Cancer Research and Treatment

Original Articles

Treatment Patterns and Changes in Quality of Life during First-Line Palliative Chemotherapy in Korean Patients with Advanced Gastric Cancer: Jin Won Kim, Jong Gwang Kim, Byung Woog Kang, Ik-Joo Chung, Young Seon Hong, Tae-You Kim, Hong Suk Song, Kyung Hee Lee, Dae Young Zang, Yoon Ho Ko, Eun-Kee Song, Jin Ho Baek, Dong‐Hoe Koo, So Yeon Oh, Hana Cho, Keun-Wook Lee; Cancer Res Treat. 2019;51(1):223-239. Published online October 19, 2018; DOI: https://doi.org/10.4143/crt.2018.073

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Purpose
The purpose of this study was to evaluate chemotherapy patterns and changes in quality of life (QOL) during first-line palliative chemotherapy for Korean patients with unresectable or metastatic/recurrent gastric cancer (GC).
Materials and Methods
Thiswas a non-interventional, multi-center, prospective, observational study of 527 patients in Korea. QOL assessments were conducted using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires (QLQ)-C30 and QLQ-STO22 every 3 months over a 12-month period during first-line palliative chemotherapy. The specific chemotherapy regimens were selected by individual clinicians.
Results
Most patients (93.2%) received combination chemotherapy (mainly fluoropyrimidine plus platinum) as their first-line palliative chemotherapy. The median progression-free survival and overall survival were 8.2 and 14.8 months, respectively. Overall, “a little” changes (differences of 5-10 points from baseline)were observed in some of the functioning or symptom scales; none of the QOL scales showed either “moderate” or “very much” change (i.e., ≥ 11 point difference from baseline). When examining the best change in each QOL domain from baseline, scales related to some aspects of functioning, global health status/QOL, and most symptoms revealed significant improvements (p < 0.05). Throughout the course of first-line palliative chemotherapy, most patients’ QOL was maintained to a similar degree, regardless of their actual response to chemotherapy.
Conclusion
This observational study provides important information on the chemotherapy patterns and QOL changes in Korean patientswith advanced GC. Overall, first-line palliative chemotherapy was found to maintain QOL, and most parameters showed an improvement compared with the baseline at some point during the course.

Citations

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Health-related quality of life with bemarituzumab plus mFOLFOX6 in patients with FGFR2b-overexpressing, advanced gastric or gastroesophageal junction cancer
Z.A. Wainberg, P.C. Enzinger, S. Qin, K. Yamaguchi, J. Wang, X. Zhou, A. Gnanasakthy, K. Taylor, A. Yusuf, I. Majer, A. Jamotte, Y.-K. Kang
ESMO Gastrointestinal Oncology.2024; 6: 100095. CrossRef
Impact of systemic cancer treatment on quality of life and mental well-being: a comparative analysis of patients with localized and advanced cancer
Adán Rodríguez-Gonzalez, Alberto Carmona-Bayonas, Raquel Hernandez San Gil, Patricia Cruz-Castellanos, Mónica Antoñanzas-Basa, David Lorente-Estelles, María Jose Corral, Manuel González-Moya, Oscar Alfredo Castillo-Trujillo, Emilio Esteban, Paula Jiménez-
Clinical and Translational Oncology.2023; 25(12): 3492. CrossRef
Reminiscence therapy-based care program alleviates anxiety and depression, as well as improves the quality of life in recurrent gastric cancer patients
Xing Wu, Weiwei Zhang
Frontiers in Psychology.2023;[Epub] CrossRef
Toxicities and Quality of Life during Cancer Treatment in Advanced Solid Tumors
Eun Mi Lee, Paula Jiménez-Fonseca, Rocio Galán-Moral, Sara Coca-Membribes, Ana Fernández-Montes, Elena Sorribes, Esmeralda García-Torralba, Laura Puntí-Brun, Mireia Gil-Raga, Juana Cano-Cano, Caterina Calderon
Current Oncology.2023; 30(10): 9205. CrossRef
Psychosocial functioning in individuals with advanced oesophago-gastric cancer: a mixed methods systematic review
Cara Ghiglieri, Martin Dempster, Sam Wright, Lisa Graham-Wisener
BMC Palliative Care.2023;[Epub] CrossRef
Multicenter phase III trial of S-1 and cisplatin versus S-1 and oxaliplatin combination chemotherapy for first-line treatment of advanced gastric cancer (SOPP trial)
Keun-Wook Lee, Ik-Joo Chung, Min-Hee Ryu, Young Iee Park, Byung-Ho Nam, Ho-Suk Oh, Kyung Hee Lee, Hye Sook Han, Bong-Gun Seo, Jae-Cheol Jo, Hyo Rak Lee, Jin Won Kim, Sook Ryun Park, Sang Hee Cho, Yoon-Koo Kang
Gastric Cancer.2021; 24(1): 156. CrossRef
Effect of early tumor response on the health-related quality of life among patients on second-line chemotherapy for advanced gastric cancer in the ABSOLUTE trial
Kazumasa Fujitani, Kohei Shitara, Atsuo Takashima, Keisuke Koeda, Hiroki Hara, Norisuke Nakayama, Shuichi Hironaka, Kazuhiro Nishikawa, Yutaka Kimura, Kenji Amagai, Hisashi Hosaka, Yoshito Komatsu, Ken Shimada, Ryohei Kawabata, Hideki Ohdan, Yasuhiro Kode
Gastric Cancer.2021; 24(2): 467. CrossRef
Quality-of-Life Assessment in Patients Receiving Palliative Chemotherapy: Call for Action
Maheswari Senthil
Annals of Surgical Oncology.2021; 28(1): 7. CrossRef
Impact of gastric cancer treatment on quality of life of patients
Kerstin Schütte, Christian Schulz, Kristina Middelberg-Bisping
Best Practice & Research Clinical Gastroenterology.2021; 50-51: 101727. CrossRef
Influencing Factors and Effects of Treatment on Quality of Life in Patients With Gastric Cancer—A Systematic Review
Sophia Kristina Rupp, Andreas Stengel
Frontiers in Psychiatry.2021;[Epub] CrossRef
Chronological changes in quality of life and body composition after gastrectomy for locally advanced gastric cancer
Ki Bum Park, Ji Yeon Park, Seung Soo Lee, Ho Young Chung, Oh Kyoung Kwon
Annals of Surgical Treatment and Research.2020; 98(5): 262. CrossRef
Viennese risk prediction score for Advanced Gastroesophageal carcinoma based on Alarm Symptoms (VAGAS score): characterisation of alarm symptoms in advanced gastro-oesophageal cancer and its correlation with outcome
Hannah Christina Puhr, Eleonore Pablik, Anna Sophie Berghoff, Gerd Jomrich, Sebastian Friedrich Schoppmann, Matthias Preusser, Aysegül Ilhan-Mutlu
ESMO Open.2020; 5(2): e000623. CrossRef

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Wernicke's Encephalopathy in Advanced Gastric Cancer: Eun Suk Jung, Obin Kwon, Soo Hyun Lee, Ki Byung Lee, Joo Hoon Kim, Sang Hyun Yoon, Gun Min Kim, Hei-Cheul Jeung, Sun Young Rha; Cancer Res Treat. 2010;42(2):77-81. Published online June 30, 2010; DOI: https://doi.org/10.4143/crt.2010.42.2.77

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Purpose

With their prolonged survival and malnutrition, cancer patients, and especially gastrointestinal (GI) tract cancer patients, can develop Wernicke's encephalopathy (WE). The aim of this study is to remind physicians of the importance of WE and prompt management in patients with GI tract cancer.

Materials and Methods

This study is a retrospective review of 2 cases of WE in advanced gastric cancer (AGC) patients, and we review the literature for cases of GI tract cancer related to WE.

Results

A 48-year-old female with AGC presented dizziness and diplopia for 5 days and a 20 kg weight loss. Neurologic exam showed nystagmus and gaze disturbance. Her symptoms improved after daily parenteral injection of thiamine 100 mg for 17 days. A 58-year-old female with AGC presented with sudden disorientation, confusion and 15 kg weight loss. Neurologic exam showed gaze limitation and mild ataxia. Despite daily parenteral injection of thiamine 100 mg for 4 days, she died 5 days after the onset of neurologic symptoms. Combining the cases noted in the literature review with our 2 cases, the 7 gastric cancer cases and 2 colorectal cancer cases related to WE showed similar clinical characteristics; 1) a history of long-period malnutrition and weight loss, 2) relatively typical neurologic signs and symptoms and 3) specific magnetic resonance image findings. Except for 2 patients who had irreversible neurologic symptoms, the other 7 patients were improved with prompt thiamine treatment.

Conclusion

It is important to consider WE in GI tract cancer patients with acute neurologic symptoms and who are in a state of malnutrition. Thiamine should be given as soon as possible when WE is suspected.

Citations

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Duodenal Adenocarcinoma in the Setting of Bariatric Surgery: A Perfect Storm for Wernicke’s Encephalopathy
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Ozaifa Kareem, Sobia Nisar, Masood Tanvir, Umar Muzaffer, G. N. Bader
Frontiers in Nutrition.2023;[Epub] CrossRef
Beware of lethal Wernicke's encephalopathy after cytoreductive surgery with HIPEC for peritoneal pseudomyxoma: Case report of morbidity and mortality review
Oumayma Lahnaoui, Nezha EL Bahaoui, Sara El Atiq, Laila Amrani, Mohammed Anass Majbar, Amine Benkabbou, Raouf Mohsine, Amine Souadka
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Annals of the New York Academy of Sciences.2021; 1498(1): 46. CrossRef
WERNICKE ENCEPHALOPATHY IN A PATIENT WITH GASTRIC CANCER RECURRENCE AFTER UPPER GASTROINTESTINAL SURGERY: A CASE REPORT AND REVIEW OF THE LITERATURE
Zining Liu, Xin Ye, Jiejin Yang, Zeyang Chen
Gastroenterology Nursing.2020; 43(6): 463. CrossRef
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Daniele Canova, Paola Scalon, Fabio Monica, Stefano A. Grassi, Anna Giacomin, Tiziana Tumelero, Gaetano Mastropaolo, Francesco Malfa
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Prognosis of pN3 Stage Gastric Cancer: Jung Ryun Ahn, Minkyu Jung, Chan Kim, Min Hee Hong, Hong Jae Chon, Hye Ryun Kim, Hei-Cheul Jeung, Woo Jin Hyung, Sung Sook Lee, Hyun Cheol Chung, Sung Hoon Noh, Sun Young Rha; Cancer Res Treat. 2009;41(2):73-79. Published online June 30, 2009; DOI: https://doi.org/10.4143/crt.2009.41.2.73

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Purpose

The aim of this study was to determine the prognosis of pN3 stage gastric cancer patients after they have undergone curative resection, and we also wanted to identify the prognostic factors according to the clinico-pathologic features.

Materials and Methods

Between January 2000 and December 2004, we retrospectively reviewed the medical records of the patients with histologically confirmed pN3 stage gastric cancer. They underwent both gastrectomy and lymphadenectomy with a curative aim. We categorized the pN3 stage patients into 2 groups; one with pN3 only (pN3M0) and the other with pN3 combined with M1 stage (pN3M1) that included peritoneal seeding, hepatic metastasis or para-aortic LN metastasis.

Results

Out of 467 patients with stage IV gastric adenocarcinoma who received surgery, 260 patients underwent curative resection and they were pathologically staged as N3. Among these 260 patients, 78 patients were classified as the pN3/M1 stage. For all the patients, the median follow-up period was 19 months (range: 1~108 months) and the median overall survival time was 16.2 months (95% CI, 14.1~18.3%). The 5-year survival rate of the pN3/M0 group was significantly higher than that of the pN3/M1 group (12.6% vs. 2.6%, respectively, p<0.0001). The identified predictor for a worse prognosis was an advanced T4 stage (HR: 3.38, 95% CI, 1.4~8.3, p=0.008) for the pN3 patients.

Conclusion

The survival for the pN3 gastric cancer patients after curative gastrectomy was significantly longer in the pN3/M0 group as compared to that of the pN3/M1 group. An advanced T stage was a predictor for a poor prognosis for the pN3 patients. Therefore, diverse treatment strategies for these heterogeneous pN3 gastric cancer patients are needed for improving their survival.

Citations

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HDAC4 promotes the growth and metastasis of gastric cancer via autophagic degradation of MEKK3
Wei-Jie Zang, Yi-Lin Hu, Chen-Yu Qian, Ying Feng, Jia-Zhou Liu, Jun-Ling Yang, Hua Huang, Yi-Zhun Zhu, Wan-Jiang Xue
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Zhe Gong, Jieyun Zhang, Weijian Guo
Cancer Medicine.2020; 9(23): 9052. CrossRef
S100A10 Accelerates Aerobic Glycolysis and Malignant Growth by Activating mTOR-Signaling Pathway in Gastric Cancer
Yan Li, Xiao-Yu Li, Li-Xiang Li, Ru-Chen Zhou, Yinhe Sikong, Xiang Gu, Bi-Ying Jin, Bing Li, Yan-Qing Li, Xiu-Li Zuo
Frontiers in Cell and Developmental Biology.2020;[Epub] CrossRef
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Randomized, Multicenter, Phase III Trial of Heptaplatin 1-hour Infusion and 5-Fluorouracil Combination Chemotherapy Comparing with Cisplatin and 5-Fluorouracil Combination Chemotherapy in Patients with Advanced Gastric Cancer: Kyung Hee Lee, Myung Soo Hyun, Hoon-Kyo Kim, Hyung Min Jin, Jinmo Yang, Hong Suk Song, Young Rok Do, Hun Mo Ryoo, Joo Seop Chung, Dae Young Zang, Ho-Yeong Lim, Jong Youl Jin, Chang Yeol Yim, Hee Sook Park, Jun Suk Kim, Chang Hak Sohn, Soon Nam Lee; Cancer Res Treat. 2009;41(1):12-18. Published online March 31, 2009; DOI: https://doi.org/10.4143/crt.2009.41.1.12

Abstract PDF PubReader ePub

Purpose

Heptaplatin (Sunpla) is a cisplatin derivative. A phase IIb trial using heptaplatin resulted in a 34% response rate with mild nephrotoxicity. We conducted a randomized phase III trial of heptaplatin plus 5-FU compared with cisplatin plus 5-FU in patients with advanced gastric cancer.

Materials and Methods

One hundred seventy-four patients (heptaplatin, n=88; cisplatin, n=86) from 13 centers were enrolled. The eligibility criteria were as follows: patients with pathologically-proven adenocarcinoma, chemonaive patients, or patients who had received only single adjuvant chemotherapy, and who had a measurable or evaluable lesion. On day 1, heptaplatin (400 mg/m²) or cisplatin (60 mg/m²) was given over 1 hour with 5-FU (1 gm/m²) on days 1~5 every 4 weeks.

Results

At the time of survival analysis, the median overall survival was 7.3 months in the 5-FU + heptaplatin (FH) arm and 7.9 months in the 5-FU + cisplatin (FP) arm (p=0.24). Of the FH patients, 34.2% (complete response [CR], 1.3%; partial response [PR], 32.9%) experienced a confirmed objective response compared with 35.9% (CR 0%, PR 35.9%) of FP patients (p=0.78). The median-time-to-progression was 2.5 months in the FH arm and 2.3 months in the FP arm. The incidence of neutropenia was higher with FP (28%) than with FH (16%; p=0.06); grade 3~4 nausea and vomiting were more frequent in the FP than in the FH arm (p=0.01 and p=0.05, respectively). The incidence of increased proteinuria and creatininemia was higher with FH than with FP; however, there was no statistical difference. There were no treatment-related deaths.

Conclusion

Heptaplatin showed similar effects to cisplatin when combined with 5-FU in advanced gastric cancer patients with tolerable toxicities.

Citations

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A Phase II Study of Paclitaxel and Cisplatin as Salvage Therapy for Patients with Advanced or Metastatic Gastric Cancer: Bong-Gun Seo, Sung Yong Oh, Dong Mee Lee, Hyun Seung Yoo, Suee Lee, Seong-Geun Kim, Sung-Hyun Kim, Hyuk-Chan Kwon, Hyo-Jin Kim; Cancer Res Treat. 2007;39(1):6-9. Published online March 31, 2007; DOI: https://doi.org/10.4143/crt.2007.39.1.6

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Purpose

To evaluate the therapeutic activity and safety of paclitaxel and cisplatin combination chemotherapy in patients with advanced or metastatic gastric cancers that are unresponsive to primary chemotherapy.

Materials and Methods

Advanced or metastatic gastric cancer patients unresponsive to first line chemotherapy were entered into this trial. The treatment regimen consisted of paclitaxel, 175 mg/m² by 3-hour infusion on day 1, and cisplatin, 60 mg/m² by 1 hour infusion on day 1, with the treatment repeated every 3 weeks.

Results

37 patients were entered in this study, with 32 fully evaluable for response. 4 (13%), 13 (40%) and 15 (47%) patients achieved a partial response, stable disease and progressed, respectively. The median time to progression was 4.0 months (95% CI: 2.0~6.0 months), and the median overall survival was 12.6 months (95% CI: 5.5~19.7 months), with a 1-year survival rate of 54%. Of a total of 135 cycles of chemotherapy, grades 3 and 4 hematological toxicities were neutropenia (14%) and anemia (3%). Grade ≥2 neuropathy was observed in 6 patients (17%).

Conclusion

The combination of paclitaxel and cisplatin is an effective and tolerable salvage treatment modality for advanced gastric cancer.

Citations

Citations to this article as recorded by

Treatment Outcome and Safety of the TCX Regimen for Advanced Gastric Cancer: A Prospective Cohort Study
Hieu Trong Nguyen, Kien Hung Do, Nguyen Ba Le, Thang Tran
Cancer Management and Research.2022; Volume 14: 2825. CrossRef
Multi-center Phase II Trial of Weekly Paclitaxel Plus Cisplatin Combination Chemotherapy in Patients with Advanced Gastric and Gastro-esophageal Cancer
Q. Sun, C. Liu, H. Zhong, B. Zhong, H. Xu, W. Shen, D. Wang
Japanese Journal of Clinical Oncology.2009; 39(4): 237. CrossRef

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Cispatin , Etoposide , Leucovorin and 5-Fluorouracil ( PELF ) Combination Chemotherapy for Advanced Gastric cancer: Interim Report: Il Rang Park, Si Young Kim, Jeong Hee Kim, Hwi Joong Yoon, Kyung Sam Cho; J Korean Cancer Assoc. 1998;30(5):907-913.

Abstract PDF: PURPOSE
In attempt to provide a feasible chemotherapeutic regimen for advanced gastric cancer patients, the combination of cisplatin, epirubicin, leucovorin and fluorouracil (PELF) has been developed. A trial was performed to confirm the clinical activity, in terms of response rate and toxicity and duration of survival, of the PELF combination chemotherapy.
MATERIALS AND METHODS
From April 1995 to July 1997, patients with measurable unresectable and/or metastatic gastric cancer received PELF combination chemotherapy. The regimen consisted of cisplatin 40 mg/m2 IV on days 1 and 5; epirubicin 30 mg/m2 IV on days 1 and 5; 5-fluorouracil 300 mg/m2 and leucovorin 20 mg/m2 IV on days 1 through 4. The cycle was repeated every 3 weeks.
RESULT
Among 21 evaluable patients, 1 patient achieved complete response (5.3%) and 8 patients, partial response (42.1%). The median survival of overall patients was 36 weeks, the median time to progression of 21 evaluable patients was 27 weeks. There was severe myelosuppression; leucopenia 73.1%, WHO grade 3~4 11.5% of cycles. Non-hematologic toxicities were also severe nausea or vomiting in 100% of patients, grade 3~4 13.0% of patients, alopecia in 91.3% of patients, grade 3~4 52.2% of patients.
CONCLUSION
This study showed that the PELF combination is effective in overall response rates. However, it is not recommended for routine clinical use because of its toxicities. Further phase III study will be warranted.

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Selection of Surgical Procedure in the Elderly with Advanced Gastric Cancer: Hyeoung Joon Kim, Tae Kyung Sohn, Woo Joong Kim, Kyung Suk Chung; J Korean Cancer Assoc. 1998;30(5):892-899.

Abstract PDF: PURPOSE
The quality of life has become increasingly important as an outcome when assessing patients who have had surgery for advanced gastric cancer in the elderly. The purpose of this study was to study the validity of quality of postoperative life as a criterion in the decision-making process as well as the results of operation for advanced gastric cancer in the elderly.
MATERIALS AND METHODS
Spitzer's quality of life index, postoperative mortality and survival were evaluated in 67 patients(over 65 years of age) with advanced gastric cancer who had undergone operation between 1988 and 1997 at the Department of Surgery, Kangnam Sacred Heart Hospital.
RESULTS
The quality of life score and median survival correlated with TNM clinical stage(IIIa; 7.1+/-1.8, 36.0 months vs. IIIb: 5.8+/-2.8, 28.6 months vs. IV: 2.9+/-1.9, 4.5 months), resectability(reseetion: 5.9+/-2.7, 21.0 months vs. no resection: 3.0+/-2.0, 4.0 months), curability(curative operation: 6.5+/-2.4, 29.0 months vs. palliative operation: 3.3+/-2.4, 6.0 months), type of gastrectomy(subtotal gastrectomy: 6.4+/-2.7, 28.0 months vs. totai gastrectomy: 4.5+/-2.6, 9.0 months), but not with age or sex. There was a difference in operative mortality according to age group(65~70 years: 7.8% vs. >70 years: 18.8%), resectability(resection: 7.4% vs. no resection: 23.0%) and curability (curative operation: 2.3% vs. palliative operation: 25.0%).
CONCLUSION
The results suggest that surgical resection offers the only chance for improved survival and qulaity of life. Gastric resection, even with total gastrectomy, can be undertaken to reduce tumor burden, decrease threats of obstruction, hemarrhage, or perforation and improve quality of life in the elderly if there is little coexisting impairment.

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Results of Hyperthermic Treatment Combiced with Radiotherapy/Chemotherapy in Locally Advanced Inoperable Gastric Cancer: Chang Woo Moon, Ha Yong Yeom, Tae Sik Jung, Young Ho Kim, Ja Young Koo; J Korean Cancer Assoc. 1998;30(4):639-651.

Abstract PDF: PURPOSE
This retrospective study is conducted to evaluate the local response rate, survival rate, median survival times and complication of hyperthermic treatment combined with radiotherapy/chemotherapy in locally advanced inoperable gastric cancer.
MATERIALS AND METHODS
One hundred and twenty-seven patients treated with hyperthermia from April, 1992 to December, 1994 were enrolled. Among 127 patients, 13(10.2%) were treated with thermo-radiotherapy(Group I), 4(3.1%) were treated with thermo-radio-chemotherapy(Group II) and 110(86.6%) were treated with thermo-chemotherapy (Group III). Hyperfractionated radiotherapy(135 cGy/fr., 2 times/day) using 6-MV X-ray Linac was delivered with total doses of 40.5~67.5 Gy(median: 45 Gy). Chemotherapy by FI(5-FU+ Interferon) or EAP(Etoposide+ Adriamycin+ Cisplatin) regimens was administered. Hyperthermia using 8-MHz RF(radiofrequency) capacitive heating eqiupment (CANCERMIA GHT-8) was applied with interval of 2 times/week, 40~60 minutes /session within 10~15 minutes following radiation, and was simultaneously done with chemotherapy. The estimation of local response was used computed tomography and endoscopy, and was divided into complete response(CR), partial response(PR), and no response(NR). The survival rate was calculated by Kaplan-Meier method.
RESULTS
Overall local response rate(CR+ PR) was 68.5% with 6.3% in CR and 62.2% in PR. The local response rates by treatment modality were 92.3% (CR: 15.4%, PR: 76.9%) in Group I, 100%(CR: 75.0%, PR: 25.0%) in Group II and 64.5%(CR: 2.7%, PR: 61.8%) in Group III. There was statistically significant difference(p=0.0001). The overall 1 and 2 years survival rates with median survival time(MST) were 20.5%, 7.1% with 9 months, respectively. The overall 1 and 2 years survival rates(with MST) by treatment modality were 7.7%, 0%(7 months) in Group I, 50.0%, 0%(9 months) in Group II and 20.9%, 8.2%(6 months) in Group III. There was no statistically significant difference. The incidence of side effect by heating was 3.1%(4 patients) and the most serious side effect was subcutaneous fat necrosis in anterior abdominal wall.
CONCLUSION
From this study we concluded that hyperthermic treatment combined with radiotherapy/chemotherapy may increase the local response rate in locally advanced inoperable gastric cancer.

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A Phase 2 Study on Combined 5 - Fluorouracil , Etoposide , Doxorubicin and Cisplatin ( F - EAP ) in Patients with Advanced Gastric Cancer: J Korean Cancer Assoc. 1994;26(1):9-16.

Abstract PDF: 5-Fluorouracil(5-FU), as a single agent, has a modest but reproducible activity against gastric cancer and continuous infusion of 5-FU is associated with less myelosuppresion. It has been reported that combination of etoposide, doxorubicin, and cisplatin(EAP) was very active in advanced gastric carcinoma with an overall response rate of 64% including 21% complete response from the German investigators. A phase II study of the combination of 5-FU infusion, etoposide, doxorubicin and cisplatin(F-EAP), which regimen has been demonstrated to have the different mechanisms of action and synergism between each of drugs in vitro and in vivo, was performed in attempts to evaluate the antitumor activity in patients with advanced gastric cancer. Fifty-five previously untreated patients with surgically unreasectable or metastatic advanced gastric adenocarcinoma were treated with 5-FU(800 mg/m, days 2, 3, and 4), etoposide(70 mg/m, days 2, 3, and 4), doxorubicin(30 mg/m, day 1), and cisplatin(60 mg/m(2), day 1) repeated every 26 days. Objective responses were observed in 14 of 47(30%) evaluable patients, and the median duration of response was 21 weeks(l3~60+ ). The median survival time of 47 evaluable patients was 40 weeks(16~62). F-EAP therapy was associated with mild myelosuppression. The common non-hematologic toxieities were nausea/vomiting(94%), mucositis(32%), peripheral neuropathy (15%), and infection(11%), but the majority of these toxicities were mild to moderate and well tolerated. These results suggest that F-EAP regimen has a modest antitumor activity in terms of response rate and duration of response, and is relatively well tolerated in advanced gastric cancer.

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A Retrospective Comparison of Infusional 5-Fluorouracil , Doxorubicin , Mitomycin - C ( Modified FAM ) Combination Chemotherapy Versus Palliative Therapy in: Joon Oh Park, Jae Kyung Roh, Hyun Cheol Chung, Hyun Jin Noh, Jae Yong Cho, Sun Young Rha, Chong In Lee, Cheol Woo Kim, Joo Hang Kim, Choong Bai Kim, Sung Hoon Noh, Kyong Sik Lee, Jin Sik Min, Byung S; J Korean Cancer Assoc. 1995;27(2):165-175.

Abstract PDF: In Korea, gastric cancer is the most common cancer and the leading cause of cancer death. About one-third of the patients with gastric cancer is unresectable at the time of diagnosis. Their median survival is less than 6 months with very poor prognosis. Accordingly, various regimens of chemotherapy have been proposed as intensive treatment for unresectable patients. After MacDonald et aL reported 42% response rate and 9 months response duration using combination of 5-Fluorouracil, Doxorubicin and Mitomycin-CFAM), it became the most widely used regimen in the treatment of advanced gastric cancer. However, despite of high initial response rate, there was no survival benefit in randomised comparative trials. To increase the drug effect, we modified the standard FAM regimen by continuously infusing the 5- Fluorouracil instead of bolus injection(modified FAM). We retrospectively reviewed the clinical recoreds of 409 patients with histologically proven advanced gastric cancer in Yonsei University Medical Center and Yonsei Cencer Center between Jan. 1, 1991 and Dec. 31, 1993. The purpose of this study is to assess the efficacy of infusional FAM combination chemotherapy compared with other palliative therapy in advanced gastric cancer. Among 409 patients, 266 were male and 143 were female with a median age of 57-year(range: 15~75). There were 202 patients in mFAM-treated group and 207 patients in control group. In mFAM-treated group, 140 patients had no surgery, 30 patients underwent a palliative bypass and 32 patients underwent a palliative resection. In control group, 151 patients had no surgery, 33 patients underwent a palliative bypass and 23 patients underwent a palliative resection. In preoperative staging, 257 patients had locally advanced disease, 48 had carcinomatosis and 104 had distant metastasis. There was no difference of distribution in age, sex, perfomance status, preoperative stege and treatment modalities between mFAM-treated and control group. 1) Among 154 of evaluable patients, no CRs were observed. PR were seen in 17.5% of patients in mFAM-treated group. The median response duration was 30 weeks and progression free survival was 23 weeks. 2) Higher 1-year survival rate was demonstrated in mFAM-treated group comparing to control group(34.1% vs 22.5)(p=0.0135). 3) Median survival was longer in mFAM-treated group than that of control group(40 week vs 28 week). 4) The toxicities were relatively tolerable and reversible. This results proposed that the infusional FAM combination chemotherapy showed a probalbility of survival pralongation, especially combined with palliative surgery in advanced gastric cancer. Further prospective randomized study will be warranted.

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5-Fluorouracil and Cisplatin ( FP ) Combination Chemotherapy in Advanced Gastric Cancer: Keum Jung Kim, Jeong Hee Kim, Si Young Kim, Hwi Joong Yoon, Kyung Sam Cho; J Korean Cancer Assoc. 1995;27(3):383-389.

Abstract PDF: Thirty-one patients with advanced gastric cancer were entered into the trial between May 1988 to June l993. The patients recieved 5-fluorouracil 1,000 mg/m by l2-hour continuous infusions for 5 consecutive days, cisplatin 100 mg/m IV on day 1 and repeated every three weeks. The results were as following: 1) Among the 31 treated patients, 27 patients had measurable disease and were evaluable for response. The overall response rate was 18.5%. The median duration of response was 6 months. 2) The estimated median survival time was 7.5 months for all 31 patients. The median survival was 8.6 months in responder, and 6.4 months in non-responder. There was no significar.t difference between the two group. 3) Nausea and vomiting of WHO grades 2 and 3 were observed in 48.7%. Alopecia was observed in all patients, but most of patients were WHO grade l or 2. WHO grades 1 and 2 neurotoxicities and diarrhea occurred in 22.6%, 7.8% of patients. WHO grades 2 and 3 neutrope- nia were observed in 2.6% of patients and WHO grade 1 thrombocytopenia was observed in 9.6 of patients, but there were no toxic deaths and no bleeding complications from thrombocytopenia. In conclusion, although this PP regimen showed similar toxicity profiles than the other regimen, response rate and survival benefit were not observed.

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