title: Final results of a randomized phase III trial of sequential high-dose methotrexate, fluorouracil, and doxorubicin versus etoposide, leucovorin, and fluorouracil versus infusional fluorouracil and cisplatin in advanced gastric cancer: A trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cancer Cooperative Group.
abstract: OBJECTIVE
  To compare the efficacy and tolerability of etoposide, leucovorin, and bolus fluorouracil (ELF) or infusional fluorouracil plus cisplatin (FUP) with that of the reference protocol of fluorouracil, doxorubicin, and methotrexate (FAMTX) in advanced gastric cancer.
  
  
  METHODS
  A total of 399 patients with advanced adenocarcinoma of the stomach were randomized and analyzed for toxicity, tumor response, and progression-free and overall survival. Only reviewed and confirmed responses were considered. The analysis of remission was based on assessable patients with documented measurable lesions. The intent-to-treat principle, log-rank test, and Cox regression model were used for the statistical analysis of time-to-event end points.
  
  
  RESULTS
  The overall response rate for 245 eligible patients with measurable disease was 9% with ELF, 20% with FUP, and 12% with FAMTX, with no significant differences. One hundred twelve patients were eligible for efficacy in assessable, nonmeasurable disease. No change was observed in 66% of patients treated with ELF, 56% with FUP, and 55% with FAMTX. Two patients achieved a complete tumor regression (one each for ELF and FAMTX). With a median follow-up time of 4.5 years, the median survival times were 7.2 months with ELF, 7.2 months with FUP, and 6.7 months with FAMTX, respectively, with no significant differences. Nonhematologic and hematologic toxicities of ELF, FUP, and FAMTX were acceptable, with neutropenia being the major toxicity for all three regimens. Seven treatment-related deaths occurred (two with FUP and five with FAMTX).
  
  
  CONCLUSIONS
  All three investigated regimens demonstrate modest clinical efficacy and should not be regarded as standard treatment for advanced gastric cancer. New strategies should be considered to achieve a better clinical efficacy in the treatment of advanced gastric cancer.
authors.affiliation: Department of Internal Medicine (Cancer Research), West German Cancer Center, University of Essen Medical School, Essen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Vanhoefer
authors.forename: P
authors.initials: P
authors.lastname: Rougier
authors.forename: H
authors.initials: H
authors.lastname: Wilke
authors.forename: M P
authors.initials: MP
authors.lastname: Ducreux
authors.forename: A J
authors.initials: AJ
authors.lastname: Lacave
authors.forename: E
authors.initials: E
authors.lastname: Van Cutsem
authors.forename: M
authors.initials: M
authors.lastname: Planker
authors.forename: J G
authors.initials: JG
authors.lastname: Santos
authors.forename: P
authors.initials: P
authors.lastname: Piedbois
authors.forename: B
authors.initials: B
authors.lastname: Paillot
authors.forename: H
authors.initials: H
authors.lastname: Bodenstein
authors.forename: H J
authors.initials: HJ
authors.lastname: Schmoll
authors.forename: H
authors.initials: H
authors.lastname: Bleiberg
authors.forename: B
authors.initials: B
authors.lastname: Nordlinger
authors.forename: M L
authors.initials: ML
authors.lastname: Couvreur
authors.forename: B
authors.initials: B
authors.lastname: Baron
authors.forename: J A
authors.initials: JA
authors.lastname: Wils
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000556:secondary; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D058766:Levoleucovorin; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D016016:Proportional Hazards Models; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016019:Survival Analysis
chemical_list: D005047:Etoposide; D004317:Doxorubicin; D058766:Levoleucovorin; D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil; D008727:Methotrexate