Patients with advanced-stage
gastric cancer and inoperable locoregional extension rarely survive more than a few months.
Chemotherapy based on intravenous
fluorouracil or oral
capecitabine slightly prolongs overall survival. An oral fixed-dose combination of
tegafur + gimeracil + oteracil (
Teysuno degrees, Nordic) has been approved in the European Union for the treatment of advanced
gastric cancer. Like
capecitabine,
tegafur is a metabolic precursor of
fluorouracil. It is combined with
gimeracil in order to increase its bioavailability and with
oteracil to try to reduce its gastrointestinal toxicity. In two randomised, controlled but unblinded trials including 91 and 129 patients with advanced
gastric cancer, there was no significant difference in median overall survival times between patients who received the
tegafur + gimeracil + oteracil combination and those who received oral
capecitabine alone (about 9 and 13 months, respectively). However, the study populations were too small to rule out a noteworthy difference in survival between the 2 treatments. Another randomised, unblinded trial compared
tegafur + gimeracil + oteracil versus flurorouracil monotherapy in 1029 patients with
gastric cancer, which was often metastastic. However, the dose of concomitantly administered
cisplatin was lower in the
tegafur group, therefore skewing the results. Median overall survival was about 8 months in both groups, and median progression-free survival was about 5 months. Neither outcome differed significantly between the 2 treatments. Compared to
capecitabine, the
tegafur + gimeracil + oteracil combination appears to cause fewer cases of severe palmoplantar dysaesthesia but more serious
gastrointestinal disorders. Like
capecitabine, the
tegafur + gimeracil + oteracil combination is administered orally twice daily. In practice, when oral
therapy is preferred for a patient with advanced
gastric cancer,
capecitabine is still the best option because it carries a lower risk of serious gastrointestinal adverse effects.