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著者: Hiroki Hara, Shigenori Kadowaki, Masako Asayama, Akira Ooki, Toko Yamada, Takako Yoshii, Kensei Yamaguchi
雑誌名: Int J Clin Oncol. 2018 Apr;23(2):275-280. doi: 10.1007/s10147-017-1198-7. Epub 2017 Oct 16.
Abstract/Text
BACKGROUND: There are few chemotherapeutic options for advanced gastric cancer with severe disseminated peritoneal metastases, which are usually accompanied by ascites. Bolus 5-fluorouracil (5-FU) plus leucovorin therapy has been widely used against gastrointestinal malignancies, with resulting mild toxicities.
METHODS: We retrospectively analyzed the efficacy and safety of first-line chemotherapy with bolus 5-FU plus l-leucovorin in 30 advanced gastric cancer patients who had massive ascites and/or inadequate oral intake. This therapy consisted of 5-FU (600 mg/m2 IV bolus) plus l-leucovorin (250 mg/m2 2-h IV infusion) administered on a 6 weeks on/2 weeks off schedule.
RESULTS: Among all the patients, 26 (87%) were unable to eat and 12 (40%) had massive ascites. Major grade 3 or 4 adverse events were neutropenia (17%), nausea (7%), fatigue (7%), and diarrhea (3%); no treatment-related deaths were observed. The median progression-free survival and overall survival (OS) were 2.4 months [95% confidence interval (CI), 0.6-4.1] and 6.0 months (95% CI, 2.1-9.9), respectively. Objective improvement in oral intake was seen in 7 patients (27%). Improvement in ascites occurred in 9 (39%) of 23 patients. In multivariate analyses, the presence of both massive ascites and inadequate oral intake was significantly associated with worse OS (hazard ratio, 5.25; 95% CI, 1.61-17.1). The median OS for patients (n = 22) without this factor was 7.2 months (95% CI, 4.2-10.3).
CONCLUSION: Our study suggests that bolus 5-FU plus l-leucovorin therapy is feasible and has clinical activity as palliative therapy in patients with severe peritoneal metastases from gastric cancer.
PMID 29039072 Int J Clin Oncol. 2018 Apr;23(2):275-280. doi: 10.1007/s10147-017-1198-7. Epub 2017 Oct 16.
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