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01 April 2008

Weekly infusional high-dose 5-fluorouracil and leucovorin and biweekly cisplatin: A convenient treatment option in advanced gastric cancer

Yulia Kundel, Ofer Purim, Arie Figer, Salomon M. Stemmer, Thomas Tichler, Jaqueline Sulkes, Aaron Sulkes, Baruch Brenner

Med Sci Monit 2008; 14(4): CR190-195 :: ID: 850286


Background: To summarize our experience using a regimen of weekly 5-FU and leucovorin (LV) and biweekly cisplatin (CDDP) in advanced gastric cancer (AGC).
Material/Methods: Patients had previously untreated histologically confirmed AGC. Treatment consisted of intravenous weekly infusional 5-FU and LV and biweekly CDDP, given for 6 weeks followed by a 2-week rest. Initially, a lower dose level was used (5-FU 2000 mg/m2, LV 500 mg/m[sup]2[/sup], CDDP 40 mg/m[sup]2[/sup]), which was later increased (5-FU 2600 mg/m[sup]2[/sup], LV 500 mg/m[sup]2[/sup], CDDP 50 mg/m[sup]2[/sup]).
Results: Forty-five patients were treated, 18 at the lower dose level and 27 at the higher dose level. The median age was 67 years and 55% were male. Grade ≥3 toxicity was documented in 37% of patients but toxicity related hospitalizations or treatment discontinuation occurred in only 22% and 13%, respectively. There were no toxic deaths. The most common hematological toxicities were anemia and neutropenia and the most common non-hematological toxicities were nausea, vomiting and fatigue. Of the 39 patients evaluable for response, 13 (33%) had partial response (PR) and 11 (28%) had stable disease (SD). Control of disease (PR+SD) was achieved in 61%. The higher dose level was associated with a higher response rate (p=0.07) and an increased toxicity (p=0.01), mostly hematological and gastrointestinal. Median progression-free survival and overall survival were 3.5 and 9.2 months, respectively.
Conclusions:This regimen appears safe, with a manageable toxicity profile. Efficacy data resemble those reported for more complex and toxic regimens. The higher dose level had enhanced activity, at the expense of increased toxicity.

Keywords: Fluorouracil - therapeutic use, Time Factors, Survival Rate, Neoplasm Staging, Leucovorin - therapeutic use, Infusions, Intravenous, Drug-Related Side Effects and Adverse Reactions, Dose-Response Relationship, Drug, Disease Progression, Cisplatin - therapeutic use, Antineoplastic Combined Chemotherapy Protocols - therapeutic use, Aged, 80 and over

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750