Abstract
The principal chemotherapeutic agents which seem to be effective for advanced or recurrent gastric cancer are mitomycin C (MMC), 5-fluorouracil (5-FU), adriamycin (ADM) and cisplatin (CDDP). Used as a single agent, these drugs have shown response rates about 20%. Therefore, various combined therapies including MMC plus 5-FU (MF), 5-FU plus ADM plus MMC (FAM), etoposide plus ADM plus CDDP (EAP), 5-FU plus ADM plus CDDP (FAP), 5-FU plus CDDP (FP), methotrexate (MTX) plus 5-FU (MTX/FU) and 5-FU plus ADM plus MTX (FAMTX) have been investigated. A unique 2-drug combination of MMC and CDDP (MP) has also been developed in our institute. Among them, FP and FAMTX appear promising in several phase II trials. However, the response rates to these therapies did not exceed 50% and the median overall survival times ranged from 6 to 9 months. Moreover, few combination therapy demonstrated survival advantages over 5-FU alone in phase III trials. Although FAMTX is showing encouraging superiority compared with FAM, the previous standard and the “supportive care only” in recent randomized trials, the standard regimen has not yet been established in the treatment of advanced or recurrent gastric cancer. Chemosensitivity testing may be a useful approach to prefer the most active regimen and to improve clinical efficasy of the treatment
