Because of the low chemosensitivity of
gastric cancer to conventionally available agents, several approaches were investigated to design "order made" treatments using chemosensitivity tests, including the histoculture
drug response assay (HDRA) which was useful in evaluating the appropriate
cancer chemotherapy for the patients with Stage III/IV
gastric cancer. A recent investigation using a molecular
biological method was introduced to predict the sensitivity of
gastric cancer specimens to
5-fluorouracil (5-FU) by
dihydropyrimidine dehydrogenase (DPD) activity and its
mRNA. The low activity of DPD and DPD
mRNA resulted in the low sensitivity to
5-FU, although
thymidylate synthetase activity was not related to the sensitivity to
5-FU. This method is promising, since a small amount of material obtained through gastrofiberscopy will be adequate to assess DPD
mRNA to predict the sensitivity to
5-FU. On the other hand, some randomized control trials with a huge cohort have indicated the usefulness of a "
docetaxel +
cisplatin + 5-FU" regimen for advanced and recurrent
gastric cancer, and "5-FU + LV + radiation" as an adjuvant
therapy for advanced
gastric cancer. Furthermore, the efficacy of
adjuvant chemotherapy after curative resection for
gastric cancer was warranted by a meta-analysis of 19 published randomized trials. The "order made" and "standard"
therapies will be complementary in the further development of
chemotherapy against
gastric cancer.