Oxali/5FU/LV for gastric cancer – pro
Lay Summary: Oxaluplatin combinations are sta
Oxaliplatin based therapy is one of the options listed by NCCN for metastatic gastric cancer. The particular regimens that is being used has been extensively studies in Phase I (2) and III(2)I; there are also studies of capecitabine and oxaliplatin.
A variety of different regimens have been studied in phase II trials (FOLFOX, EOF, XELOX [CAPOX], S1 plus oxaliplatin), all of which are associated with response rates in the range of 40 to 67 percent, with median survival durations between 8 and 15 months.
Uptodate 2015 says: ” For patients who retain an adequate performance status, there is no standard approach for second-line therapy after failure of the first-line regimen.
For other patients (not Cyramza candidates), utilization of other active cytotoxic chemotherapy agents not used in the first-line regimen is reasonable, either in combination or as serial single agents.”
NCCN recommends palliative chemohthrapy on p. GAST-7. Although it only lists Folfox in first line, using the Uptodate recommendation, I consider it to be an appropriate palliative regimen when not having been used in first line.
1.AUAl-Batran SE, Hartmann JT, Probst S, Schmalenberg H, Hollerbach S, Hofheinz R, Rethwisch V, Seipelt G, Homann N, Wilhelm G, Schuch G, Stoehlmacher J, Derigs HG, Hegewisch-Becker S, Grossmann J, Pauligk C, Atmaca A, Bokemeyer C, Knuth A, Jäger E, Arbeitsgemeinschaft Internistische OnkologiePhase III trial in metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: a study of the Arbeitsgemeinschaft Internistische Onkologie. SOJ Clin Oncol. 2008;26(9):1435.
2.Enzinger PC, Burtness B, Hollis D, et al. CALGB 80403/ECOG 1206: A randomized phase II stidu of three standard chemotherapy regimens (SCF, IC, FOLFOX) plus cetuximab in metastatic esophageal and GE junction cancer (Abstract 4006). J Clin Oncol 2010; 28:302s.
3.Uptodate, http://www.uptodate.com/contents/systemic-therapy-for-locally-advanced-unresectable-and-metastatic-esophageal-and-gastric-cancer, 2015
4.Provincial Gastric and Gastro-Esophageal Junction
Cancer Treatment Guidelines
As per consensus at the Provincial Upper Gastrointestinal Tract Cancers
Guideline Meeting, June 12-13, 2014