Chemotherapy for advanced gastric cancer: across the years for a standard of care.
Chemotherapy is of crucial importance in advanced gastric cancer patients, in order to obtain palliation of symptoms and improve survival. The most extensively studied drugs as single agents are 5-fluorouracil, cisplatin, doxorubicin, epirubicin, mitomycin C and etoposide. Newer chemotherapeutic agents include the taxanes (docetaxel and paclitaxel), oral fluoropyrimidines (capecitabine and S-1), oxaliplatin and irinotecan. Randomised trials comparing monotherapy with combination regimens have consistently shown increased response rates in favour of combination regimens, whereas only marginally improved survival rates were usually found. Several combination therapies have been developed and have been examined in Phase III trials. However, in most cases, they have failed to demonstrate a survival advantage over the reference arm. There is no internationally accepted standard of care, and uncertainty remains regarding the choice of the optimal chemotherapy regimen. The objective of this article is to review the present literature available on major Phase II - III clinical trials, in which patients suffering from advanced gastric cancer were treated with cytotoxic chemotherapy.
Scartozzi
Mario
M
Università Politecnica delle Marche, Department of Clinica di Oncologia Medica, Azienda Ospedaliera Ospedali Riuniti, Ancona, Italy.
Galizia
Eva
E
Verdecchia
Lorena
L
Berardi
Rossana
R
Antognoli
Stefania
S
Chiorrini
Silvia
S
Cascinu
Stefano
S
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D018572:Disease-Free Survival; D006801:Humans; D005791:Patient Care / Q000592:standards*; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality