title: Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: results of a randomized trial.
abstract: We report the final results of a prospectively randomized study that compared the combination of epirubicin, cisplatin and protracted venous infusion fluorouracil (5-FU) (ECF regimen) with the standard combination of 5-FU, doxorubicin and methotrexate (FAMTX) in previously untreated patients with advanced oesophagogastric cancer. Between 1992 and 1995, 274 patients with adenocarcinoma or undifferentiated carcinoma were randomized from eight oncology centres in the UK and analysed for response and survival. The overall response rate was 46% (95% confidence interval (CI), 37-55%) with ECF, and 21% (95% CI, 13-28%) with FAMTX (P = 0.00003). The median survival was 8.7 months with ECF and 6.1 months with FAMTX (P = 0.0005). The 2-year survival rates were 14% (95% CI, 8-20%) for the ECF arm, and 5% (95% CI, 2-10%) for the FAMTX arm (P = 0.03). Histologically complete surgical resection following chemotherapy was achieved in ten patients in the ECF arm (three pathological complete responses to chemotherapy) and three patients in the FAMTX arm (no pathological complete responses). The ECF regimen resulted in a response and survival advantage compared with FAMTX chemotherapy. The probability of long-term survival following surgical resection of residual disease is increased by this treatment. The high response rates seen with ECF support its use in the neoadjuvant setting.
authors.affiliation: Cancer Research Campaign, Section of Medicine and Gastrointestinal Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Waters
authors.forename: A
authors.initials: A
authors.lastname: Norman
authors.forename: D
authors.initials: D
authors.lastname: Cunningham
authors.forename: J H
authors.initials: JH
authors.lastname: Scarffe
authors.forename: A
authors.initials: A
authors.lastname: Webb
authors.forename: P
authors.initials: P
authors.lastname: Harper
authors.forename: J K
authors.initials: JK
authors.lastname: Joffe
authors.forename: M
authors.initials: M
authors.lastname: Mackean
authors.forename: J
authors.initials: J
authors.lastname: Mansi
authors.forename: M
authors.initials: M
authors.lastname: Leahy
authors.forename: A
authors.initials: A
authors.lastname: Hill
authors.forename: J
authors.initials: J
authors.lastname: Oates
authors.forename: S
authors.initials: S
authors.lastname: Rao
authors.forename: M
authors.initials: M
authors.lastname: Nicolson
authors.forename: T
authors.initials: T
authors.lastname: Hickish
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy*; D016019:Survival Analysis
chemical_list: D015251:Epirubicin; D004317:Doxorubicin; D002945:Cisplatin; D005472:Fluorouracil; D008727:Methotrexate