Abstract and Introduction
Abstract
For many years, a regimen of fluorouracil and cisplatin has been the standard of care for the treatment of patients with metastatic gastric cancer. More recently, triplet regimens that incorporate fluorouracil and cisplatin with epirubicin (ECF) or docetaxel are being used in the management of patients with metastatic disease; ECF is also being used as preoperative treatment of resectable disease. Capecitabine, a prodrug of fluorouracil that can be taken orally, has been assessed as an alternative to intravenous fluorouracil and has demonstrated noninferiority to its parent compound. Several trials have demonstrated the safety and efficacy of regimens combining capecitabine with other known active drugs against gastric cancer in doublet and triplet combinations. Oral capecitabine appears to be more convenient to administer than infused fluorouracil because it may obviate the need for central venous access and its associated risk of complications. All of these findings support consideration of capecitabine among the available drug treatment options for patients with metastatic and those with operable gastric cancers.
Introduction
Gastric cancer is a significant global health problem. Recent data indicate that 1.4 million new cases of gastroesophageal and gastric cancer are diagnosed annually, and 1.1 million deaths are attributed to this disease. In 2005 in the United States, 21,860 new cases were estimated to have occurred in both sexes (representing 1.6% of all new cancer diagnoses) and 11,550 patients were estimated to have died of this disease. In the same year, about 13,000 new cases and about 8000 deaths were estimated to have occurred in Italy.
In patients with metastatic gastric cancer, chemotherapy may provide a substantial palliation and can improve survival and quality of life, compared with best supportive care. Fluorouracil, alone or administered with leucovorin, still represents the cornerstone of treatment for this disease. Moreover, a recent meta-analysis showed that combination regimens achieve better survival outcomes than fluorouracil monotherapy, and that regimens containing fluorouracil, anthracyclines, and cisplatin are the most effective.
Capecitabine, a prodrug of fluorouracil that can be taken orally, has been assessed as an alternative to intravenous fluorouracil and has demonstrated noninferiority to its parent compound. Several phase II and III trials have demonstrated the safety and efficacy of regimens combining capecitabine with other known active drugs against gastric cancer in doublet and triplet combinations in metastatic and operable gastric cancer.