Although many treatments for advanced gastric cancer have been developed, systemic therapy remains elusive.
Methods
The author reviewed data on recent phase II and III trials of the main new agents and combinations.
Results
Chemotherapy appears to improve survival of patients with advanced disease, albeit slightly. New drugs that might improve response rates and survival include the taxanes.
Conclusions
New combinations, including the taxanes, must be designed and evaluated to further improve the outcome for patients with advanced gastric cancer.
References
1.
World Health Report 1998: A Vision for All.Geneva, Switzerland: World Health Organization; 1998.
2.
ParkerS.L., TongT., BoldenT.. Cancer statistics, 1997.CA Cancer J Clin.1997; 47: 5–27.
3.
Cancer Facts & Figures 1999.Atlanta, Ga: American Cancer Society; 1999.
4.
Ministério da Saúde, Brasil. Secretaria Nacional de Assistência à Saúde. Instituto Nacional de Câncer. Coordenação de Programas de Controle de Câncer — Pro-Onco. Estimativas da Incidência e Mortalidade por Câncer no Brasil 1998: Rio de Janeiro, Pro-Onco.
5.
ClarkeJ.S., CruzeK., El FarraS.. The natural history and results of surgical therapy for carcinoma of the stomach: an analysis of 250 cases.Am J Surg.1961; 102: 143–149.
6.
KatzA.. Câncer gàstrico. In: MuradA.M., KatzA., eds. Oncologia. Bases Clínicas do Tratamento.Rio de Janeiro, Brazil: Guanabara Koogan;1996: 163–167.
7.
KelsenD.. Chemotherapy of gastric cancer: a review.Isr J Med Sci.1988; 24: 557–561.
8.
MacdonaldJ.S., ScheinP.S., WoolleyP.V.. 5-Fluorouracil, doxorubicin and mitomycin (FAM) combination chemotherapy for advanced gastric cancer.Ann Intern Med.1980; 93: 533–536.
9.
CullinanS.A., MoertelC.G., FlemingT.R.. A comparison of three chemotherapeutic regimens in the treatment of advanced pancreatic and gastric carcinoma: fluorouracil vs fluorouracil and doxorubicin vs fluorouracil, doxorubicin, and mitomycin.JAMA.1985; 253: 2061–2067.
10.
LeichmanL.. Gastric cancer therapy: a translational research paradigm. In: ASCO Educational Book.Alexandria, Va: American Society of Clinical Oncology; 1997: 262–271.
11.
MuradA.M., SantiagoF.F., PetroianuA.. Modified therapy with 5-fluorouracil, doxorubicin and methotrexate in advanced gastric cancer.Cancer.1993; 72: 37–41.
12.
MuradA.M.. Uso do esquema EFAMTX: etoposide, 5-fluorouracil, adriamicina, metotrexate e leucovorin no tratamento do cancer gàstrico avançado.Rev Med Minas Gerais.1993; 3(suppl 2): 32.
13.
PyrhonenS., KuitumenT., KouriM.. A randomized, phase III trial comparing fluorouracil, epidoxorubicin and methotrexate (FEMTX) with best supportive care in non-resectable gastric cancer.Ann Oncol.1992; 3(suppl 5): 12. Abstract.
14.
WilsJ.A., KleinH.O., WagenerD.J.. 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.J Clin Oncol.1991; 9: 827–831.
15.
KelsenD., AtiqO., SaltzL.. FAMTX (fluorouracil, methotrexate, adriamycin) is as effective and less toxic than EAP (etoposide, adriamycin, cisplatin): a random assignment trial in gastric cancer.Proc Annu Meet Am Soc Clin Oncol.1991; 10: 137. Abstract.
16.
WebbA., CunninghamD., ScarffeJ.H.. A randomized trial comparing ECF with FAMTX in advanced oesophago-gastric cancer.Ann Oncol.1996; 7(suppl): 50.
17.
WilkeH., WilsJ., RougierP.. Preliminary analysis of a randomized phase III trial of FAMTX versus ELF versus cisplatin/FU in advanced gastric cancer (gastric cancer): a trial of the EORTC Gastrointestinal Tract Cancer Cooperative Group and the AIO (Arbeitsgemeinschaft Internistische Onkologie).Proc Annu Meet Am Soc Clin Oncol.1995; 14: 206. Abstract.
18.
CascinuS., LabiancaR., AlessandroniP.. Intensive weekly chemotherapy for advanced gastric cancer using fluorouracil, cisplatin, epi-doxorubicin, 6S-leucovorin, glutathione, and filgrastim: a report from the Italian Group for the Study of Digestive Tract Cancer.J Clin Oncol.1997; 15: 3313–3319.
19.
KingstonD.G., SamaranayakeG., IveyC.A.. The chemistry of Taxol, a clinically useful anticancer agent.J Nat Prod.1990; 53: 1–12.
20.
McGuireW.P., RowinskyE.K., RosensheinN.B.. Taxol: a unique antineoplastic agent with significant activity in advanced ovarian epithelial neoplasms.Ann Intern Med.1989; 111: 273–279.
21.
ThigpenJ., BlessingJ., BallH.. Phase II trial of Taxol as a second-line therapy for ovarian carcinoma: a Gynecologic Oncology Group study.Proc Annu Meet Am Soc Clin Oncol.1990; 9: A604. Abstract.
22.
EinzigA.I., WiernikP.H., LipsitzS.. Phase II trial of Taxol in patients with adenocarcinoma of upper gastrointestinal tract (UGIT): the Eastern Cooperative Oncology Group (ECOG) results.Proc Annu Meet Am Soc Clin Oncol.1993; 12: A566. Abstract.
23.
AjaniJ.A., IlsonD.H., DaughertyK.. Activity of Taxol in patients with squamous cell carcinoma and adenocarcinoma of the esophagus.J Natl Cancer Inst.1994; 86: 1086–1091.
24.
AjaniJ.A., FairweatherJ., DumasP.. A phase II study of Taxol in patients with advanced untreated gastric carcinoma.Proc Annu Meet Am Soc Clin Oncol.1997; 16: A933. Abstract.
25.
TamuraF., OhtsuA., BokuN.. Three-hour infusion of paclitaxel for advanced gastric cancer.Proc Annu Meet Am Soc Clin Oncol.1997; 16: A1091. Abstract.
26.
SulkesA., SmythJ., SessaC.. Docetaxel (Taxotere) in advanced gastric cancer: results of a phase II clinical trial. EORTC Early Clinical Trials Group.Br J Cancer.1994; 70: 380–383.
27.
FurueH., TaguchiT.. A late phase II study of RP56976 (docetaxel) in advanced or recurrent gastric cancer.Ann Oncol.1998(suppl 4);9: 49. Abstract.
28.
RothA.D., MaibachR., MartinelliN.. Taxotere-cisplatin in advanced gastric carcinoma (Agastric cancer): an active drug combination.Proc Annu Meet Am Soc Clin Oncol.1998; 17: 283. Abstract.
29.
KöhneC.H., ThusspatienceP., CataneR.. A phase II trial of CPT-11 in patients (pts) with advanced gastric carcinoma (Agastric cancer).Ann Oncol.1998; 9(suppl 4): 46.
30.
HorikoshiN., MitachiY., SakataY.. S-1, new oral fluoropyrimidine is very active in patients with advanced gastric cancer (early phase II study).Proc Annu Meet Am Soc Clin Oncol.1996; 15: 206.
31.
MuradA.M., TinocoL.A., GuimaresR.C.. Paclitaxel (T) plus 5-fluorouracil (5-FU): a novel and very active regimen for advanced gastric cancer (Agastric cancer). A phase II trial.Proc Annu Meet Am Soc Clin Oncol.1997; 16: A1063. Abstract.
32.
MuradA.M.. Estudo prospectivo do uso da associação de paclitaxel e 5-fluorouracil no tratamento do câncer gàstrico avançado. Tese (Doutorado). Faculdade de Medicina da UFMG. Belo Horizonte, 1997.
33.
MuradA.M.. Phase II trial of combination of paclitaxel and 5-fluorouracil in the treatment of advanced gastric cancer.South Am J Cancer.1998; 2: 35–43.
34.
AndersenJ.S., BurrisH.A., CasperE.. Development of a new system for assessing clinical benefit for patients with advanced pancreatic cancer.Proc Annu Meet Am Soc Clin Oncol.1994; 13: A1600. Abstract.
