Many phase II studies have reported improved response rates with severe toxicity of
etoposide,
doxorubicin (
Adriamycin), and
cisplatin in advanced
gastric cancer. In an attempt to obtain a better regimen with high efficacy and less toxicity, a combination regimen of
etoposide,
doxorubicin, and
carboplatin (EAC) had been developed and evaluated in this phase II study. Forty-six patients with advanced
gastric cancer were enrolled in the study. The treatment consisted of
doxorubicin 20 mg/m2 given intravenously on days 1 and 7,
etoposide 70 mg/m2 intravenously on days 4, 5, and 6, and
carboplatin 200 mg/m2 intravenously on days 2 and 8.
Therapy was repeated every 4 weeks. Patients who had stable disease or who responded, received an additional two to six cycles of
therapy. Among 45 patients evaluable for response and toxicity, there was a 49% objective response rate, including 7% complete remission and 42% partial response. There was 11% stable disease and 27% progressive disease. Among 11 patients with
lymph node metastasis only after a curative
gastrectomy, there was an 82% objective response rates with 27% having complete remission and 55% having partial response. The median follow-up was 16 months. The median survival duration of all 45 patients was 11 months. The median time to progression was 5 months. The main toxicity was myelosuppression, with a high incidence of 82%
leukopenia but only 9% of grades III to IV. Gastrointestinal toxicity was mild, with a low incidence of 42%
nausea and
vomiting and only 2% of grades III to IV. There were no
chemotherapy-related deaths. With mild and tolerable toxicity, the
EAC regimen in our study has active antitumor activity in advanced
gastric cancer, which may have a positive influence on long-term survival time. It has a high efficacy, especially in patients with
lymph node metastasis only after a curative
gastrectomy. This regimen deserves further clinical studies for testing activity and toxicity in advanced
gastric cancer.