Long-term results with FAMTX (5-fluorouracil, adriamycin, methotrexate) in advanced gastric cancer.
In a phase II trial we tried to evaluate the efficacy of a sequential combination of high-dose (HD) MTX and 5-FU combined with Adriamycin (ADM). In a pilot study we found HDMTX effective as a single agent in gastric cancer. MTX and 5-FU were combined sequentially because Cadman and Bertino had shown synergism for this combination. The treatment protocol consisted of HDMTX, 1.5 g/m2 of body surface, and HD5-FU, 1.5 g/m2. MTX was administered 1 hour prior to 5-FU. Both drugs were given as a bolus. 24 hours after MTX administration, citrovorum factor rescue was started, 15 mg/m2, q6h x 12, orally. 48 hours after MTX administration, the serum concentration of the drug was measured by HPLC. 14 days after MTX was given, ADM, 30 mg/m2, was injected as a bolus. This protocol was repeated every 28 days. Patients eligible for this treatment were required to have a creatinine clearance of greater than 60 ml/min. 116 patients with metastasized gastric cancer and a performance status between 40 and 70% were treated. The response rate was 58% (67/116 patients). 14/116 patients (12%) had complete remission. The median survival probability for all patients was 9 months, for responders 15 months, while for patients with complete response it has not been reached. The median survival for nonresponders was only 4 months. Around 10% of all patients lived longer than 6 years. The median follow-up-time was 4 years. Cytostatic treatment was relatively well tolerated. The deaths of 3 patients were drug-related. A quarter of all patients could be treated on an outpatient basis.
Klein
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Medical Clinic, University of Cologne, F.R.G.
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D004317:Doxorubicin / Q000008:administration & dosage; D004341:Drug Evaluation; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008727:Methotrexate / Q000008:administration & dosage; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology
D004317:Doxorubicin; D005472:Fluorouracil; D008727:Methotrexate