Gastric cancer. Conclusion
The other thing that appears to be important is cisplatin. Not carboplatin, but cisplatin used in about every three weeks, every month. Larry Leishman at Roswell Park uses a regimen that uses continuous infusion 5FU plus monthly platinum at 100 mg per meter square. This regimen, ECF, is from David Cunningham at the Royal Marsden and he included epirubicin. Of course epirubicin is a anthracycline analog that was available in Europe up until three weeks ago when it was approved by the FDA for breast cancer. So actually it will be available here to test. I don’t have a great deal of confidence in anthracyclines in gastric cancer.
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I don’t know whether this adds anything. But in any event, a randomized study was performed by Cunningham, Webb and their associates, published in January of ’97 in the Journal of Clinical Oncology. It was FAM-TX, which is a standard chemotherapy regimen in advanced gastric cancer, versus ECF. Over 100 patients in each arm. And if you look here you can see that the CR and PR rate, including complete responses, were substantially higher in the patients who received the ECF regimen. This was locally advanced cardioesophageal junction adenocarcinoma. When one looks at survival, the survival was also beneficial. There also was a quality of life done with this and the quality of life on the ECF patients was benefit. But again, when you look out here you see that this is a temporary fix. We are not curing patients but it’s useful to see that we are actually doing controlled randomized studies and that we seem to be making some advances. I think that cisplatin plus 5FU regimens of some sort will be around for a long while and will be of interest in this disease.
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There are a variety of other regimens in gastric cancer that are being looked at. The Taxol/platinum regimens are interesting. Taxotere needs to be explored more. CPT-11 clearly has some activity in this disease. At Memorial they are doing a Taxotere/CPT-11. We’ve gotten very interested in this combination of CPT-11 and cisplatin, which is quite tolerable and is an effective regimen in gastric cancer. Of course gemcitabine is also beginning to come on line, and there is some evidence of gemcitabine/platinum synergies.