title: Phase II study of sequential high-dose methotrexate (MTX) and 5-fluorouracil (F) alternated with epirubicin (E) and cisplatin (P) [FEMTX-P] in advanced gastric cancer.
abstract: BACKGROUND
  FAMTX (5-fluorouracil, adriamycin, methotrexate) is one of the most effective drug combinations in gastric cancer. Therefore, modifications of FAMTX appear of interest and the FEMTX-P regiment was conceived.
  
  
  METHODS
  Fifty patients with unresectable locally advanced and/or metastatic gastric carcinoma were treated with methotrexate 1500 mg/m2 i.v. and 5-fluorouracil 1500 mg/m2 i.v. on day 1; leucovorin rescue 15 mg/m2 orally every 6 hours for 8 doses on days 2 and 3; epirubicin 60 mg/m2 i.v. and cisplatin 50 mg/m2 i.v. on day 15, q 4 weeks.
  
  
  RESULTS
  Of forty-seven patients evaluable for response, five (11%) achieved complete responses and seventeen (36%) partial responses (total response rate 47%). The median duration of response was 8+ months (range: 5-25+ months). Four of 14 patients with locally advanced disease were successfully downstaged and subsequently resected. The median duration of survival of all patients was 10 months (range: 1-25+ months). Leukopenia grade 4 occurred in 18% of patients and thrombocytopenia grade 4 and mucositis grade 4 in 4% and 2%, respectively. Treatment postponement for hematologic toxicity was necessary in 54% of patients.
  
  
  CONCLUSIONS
  The FEMTX-P regimen is an active regimen in advanced gastric carcinoma, with acceptable toxicity.
authors.affiliation: University Hospital St. Radboud, Nijmegen, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Roelofs
authors.forename: D J
authors.initials: DJ
authors.lastname: Wagener
authors.forename: T
authors.initials: T
authors.lastname: Conroy
authors.forename: J
authors.initials: J
authors.lastname: Wils
authors.forename: J T
authors.initials: JT
authors.lastname: Burghouts
authors.forename: M
authors.initials: M
authors.lastname: Fickers
authors.forename: A
authors.initials: A
authors.lastname: de Graeff
authors.forename: F
authors.initials: F
authors.lastname: Lalisang
authors.forename: B
authors.initials: B
authors.lastname: Paillot
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007970:Leukopenia / Q000139:chemically induced; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000188:drug therapy*; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D015251:Epirubicin; D002945:Cisplatin; D005472:Fluorouracil; D008727:Methotrexate