title: Second-line irinotecan after cisplatin, fluoropyrimidin and docetaxel for chemotherapy of metastatic gastric cancer.
abstract: OBJECTIVE
  Tumors of upper gastrointestinal tract are among the cancers that have a quite lethal course. Cytotoxic chemotherapy is the most efficient therapeutic modality for metastatic gastric cancer. In patients who do not respond to first-line treatment, the response rate to second-line therapies is generally low and the toxicity rates high. This study concerned the efficacy and the side effect profile of second-line therapy with irinotecan in the patients who were being followed-up with the diagnosis of metastatic gastric cancer in Izmir, Turkey.
  
  
  METHODS
  We retrospectively evaluated the efficacy and toxicity in 31 patients with metastatic gastric adenocarcinoma who presented to the polyclinic of Medical Oncology of Izmir Ataturk Education and Research Hospital between May 2008 and July 2011. All received chemotherapy regimens containing cisplatin, fluoropyrimidine (5-FU) and docetaxel as the first-line therapy for late stage disease. Irinotecan as a single agent was given at a dose of 210 mg/m(2) on each 21 days. Irinotecan (180 mg/m(2) on day 1), 5-FU (500 mg/m(2) on days 1-2) and leucovorin (LV; 60 mg/m(2) on days 1-2) as a combined regimen were given over a 14 day period.
  
  
  RESULTS
  Median age was 54 (range, 31-70). Irinotecan was given as a combined regimen for median 6 cycles (range, 3-12) and as a single agent for median 3 cycles (range, 1-10). Metastases were detected in one site in six patients (19%), in two different sites in 17 patients (55%) and in three or more sites in eight patients (26%). Four patients (12.9%) showed partial response and six patients (19.3%) showed stable disease. Progression- free survival (PFS) was found to be 3.26 months (95% CI, 2.3-4.2). Median overall survival (OS) was found to be 8.76 months (95% CI, 4.5-12.9). The most commonly seen grade 3/4 side effect was neutropenia but the the therapy was generally well-tolerated.
  
  
  CONCLUSIONS
  In this study, it was demonstrated that second-line therapy with irinotecan given following the first-line therapy with cisplatin, fluoropyrimidine (5-FU) and docetaxel was efficient and safe. Further studies are needed for confirmation.
authors.affiliation: Medical Oncology Clinic, Izmir Ataturk Training and Research Hospital, Izmir, Turkey. ahmetdirican@yahoo. com
authors.forename: Yuksel
authors.initials: Y
authors.lastname: Kucukzeybek
authors.forename: Ahmet
authors.initials: A
authors.lastname: Dirican
authors.forename: Cigdem
authors.initials: C
authors.lastname: Erten
authors.forename: Isil
authors.initials: I
authors.lastname: Somali
authors.forename: Alper
authors.initials: A
authors.lastname: Can
authors.forename: Lutfiye
authors.initials: L
authors.lastname: Demir
authors.forename: Ibrahim Vedat
authors.initials: IV
authors.lastname: Bayoglu
authors.forename: Murat
authors.initials: M
authors.lastname: Akyol
authors.forename: Murat
authors.initials: M
authors.lastname: Medeni
authors.forename: Mustafa Oktay
authors.initials: MO
authors.lastname: Tarhan
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000556:secondary; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D000077143:Docetaxel; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology; D015996:Survival Rate; D043823:Taxoids / Q000627:therapeutic use; D014421:Turkey
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D000077146:Irinotecan; D002945:Cisplatin; D005472:Fluorouracil; D002166:Camptothecin