Perspectives in chemotherapy of advanced gastric cancer

A review of recent phase II and III studies in advanced gastric carcinoma is presented. Several combination regimens have been developed with high activity in locally advanced and metastatic disease. Among them are etoposide plus adriamycin plus cisplatin (EAP), etoposide plus 5-fluorouracil plus leucovorin (ELF), continuous infusion 5-fluorouracil plus cisplatin and high dose methotrexate plus 5-fluorouracil plus adriamycin (FAMTX). In locally advanced disease a resectability rate of +/- 50% has been reported with these protocols. So far only FAMTX has demonstrated superiority compared with 5-fluorouracil, adriamycin and mitomycin (FAM), which regimen has been considered 'standard' treatment for many years. Randomized studies in which the other regimens are being more definitely assessed are underway.