Hereditary diffuse gastric cancer.
SO - Adv Cancer Res 2001;83():55-65
AD - Department of Biochemistry, University of Otago, Dunedin, New Zealand.
Hereditary diffuse gastric cancer (HDGC) is a cancer predisposition
syndrome caused by germline mutation of the gene for the cell-to-cell
adhesion protein E-cadherin. The syndrome is dominated by predisposition
to the histologically diffuse, poorly differentiated form of gastric
cancer. It is not associated with intestinal-type gastric cancer, but
families may have an elevated risk of lobular breast cancer. Here, we
review the identified families, mutations, and proposed mechanisms by
which E-cadherin loss promotes tumorigenesis.
20
UI - 11872272
AU - Smalley SR; Gunderson L; Tepper J; Martenson JA Jr; Minsky B; Willett C;
TI -
Rich T
Gastric surgical adjuvant radiotherapy consensus report: rationale and
treatment implementation.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):283-93
AD - Radiation Oncology Center of Olathe, Olathe, KS 66061, USA.
s_smalley@msn.com
PURPOSE: Radiation therapy has recently emerged as a pivotal modality in
the management of completely resected, high-risk gastric cancer. The
recently published results of the Intergroup 0116 Gastric Surgical
Adjuvant Trial randomized high-risk (T3,4 and/or node positive),
completely resected gastric or gastroesophageal adenocarcinomas to
receive either observation alone or radiochemotherapy after complete
resection. Radiochemotherapy produced significant improvements in
relapse-free (p < 0.0001) and overall survival (p = 0.01). Radiation
oncologists must now clearly comprehend the principles governing the
rationale supporting this therapy to apply it to those afflicted with
this disease. This paper represents a consensus report reviewing data
supporting radiotherapy, important clinical and anatomic issues related
to radiotherapy, and details of the practical application of radiation
therapy to commonly occurring clinical presentations. Supportive therapy
during and after radiochemotherapy is also discussed.
21
UI - 11848528
AU - Kikuchi S; Sakakibara Y; Sakuramoto S; Kobayashi N; Shimao H; Mieno H;
TI -
Kato Y; Kadowaki K; Hiki Y; Kakita A
Recent results in the surgical treatment of gastric cancer according to
the Japanese and TNM classification.
SO - Anticancer Res 2001 Sep-Oct;21(5):3589-93
AD - Department of Surgery, School of Medicine, Kitasato University,
Sagamihara-shi, Kanagawa, Japan.
BACKGROUND: Recent outcomes based on surgical long-term follow-up of
patients with gastric cancer using current staging systems have not been
fully evaluated. MATERIALS AND METHODS: A total of 1357 patients with
primary gastric carcinoma (911 males and 446 females, ranging in age
from 20 to 87 years; average 59.1 years) who had undergone gastric
resection between 1986 and 1996 were examined with respect to their
clinicopathological features, surgical procedures and patient survival
according to Japanese and UICC-TNM classifications. RESULTS: The 5-year
survival rate was 95.3% for stage Ia, 85.5% for stage Ib, 73.8% for
stage II, 45.7% for stage IIIa, 20.9% for stage IIIb, 17.3% for stage
IVa and 5.8% for stage IVb (8.8% for IVa and IVb) on the Japanese
classification. By way of contrast, the 5-year survival rate was 95.6%
for stage Ia, 85.0% for stage Ib, 72.1% for stage II, 49.3% for stage
IIIa, 30.2% for stage IIIb and 12.0% for stage IV on the TNM
classification. CONCLUSION: Although minor problems are associated with
both the Japanese and TNM classification systems, both appear to be
clinically significant and appropriate independent predictors of
prognosis. The findings of the present study provide important
information for comparing results among different institutes and for
introducing new clinical trials for gastric cancer at the beginning of
the new century.
22
UI - 11869013
AU - Sutton CD; White SA; Marshall LJ; Berry DP; Veitch PS
TI -
Endoscopic-assisted intrathoracic oesophagogastrostomy without
thoracotomy for tumours of the lower oesophagus and cardia.
SO - Eur J Surg Oncol 2002 Feb;28(1):46-8
AD - Department of Surgery, Leicester General Hospital, Leicester, UK.
crisdsutton@hotmail.com
AIMS: This study aimed to evaluate the efficacy of a novel technique
enabling a trans-hiatal oesophagectomy with intrathoracic anastomosis
under direct vision, without thoracotomy. METHODS: Trans-hiatal
dissection of the oesophagus was performed using direct and laparoscopic
visualization. The oesophagus was transected above the tumour with a
linear endo-GIA-2 60 mum stapler. The stomach was transected and a
gastric tube fashioned. The anvil of an appropriately sized CEEA
circular stapler was modified enabling it to flatten. It was attached to
a novel delivery system introduced under direct vision along a guidewire
into the stapled oesophagus. The anvil was realigned to its original
position in the distal oesophagus, docked with the body of the stapler
and an intrathoracic anastomosis performed. RESULTS: Ten patients
(female n=3, male n=7) aged from 39--77 years (mean age 65 years), ASA
2--3 with distal third tumours were treated. Duration of procedure
ranged from 2--5 hours (mean 4 hours). One patient suffered a
post-operative chest infection and an anastomotic leak treated
successfully with a self-expanding metal stent. Hospital stay ranged
from 6--28 days (mean 17 days). There was no mortality. CONCLUSION: This
technique allows a safe intrathoracic anastomosis to be performed
trans-hiatally under direct vision, avoiding the need for thoracotomy in
patients with high comorbidity. Copyright Harcourt Publishers Limited.
23
UI - 11870508
AU - Cascinu S; Baldelli AM; Catalano V; Giordani P; Beretta GD; Silva RR;
TI -
Gasparini G; Mari D; Maisano R; Salvagni S; Barni S; Labianca R;
Frontini L; Curti C; Catalano G
Infusional 5-fluorouracil, cisplatin and mitomycin C in advanced gastric
cancer: a low cost effective regimen.
SO - Br J Cancer 2002 Jan 21;86(2):213-7
AD - Department of Medical Oncology, V.le Gramsci 14, 43100 Parma, Italy.
cascinu@yahoo.com
Recently, we reported a highly active regimen in advanced gastric cancer
including a weekly administration of cisplatin, epidoxorubicin,
leucovorin, 5-fluorouracil with the support of filgrastim. In order to
simplify the administration and to decrease the toxicity of these drugs,
mainly epidoxorubicin-induced alopecia, we designed a regimen including
an infusional 5-fluorouracil schedule according to the de Gramont
regimen, cisplatin and mitomycin C replacing epidoxorubicin. Forty-five
patients with advanced or metastatic gastric cancer were treated with
cisplatin 50 mg m(-2) i.v. on day 1, every 2 weeks,
6S-stereoisomer-leucovorin 100 mg m(-2) i.v. followed by 5-fluorouracil
400 mg m(-2) i.v. bolus and 600 mg m(-2) i.v. in a 22-h infusion, on
days 1 and 2, every 2 weeks, and mitomycin C 7 mg m(-2) i.v. bolus on
day 2, every 6 weeks. Grades 3-4 toxicities (National Cancer
Institute-Common Toxicity Criteria) consisted mainly of neutropenia and
thrombocytopenia. Five patients had a complete response and 16 had a
partial response for an overall response rate of 46.7% (95% confidence
interval, 32.1-61.2%). The median survival was 11 months. The
combination of cisplatin, 5-fluorouracil and leucovorin according to de
Gramont, and mitomycin C seems to be an active and safe regimen in the
treatment of advanced gastric cancer. Because of its low cost it may be
suggested for patients not enrolled into clinical trials. Copyright 2002
The Cancer Research Campaign
24
UI - 2016625
AU - Wils JA; Klein HO; Wagener DJ; Bleiberg H; Reis H; Korsten F; Conroy T;
TI -
Fickers M; Leyvraz S; Buyse M; et al
Sequential high-dose methotrexate and fluorouracil combined with
doxorubicin--a step ahead in the treatment of advanced gastric cancer: a
trial of the European Organization for Research and Treatment of Cancer
Gastrointestinal Tract Cooperative Group.
SO - J Clin Oncol 1991 May;9(5):827-31
AD - Laurentius Hospital, Roermond, The Netherlands.
In a prospective phase III multicenter trial, 213 patients with advanced
measurable or nonmeasurable gastric cancer were randomized to receive
methotrexate (MTX), fluorouracil (5-FU), and Adriamycin (doxorubicin;
Farmitalia Carlo Erba, Milan, Italy) (FAMTX) or 5-FU, Adriamycin, and
mitomycin (FAM). The results show a significantly superior response rate
(41% v 9% [P less than .0001]), and survival (median, 42 weeks v 29
weeks [P = .004]) for FAMTX. There was a cumulative thrombocytopenia in
FAM and not in FAMTX. The FAMTX protocol should be the reference
treatment in future clinical trials that seek to improve the therapeutic
outcome in advanced gastric cancer.
25
UI - 8996151
AU - Webb A; Cunningham D; Scarffe JH; Harper P; Norman A; Joffe JK; Hughes
TI -
M; Mansi J; Findlay M; Hill A; Oates J; Nicolson M; Hickish T; O'Brien
M; Iveson T; Watson M; Underhill C; Wardley A; Meehan M
Randomized trial comparing epirubicin, cisplatin, and fluorouracil
versus fluorouracil, doxorubicin, and methotrexate in advanced
esophagogastric cancer.
SO - J Clin Oncol 1997 Jan;15(1):261-7
AD - Cancer Research Campaign (CRC) Section of Medicine, Royal Marsden
Hospital, Sutton, Surrey, United Kingdom.
PURPOSE: We report the results of a prospectively randomized study that
compared the combination of epirubicin, cisplatin, and protracted venous
infusion fluorouracil (5-FU) (ECF regimen) with the standard combination
of 5-FU, doxorubicin, and methotrexate (FAMTX) in previously untreated
patients with advanced esophagogastric cancer. PATIENTS AND METHODS: Two
hundred seventy-four patients with adenocarcinoma or undifferentiated
carcinoma were randomized and analyzed for survival, tumor response,
toxicity, and quality of life (QL). RESULTS: The overall response rate
was 45% (95% confidence interval [CI], 36% to 54%) with ECF and 21% (95%
CI, 13% to 29%) with FAMTX (P = .0002). Toxicity was tolerable and there
were only three toxic deaths. The FAMTX regimen caused more hematologic
toxicity and serious infections, but ECF caused more emesis and
alopecia. The median survival duration was 8.9 months with ECF and 5.7
months with FAMTX (P = .0009); at 1 year, 36% (95% CI, 27% to 45%) of
ECF and 21% (95% CI, 14% to 29%) of FAMTX patients were alive. The
median failure-free survival duration was 7.4 months with ECF and 3.4
months with FAMTX (P = .00006). The global QL scores were better for ECF
at 24 weeks, but the remaining QL data showed no differences between
either arm of the study. Hospital-based cost analysis on a subset of
patients was similar for each arm and translated into an increment cost
of $975 per life-year gained. CONCLUSION: The ECF regimen results in a
survival and response advantage, tolerable toxicity, better QL and
cost-effectiveness compared with FAMTX chemotherapy. This regimen should
now be considered the standard treatment for advanced esophagogastric
cancer.
26
UI - 10894863
AU - Vanhoefer U; Rougier P; Wilke H; Ducreux MP; Lacave AJ; Van Cutsem E;
TI -
Planker M; Santos JG; Piedbois P; Paillot B; Bodenstein H; Schmoll HJ;
Bleiberg H; Nordlinger B; Couvreur ML; Baron B; Wils JA
Final results of a randomized phase III trial of sequential high-dose
methotrexate, fluorouracil, and doxorubicin versus etoposide,
leucovorin, and fluorouracil versus infusional fluorouracil and
cisplatin in advanced gastric cancer: A trial of the European
Organization for Research and Treatment of Cancer Gastrointestinal Tract
Cancer Cooperative Group.
SO - J Clin Oncol 2000 Jul;18(14):2648-57
AD - Department of Internal Medicine (Cancer Research), West German Cancer
Center, University of Essen Medical School, Essen, Germany.
PURPOSE: To compare the efficacy and tolerability of etoposide,
leucovorin, and bolus fluorouracil (ELF) or infusional fluorouracil plus
cisplatin (FUP) with that of the reference protocol of fluorouracil,
doxorubicin, and methotrexate (FAMTX) in advanced gastric cancer.
PATIENTS AND METHODS: A total of 399 patients with advanced
adenocarcinoma of the stomach were randomized and analyzed for toxicity,
tumor response, and progression-free and overall survival. Only reviewed
and confirmed responses were considered. The analysis of remission was
based on assessable patients with documented measurable lesions. The
intent-to-treat principle, log-rank test, and Cox regression model were
used for the statistical analysis of time-to-event end points. RESULTS:
The overall response rate for 245 eligible patients with measurable
disease was 9% with ELF, 20% with FUP, and 12% with FAMTX, with no
significant differences. One hundred twelve patients were eligible for
efficacy in assessable, nonmeasurable disease. No change was observed in
66% of patients treated with ELF, 56% with FUP, and 55% with FAMTX. Two
patients achieved a complete tumor regression (one each for ELF and
FAMTX). With a median follow-up time of 4.5 years, the median survival
times were 7.2 months with ELF, 7.2 months with FUP, and 6.7 months with
FAMTX, respectively, with no significant differences. Nonhematologic and
hematologic toxicities of ELF, FUP, and FAMTX were acceptable, with
neutropenia being the major toxicity for all three regimens. Seven
treatment-related deaths occurred (two with FUP and five with FAMTX).
CONCLUSION: All three investigated regimens demonstrate modest clinical
efficacy and should not be regarded as standard treatment for advanced
gastric cancer. New strategies should be considered to achieve a better
clinical efficacy in the treatment of advanced gastric cancer.
27
UI - 11764539
AU - Krishnan K; Brenner DE
TI -
Prostaglandin inhibitors and the chemoprevention of noncolonic
malignancy.
SO - Gastroenterol Clin North Am 2001 Dec;30(4):981-1000
AD - Division of Hematology and Oncology, Department of Internal Medicine,
James H. Quillen Veterans Administration Medical Center, James H.
Quillen College of Medicine, East Tennessee State University, Johnson
City, Tennessee, USA. krishnak@etsu.edu
Much has been learned about the role of NSAIDs as cancer preventives
through epidemiologic and experimental studies. The pathways of
carcinogenesis in the gastrointestinal tract are initiated by many
different genetic, environmental, infective, and lifestyle factors. It
is possible that the final common pathway of all these malignancies may
have some common features. It is conceivable that head and neck,
esophageal, gastric, and colorectal epithelial carcinogenesis all are
influenced by or require COX-2 up-regulation as a step toward
transformation. Intuitively, it is possible that selective COX-2
inhibitors may have a preventive role in all these epithelial
malignancies. Today's challenge is to translate this information into
clinical trials to define what role, if any, COX inhibition might play
in the prevention of these malignancies.
28
UI - 11815399
AU - Jacobs EJ; Connell CJ; McCullough ML; Chao A; Jonas CR; Rodriguez C;
TI -
Calle EE; Thun MJ
Vitamin C, vitamin E, and multivitamin supplement use and stomach cancer
mortality in the Cancer Prevention Study II cohort.
SO - Cancer Epidemiol Biomarkers Prev 2002 Jan;11(1):35-41
AD - Department of Epidemiology and Surveillance Research, American Cancer
Society, 1599 Clifton Road NE, Atlanta, GA 30329-4251, USA.
Supplementation with antioxidant vitamins has been associated with
decreased risk of stomach cancer or regression of precancerous lesions
in high-risk areas of China and Colombia. We examined the association
between stomach cancer mortality and regular use (> or =15 times per
month) of individual vitamin C supplements, individual vitamin E
supplements, and multivitamins among 1,045,923 United States adults in
the Cancer Prevention Study II (CPS-II) cohort. CPS-II participants
completed a questionnaire at enrollment in 1982 and were followed for
mortality through 1998. During follow-up, there were 1,725 stomach
cancer deaths (1,127 in men and 598 in women). After adjustment for
multiple potential stomach cancer risk factors, vitamin C use at
enrollment was associated with reduced risk of stomach cancer mortality
[rate ratio (RR), 0.83; 95% confidence interval (CI), 0.68-1.01].
However, this reduction in risk was observed only among participants
with short duration use at enrollment (RR, 0.68; 95% CI, 0.51-0.91 for
<10 years of use; RR, 1.00; 95% CI, 0.73-1.38 for > or =10 years of
use). There was no association between stomach cancer mortality and
regular use of vitamin E (RR, 1.02; 95% CI, 0.82-1.27) or multivitamins
(RR, 0.89; 95% CI, 0.77-1.03), regardless of duration of use. Our
results suggest that the use of vitamin C, vitamin E, or multivitamin
supplements may not substantially reduce risk of stomach cancer
mortality in North American populations in which stomach cancer rates
are relatively low. Our results do not rule out effects of vitamin
supplementation in areas in which stomach cancer rates are high and
stomach cancer etiology may differ.
29
UI - 11810570
AU - Kim R; Nishimoto N; Inoue H; Yoshida K; Toge T
TI -
An analysis of the therapeutic efficacy of protracted infusion of
low-dose 5-fluorouracil and cisplatin in advanced gastric cancer.
SO - J Infect Chemother 2000 Dec;6(4):222-8
AD - Department of Surgical Oncology, Research Institute for Radiation
Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku,
Hiroshima 734-8553, Japan. rkim@ipc.hiroshima-u.ac.jp
To analyze the clinical efficacy of a protracted infusion of low-dose
5-fluorouracil (5-FU) and cisplatin (CDDP), a phase II study was
performed in 36 patients with advanced gastric cancer. The treatment
schedule of the low-dose administration of 5-FU and CDDP (FP) was a
continuous infusion of 5-FU (250 mg/m2) for 28 consecutive days and a
drip infusion of CDDP (3.5 mg/m2) for 5 consecutive days, followed by a
2-day interval each week in one cycle. The overall response rate was
47.2%. Of importance, the improvement in quality of life assessed by
performance status (PS) and oral intake was 13.9% and 33.3%,
respectively. The toxicity in low-dose FP treatment was less than grade
2, including gastrointestinal toxicities and bone marrow suppression,
and this was tolerable during the treatment. The median survival time
(MST) and 1-year survival rate were 8 months and 36.2%, respectively. In
a pharmacokinetic analysis following the protracted infusion of low-dose
FP, the plasma concentrations of 5-FU and CDDP were increased to about
120-130 ng/ml and 0.3-0.5 microg/ml on day 21 after the treatment,
respectively. The plasma concentrations of 5-FU and CDDP were not
significantly different between responders and non-responders. The tumor
response to low-dose FP treatment was associated with the induction of
apoptotic cell death and with the overexpression of apoptosis-related
genes, such as Bax and Bcl-Xs, in cancer cells. These results indicate
that the protracted infusion of low-dose FP could be a useful regimen
for patients with advanced gastric cancer, in terms of the high response
rate and low toxicity, possibly leading to the prolongation of survival
and improvement in the quality of life.
30
UI - 11857350
AU - Stein U; Lage H; Jordan A; Walther W; Bates SE; Litman T; Hohenberger P;
TI -
Dietel M
Impact of BCRP/MXR, MRP1 and MDR1/P-Glycoprotein on thermoresistant
variants of atypical and classical multidrug resistant cancer cells.
SO - Int J Cancer 2002 Feb 20;97(6):751-60
AD - Max-Delbruck-Center for Molecular Medicine, Berlin, Germany.
ustein@mdc-berlin.de
The impact of the ABC transporters breast cancer resistance
protein/mitoxantrone resistance associated transporter (BCRP/MXR),
multidrug resistance-associa
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