title: Treatment of advanced gastric cancer with oral etoposide, leucovorin and tegafur: experience with an oral modification of the etoposide, leucovorin and 5-fluorouracil (ELF) regimen.
abstract: Recent data have suggested enhanced therapeutic activity with prolonged administration of both etoposide as well as fluoropyrimidines in the treatment of gastrointestinal malignancies. Based on this rationale, we investigated the clinical effectiveness and tolerance of an oral modification of the widely applied etoposide, leucovorin and 5-fluorouracil (ELF) regimen in patients with advanced gastric cancer. 32 patients with advanced gastric cancer were treated with oral etoposide (100 mg), leucovorin (3 x 100 mg), and tegafur (3 x 200 mg) over 14-21 days for a maximum of six cycles. Objective response was seen in only 5 patients (16%), stable disease was documented in 7 (22%), while the remaining patients progressed during therapy. The median time to progression was 2.8 months (range 0.7-12 months) and median overall survival was 6 months (range 1-18+ months). Due to grade 3 nausea/emesis, 8 patients discontinued treatment prematurely, while 12 patients experienced anorexia and progressive weight loss. Haematological toxicity was modest, with 4 patients developing asymptomatic grade 3-4 granulocytopenia. We conclude that this oral combination regimen cannot be recommended for the treatment of advanced gastric cancer.
authors.affiliation: Department of Internal Medicine I, University of Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Raderer
authors.forename: G V
authors.initials: GV
authors.lastname: Kornek
authors.forename: M H
authors.initials: MH
authors.lastname: Hejna
authors.forename: J
authors.initials: J
authors.lastname: Miholic
authors.forename: G
authors.initials: G
authors.lastname: Weinlaender
authors.forename: T
authors.initials: T
authors.lastname: Brodowicz
authors.forename: W C
authors.initials: WC
authors.lastname: Fiebiger
authors.forename: J B
authors.initials: JB
authors.lastname: Valencak
authors.forename: W
authors.initials: W
authors.lastname: Scheithauer
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D058766:Levoleucovorin; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000188:drug therapy*; D005641:Tegafur / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005641:Tegafur; D005047:Etoposide; D058766:Levoleucovorin; D002955:Leucovorin; D005472:Fluorouracil