Irinotecan in the treatment of gastric cancer.
Chemotherapy has a proven palliative role in advanced gastric cancer, significantly improving quality of life and prolonging survival compared with best supportive care alone. Although there is no standard of treatment, 5-fluorouracil (5-FU)/cisplatin doublets and the combination of epirubicin, cisplatin and 5-FU (ECF) have both achieved response rates in the range of 40-50% and median overall survival of 8-10 months. Either could claim the status of a reference regimen. Single-agent irinotecan achieved response rates (RR) of 18% and 23% in phase II studies, and 48% when combined with cisplatin. However, a randomized trial of irinotecan plus cisplatin versus irinotecan plus 5-FU/folinic acid (FA) showed that the latter regimen achieved a higher RR (34% versus 28%) and significantly longer median survival (10.7 versus 6.9 months). Hematological toxicity was lower with the irinotecan/5-FU/FA combination. This regimen has therefore been taken forward into a randomized phase III comparison against a 5-FU/cisplatin doublet. Use of irinotecan-based combinations should also be investigated as an adjuvant treatment (probably in combination with radiotherapy) and in the neoadjuvant setting.
Bugat
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Institut Claudius Regaud, Centre Régional De Lutte Contre le Cancer, Midi-Pyrenees, Toulouse, France. bugat@icr.fnclcc.fr
D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D017322:Clinical Trials, Phase II as Topic; D004305:Dose-Response Relationship, Drug; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D000077146:Irinotecan; D020360:Neoadjuvant Therapy; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000188:drug therapy*
D000972:Antineoplastic Agents, Phytogenic; D000077146:Irinotecan; D002945:Cisplatin; D005472:Fluorouracil; D002166:Camptothecin