The
chemotherapy of gastric
carcinoma is at an important point in its evolution. Multiple studies with a variety of agents have demonstrated that
combination chemotherapy appears to be superior to single-agent
chemotherapy in regard to response rate but not survival rate. The typical single agent results in response rates of 20% or less, whereas the typical
combination chemotherapy regimen results in response rates of 30% to 50%. The FAM (
5-fluorouracil [5-FU],
doxorubicin,
mitomycin C)
chemotherapy regimen, widely used during the last 10 years, produces partial responses (PRs) in 35% of patients. However, the overall complete response (CR) rate is only 2%. Long-term survival of patients with disseminated
malignancy is only achieved when treatments produce CR of disease. Because available
combination chemotherapy approaches to
gastric cancer only produce PRs, it is not surprising that there has been no impact on patient survival from these approaches. There are several newer approaches that hold promise in the treatment of
gastric cancer. For example, the role of
cisplatin in
gastric cancer has not been completely defined. A recent study of FAP (5-FU,
doxorubicin,
cisplatin) has reported a 50% response rate with a significant number of CRs. The
FAP regimen needs further exploration. The
drug triazinate appears to have activity in
gastric cancer, and in combination with
mitomycin C produces a 28% response rate in patients who had failed
chemotherapy regimens containing fluorinated
pyrimidine. Thus, the efficacy of this
drug needs further exploration in
stomach cancer therapy. There is no clear definition of the future role of hepatic arterial infusion in
gastric cancer. There is no question that, in
colon cancer, response rates with fluorinated
pyrimidine alone or fluorinated
pyrimidine with
mitomycin C are in the range of 50% when hepatic arterial infusion is used. This approach needs to be explored in
gastric cancer. Finally, the use of intraperitoneal (IP)
therapy in patients with minimal disease should be explored, because a common form of relapse in
carcinoma of the stomach is IP dissemination.