Advanced gastric
carcinoma remains an incurable disease with a median survival of 6 to 9 months, and available therapeutic approaches are predominantly palliative. In small controlled trials, systemic
chemotherapy has improved survival and quality of life of patients with advanced gastric
carcinoma when compared with best supportive care. Patients with good performance status (Zubrod < or = 2), low
tumor bulk, and good organ function are most likely to benefit from
chemotherapy or
combined-modality therapy. There is no generally accepted standard
chemotherapy for advanced gastric
carcinoma.
Fluorouracil-and/or
cisplatin-based combinations are often employed. Recently, several new classes of drugs have demonstrated activity against advanced disease. These include the
taxanes (
paclitaxel [
Taxol] and
docetaxel [
Taxotere]), camptothecins (
irinotecan [
Camptosar], and flurouracil
prodrugs (second-and third-generation agents, such as UFT [
uracil and
tegafur] and S-1). Early results with either single-agent
therapy or combinations of new agents (
irinotecan,
paclitaxel, and
docetaxel) and more conventional agents (
cisplatin [
Platinol] and
fluorouracil) are encouraging. Several of these results need to be confirmed and eventually studied in well-designed, phase III trials. Similarly, a number of new combinations may be used in the future as preoperative
therapies for gastric
carcinoma. Nearly all of the new agents have radiosensitizing properties. This affords another opportunity to investigate new chemotherapeutic agents in conjunction with
radiation therapy in patients with locoregional gastric
carcinoma.