Authors: Varadhachary Gauri R.; Yu Christina; Ajani Jaffer A.

Source: American Journal of Cancer, Volume 4, Number 1, 2005 , pp. 65-70(6)

Publisher: Adis International

Abstract:

The role of chemotherapy in advanced gastric and gastroesophageal junction cancers is evolving. Although there is no established global front-line treatment regimen, combination therapy with fluorouracil and cisplatin is often used as first-line therapy in untreated patients with advanced disease. Reference regimens vary depending on regional and cultural preferences. In the last 5 years, there has been increased enthusiasm for newer agents used as monotherapy or in combination. These agents include camptothecins, notably irinotecan, taxanes oxaliplatin, and the novel oral fluoropyrimidine S-1. Modest activity has been observed with these drugs as single agents with objective responses in the range of 12–20% and slightly higher for S-1. Combination regimens with two or three agents have resulted in higher response rates (in the range of 30–50%). However, this it at the expense of increased toxicity; the toxic effects have varied depending on the class of drugs combined.

With improving clinical trial designs and the availability of a larger number of newer agents, the challenge to establish new combinations and new paradigms that improve the outcome of patients with advanced gastric and gastroesophageal cancers continues. The future offers a greater understanding of pharmacogenomics and molecular biology that will help identify better therapeutic targets. When possible, all eligible patients with metastatic gastric or gastroesophageal cancer should be enrolled in a clinical trial.

Keywords: Gastric cancer, treatment; Irinotecan, therapeutic use; S 1, therapeutic use; Oxaliplatin, therapeutic use; Docetaxel, therapeutic use; Cisplatin, therapeutic use; Epirubicin, therapeutic use

Document Type: Review article

Affiliations: 1: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA

Publication date: 2005-01-01

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