The treatment of advanced gastric cancer

"Second generation" combination chemotherapy regimens were developed in the 1980s with high activity in locally advanced and metastatic disease. Among them were etoposide plus doxorubicin plus cisplatin (EAP), etoposide plus 5-fluorouracil plus leucovorin (ELF), continuous infusion of 5-fluorouracil plus cisplatin (FP) and high-dose methotrexate plus S-fluorouracil plus doxorubicin (FAMTX). In locally advanced disease a resectability rate of +/- 50% was reported with these protocols. FAMTX was felt to be superior to 5-fluorouracil, doxorubicin and mitomycin (FAM), which regimen had been considered "standard" treatment for many years. Randomized studies, however, did not reveal significant differences among various second generation regimens. Future studies should focus on innovative protocols in advanced disease, the role of neoadjuvant chemotherapy in clinically staged locally advanced disease, the role of local "consolidation treatment," ie, radiotherapy or intraperitoneal chemotherapy after primary chemotherapy plus resection, and preoperative and postoperative chemotherapy in operable disease.