Skip to main content

Advertisement

SpringerLink
Log in

Role of low dose capecitabine combined to irinotecan in advanced and metastatic gastric cancer

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Chemotherapy has a proven role in advanced and metastatic gastric cancer (AMGC) significantly improving quality of life and prolonging survival compared with best supportive care alone. Multiple regimens have been explored. The choice of treatment should be individualized and tailored to the patient’s overall conditions and preference. This manuscript is divided into two sections. The first section illustrates the results of a phase II trial combining weekly irinotecan and low dose capecitabine in the management of untreated AMGC patients. The second section aims to identify the current optimal place of this combination in the management of AMGC in the light of the latest advances. In this manuscript we detail our phase II trial which showed objective response rate of 47% (15 patients), disease stabilization of 28% (9 patients), and overall tumor control rate of 75% (24 patients). Median time to progression and overall survival were 5.8 and 8 months, respectively. Grades III–IV toxicities were reported in 7 cases. Low-dose capecitabine plus irinotecan is effective in the treatment of AMGC with an acceptable toxicity profile. Compared to the recent published data, this combination is indicated in the second-line treatment of AMGC and in the first-line treatment where a contraindication for docetaxel- and/or oxaliplatin-based regimen is present.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Tsai JY, Safran H. Status of treatment for advanced gastric carcinoma. Curr Oncol Rep. 2003;5:210–8.

    Article  PubMed  Google Scholar 

  2. Wöhrer S, Raderer M, Hejna M. Palliative chemotherapy for advanced gastric cancer. Ann Oncol. 2004;15:1585–95.

    Article  PubMed  Google Scholar 

  3. Cervantes A, Roselló S, Roda D, Rodríguez-Braun E. The treatment of advanced gastric cancer: current strategies and future perspectives. Ann Oncol. 2008;19(Suppl 5):v103–7.

    Article  PubMed  Google Scholar 

  4. Wagner AD, et al. Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol. 2006;24:2903–9.

    Article  PubMed  CAS  Google Scholar 

  5. Kyoto Research Group for Chemotherapy of Gastric Cancer. A randomized, comparative study of combination chemotherapies in advanced gastric cancer: 5-fluorouracil and cisplatin (FP) versus 5-fluorouracil, cisplatin 4-epirubicin (FPEPIR). Anticancer Res. 1992;12:1983–8.

    Google Scholar 

  6. Waters JS, et al. Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: results of a randomized trial. Br J Cancer. 1999;80:269–72.

    Article  PubMed  CAS  Google Scholar 

  7. Ross P, et al. Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) with epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer. J Clin Oncol. 2002;20:1996–2004.

    Article  PubMed  CAS  Google Scholar 

  8. Roth A, et al. High doses of 5-fluorouracil and epirubicin with or without cisplatin in advanced gastric cancer: a randomized study. Tumori. 1999;85:234–8.

    PubMed  CAS  Google Scholar 

  9. Bamias A, et al. Epirubicin, cisplatin, and protracted venous infusion of 5-fluorouracil for esophagogastric adenocarcinoma: response, toxicity, quality of life, and survival. Cancer. 1996;77:1978–85.

    Article  PubMed  CAS  Google Scholar 

  10. Webb A, et al. Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin methotrexate in advanced esophagogastric cancer. J Clin Oncol. 1997;15:261–7.

    PubMed  CAS  Google Scholar 

  11. Cunningham D, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 2008;358:36–46.

    Article  PubMed  CAS  Google Scholar 

  12. Van Cutsen E, et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol. 2006;24:4991–7.

    Article  CAS  Google Scholar 

  13. Bouché O, et al. Randomized multicenter phase II trial of a biweekly regimen of fluorouracil and leucovorin (LV5FU2), LV5FU2 plus cisplatin, or LV5FU2 plus irinotecan in patients with previously untreated metastatic gastric cancer: a Federation Francophone de Cancerologie Digestive Group Study–FFCD 9803. J Clin Oncol. 2004;22:4319–28.

    Article  PubMed  CAS  Google Scholar 

  14. Moehler M, et al. Randomized phase II evaluation of irinotecan plus high-dose 5-fluorouracil and leucovorin (ILF) versus 5-fluorouracil, leucovorin, and etoposide (ELF) in untreated metastatic gastric cancer. Br J Cancer. 2005;92:2122–8.

    Article  PubMed  CAS  Google Scholar 

  15. Dank M, et al. Randomized phase III trial of irinotecan (CPT11) 5-FU/folinic acid (FA) vs CDDP-5-FU in first line advanced gastric cancer patients. J Clin Oncol. 2005;23:308. (Abstr 4003).

    Google Scholar 

  16. Farhat F. A general review of the role of irinotecan (CPT11) in the treatment of gastric cancer. Med Oncol. 2007;24:137–46.

    Article  PubMed  CAS  Google Scholar 

  17. Boku N, et al. Phase II study of a combination of irinotecan and cisplatin against metastatic gastric cancer. J Clin Oncol. 1999;17:319–23.

    PubMed  CAS  Google Scholar 

  18. Shimada S, Yagi Y, Kuramoto M, Aoki N, Ogawa M. Second-line chemotherapy with combined irinotecan and low-dose cisplatin for patients with metastatic gastric carcinoma resistant to 5-fluorouracil. Oncol Rep. 2003;10:687–91.

    PubMed  CAS  Google Scholar 

  19. Kohne CH, et al. Irinotecan is active in chemonaive patients with metastatic gastric cancer: a phase II multicentric trial. Br J Cancer. 2003;89:997–1001.

    Article  PubMed  CAS  Google Scholar 

  20. Cunningham D, et al. Randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric (OG) cancer: the REAL 2 trial. J Clin Oncol. 2006;24(18S):LBA4017 (2006 ASCO Annual Meeting Proceedings).

    Google Scholar 

  21. Moehler M, et al. Weekly treatment with irinotecan, folinic acid and infusional 5-fluorouracil (ILF) in patients with advanced gastric cancer. Anticancer Drugs. 2003;14:645–50.

    Article  PubMed  CAS  Google Scholar 

  22. Bamias A, Papamichael D, Syrigos K, Pavlidis N. Phase II study of irinotecan and mitomycin C in 5-fluorouracil-pretreated patients with advanced colorectal and gastric cancer. J Chemother. 2003;15:275–81.

    PubMed  CAS  Google Scholar 

  23. Yoshioka T, et al. Biweekly administration regimen of docetaxel combined with CPT-11 in patients with inoperable or recurrent gastric cancer. Gastric Cancer. 2003;6:153–8.

    Article  PubMed  CAS  Google Scholar 

  24. Pozzo C, et al. Irinotecan in combination with 5-fluorouracil and folinic acid or with cisplatin in patients with advanced gastric or esophageal-gastric junction adenocarcinoma: results of a randomized phase II study. Ann Oncol. 2004;15:1773–81.

    Article  PubMed  CAS  Google Scholar 

  25. Koizumi W, et al. A pilot phase II study of capecitabine in advanced and recurrent gastric carcinoma. Oncology. 2003;64:232–6.

    Article  PubMed  CAS  Google Scholar 

  26. Ajani J. Review of capecitabine as oral treatment of gastric, gastroesophageal, and esophageal cancers. Cancer. 2006;107:221–31.

    Article  PubMed  CAS  Google Scholar 

  27. Baek JH, et al. Phase II study of capecitabine and irinotecan combination chemotherapy in patients with advanced gastric cancer. Br J Cancer. 2006;94:1407–11.

    Article  PubMed  CAS  Google Scholar 

  28. Burge ME, et al. A phase I and II study of 2-weekly irinotecan with capecitabine in advanced gastroesophageal adenocarcinoma. Br J Cancer. 2006;94:1281–6.

    Article  PubMed  CAS  Google Scholar 

  29. Oh SC, et al. A phase II study of biweekly dose-intensified oral capecitabine plus irinotecan (bXELIRI) for patients with advanced or metastatic gastric cancer. Br J Cancer. 2007;96:1514–9.

    Article  PubMed  CAS  Google Scholar 

  30. Rougier P, et al. Neoadjuvant chemotherapy in locally advanced gastric carcinoma—a phase II trial with combined continuous intravenous 5-fluorouracil and bolus cisplatinum. Eur J Cancer. 1994;30A(9):1269–75.

    Article  PubMed  CAS  Google Scholar 

  31. Wils JA, et al. Sequential high-dose methotrexate and fluorouracil combined with doxorubicin—a step ahead in the treatment of advanced gastric cancer: a trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. J Clin Oncol. 1991;9:827–31.

    PubMed  CAS  Google Scholar 

  32. Kelsen D, et al. FAMTX versus etoposide, doxorubicin, and cisplatin: a random assignment trial in gastric cancer. J Clin Oncol. 1992;10:541–8.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mount Lebanon Hospital, Beirut, Lebanon

    Fadi S. Farhat

  2. Hotel Dieu de France University Hospital, Beirut, Lebanon

    Fadi S. Farhat, Joseph Kattan, Georges Y. Chahine, Fadi L. Nasr & Marwan G. Ghosn

  3. Hammoud Hospital University Medical Center, Ghassan Hammoud Street, 652, Saida, Lebanon

    Fadi S. Farhat & Raghda M. Mroue

  4. Cancer Research Group-Collaborative Group, Beirut, Lebanon

    Joseph Kattan, Georges Y. Chahine, Fariha C. Younes, Fadi L. Nasr & Marwan G. Ghosn

Authors
  1. Fadi S. Farhat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph Kattan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Georges Y. Chahine
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fariha C. Younes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fadi L. Nasr
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raghda M. Mroue
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marwan G. Ghosn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fadi S. Farhat.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Farhat, F.S., Kattan, J., Chahine, G.Y. et al. Role of low dose capecitabine combined to irinotecan in advanced and metastatic gastric cancer. Med Oncol 27, 722–727 (2010). https://doi.org/10.1007/s12032-009-9275-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12032-009-9275-z

Keywords

Search

Navigation