A regimen of epirubicin, cisplatin, and infused fluorouracil improves survival in incurable locally advanced or metastatic gastric adenocarcinoma.
Professor David Cunningham and colleagues from England assessed whether the addition of this perioperative regimen to surgery improves outcomes in potentially curable gastric cancer.
The doctors randomly assigned 250 patients with resectable adenocarcinoma of the stomach, esophagogastric junction, or lower esophagus to either perioperative chemotherapy and surgery.
The team of doctors randomized a further 253 patients to surgery alone.
Chemotherapy consisted of three preoperative and 3 postoperative cycles of intravenous epirubicin, and cisplatin on day 1.
|Resected tumors were less advanced with perioperative-chemotherapy
|New England Journal of Medicine|
A continuous intravenous infusion of fluorouracil for 21 days was also administered.
The team's primary end point was overall survival.
Epirubicin, cisplatin, and infused fluorouracil-related adverse effects were similar to those previously reported among patients with advanced gastric cancer.
The doctors found that rates of postoperative complications were similar in the perioperative-chemotherapy group and the surgery group.
The team also noted that the numbers of deaths within 30 days after surgery were similar in the 2 groups.
The resected tumors were significantly smaller and less advanced in the perioperative-chemotherapy group.
With a median follow-up of 4 years, 149 patients in the perioperative-chemotherapy group and 170 in the surgery group had died.
The doctors observed that the perioperative-chemotherapy group had a higher likelihood of overall survival and of progression-free survival.
Professor Cunningham's team concluded, “In patients with operable gastric or lower esophageal adenocarcinomas, a perioperative regimen of epirubicin, cisplatin, and infused fluorouracil decreased tumor size and stage, and significantly improved progression-free and overall survival.”