What is the Treatment of Metastatic Disease

Many patients with gastric cancer (20% - 30%) stage IV disease is supposed to be localized to appeal to the patients before and even after a complete staging, determined that an additional% 28-37 metastatic. Five-year survival for patients with Stage IV is close to zero. Thus, newly diagnosed, many patients have lost the chance of cure (39). Chemotherapy in advanced gastric cancer compared with the best support care, improving the quality of life and prolong survival (42). Maintenance-free survival in metastatic disease, often the best support for 3-6 months, 9-11 months with chemotherapy can be extended. For this reason, the idea of implementation of the standard chemotherapy.

Stomach cancer, many chemotherapeutic agents used. 5-FU'dur cornerstone of chemotherapy in gastric cancer. Single-agent response rates of about% 20 -% in the 30s. Major side effects, mucositis, diarrhea, hand foot syndrome, myelosuppression, and is used as a continuous infusion. Other active single agents for the treatment of gastric cancer mitomycin C, anthracyclines (doxorubicin, epirubicin), cisplatin and etoposittir. Response rates vary between 6-30% of these agents.

Palliative chemotherapies, today both progression-free survival and overall survival in patients with gastric cancer was significantly prolonged in duration. FAM than in previous years, using diagrams, such as FAMTX, in recent years, cisplatin, epirubicin, 5-FU'dan of the ECF scheme or docetaxel, cisplatin, 5-FU'dan diagram of the DCF is used (43). ECF is one of the most active and best tolerated regimens, although that increase the activity of docetaxel is markedly more toxic than 5FU/cisplatin

In 1997, Webb et al. ECF (n = 126) with the FAMTX (n = 130) were randomized to regimens (55). FAMTX better survival rates compared with the ECF (21% and 45% respectively, p = 0.0002), higher median survival (5.7 months, 8.9 months, respectively, p = 0.0009) and mean duration of disease-free survival (3.4 months, 7.4 months, respectively, , p = 0.00006) was obtained. DCF with CF (cisplatin, 5FU) v325 phase III study comparing treatment, time to progesyona (5.6 months - 3.7 months, p <0.001, 32% risk reduction), the best response rate (37% - 25% p = 0.01) and median survival (9.2 months - 8.6 months p = 0.02) were better in favor of the DCF (41.56). However, the addition of docetaxel CF'ye especially hematologic: grade 3 / 4 neutropenia and febrile neutropenic led to an increase in toxicity. Clinical benefit in patients with metastatic gastric cancer study with V325 (57) and a better quality of life (QoL) were obtained

REAL-2 study instead of the 5-FU and cisplatin capecitabine'in oxaliplatinin substituting instead demonstrated the effectiveness does not decline (59). Phase I-II trials, irinotecan is used alone or in combination cisplatinle. Acceptable toxicity, response rates were respectively 23% and 41% have been reported. S-1, tegafur (5-FU pro-drug), potassium (gastrointestinal toxicity blocker) and 5-chloro-2.4 (5-FU degradation inhibitor) is a derivative of a new oral floroprimidin. Phase II study, 53.6% 'health, a retrospective study showed a response rate of 32%. Cetuximab, panitumumab, bevacizumab and in combination with chemotherapy in clinical trials, although the use of experimental investigation

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