Difference between revisions of "Gastric cancer"
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| − | *[[Epirubicin (Ellence)]] 50 mg/ | + | ====Chemotherapy==== |
| − | *[[Cisplatin (Platinol)]] 60 mg/ | + | *[[Epirubicin (Ellence)]] 50 mg/m<sup>2</sup> IV once on day 1 |
| − | *[[Fluorouracil (5-FU)]] 200 mg/ | + | *[[Cisplatin (Platinol)]] 60 mg/m<sup>2</sup> IV once on day 1 |
| + | *[[Fluorouracil (5-FU)]] 200 mg/m<sup>2</sup>/day IV continuous infusion on days 1 to 21 | ||
*Surgery is performed 3 to 6 weeks after the completion of cycle 3 | *Surgery is performed 3 to 6 weeks after the completion of cycle 3 | ||
| − | + | ====Supportive medications==== | |
| + | *[[Warfarin (Coumadin)]] 1 mg PO once per day suggested as thrombosis prophylaxis | ||
| − | + | '''21-day cycle for 3 cycles prior to surgery, then 3 more cycles to begin 6 to 12 weeks after surgery''' | |
| − | |||
===References=== | ===References=== | ||
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| − | *[[Cisplatin (Platinol)]] 100 mg/ | + | ====Chemotherapy==== |
| − | *[[Fluorouracil (5-FU)]] 800 mg/ | + | *[[Cisplatin (Platinol)]] 100 mg/m<sup>2</sup> IV as a 1 hour infusion once on day 28 |
| + | *[[Fluorouracil (5-FU)]] 800 mg/m<sup>2</sup>/day IV continuous infusion on days 1 to 5 | ||
| − | '''28-day cycle | + | '''28-day cycle for 2 to 3 cycles prior to surgery, then 3 to 4 more cycles after surgery, for a total of 6 cycles''' |
===References=== | ===References=== | ||
| Line 106: | Line 108: | ||
''Treatment is to start 20 to 40 days after surgery.'' | ''Treatment is to start 20 to 40 days after surgery.'' | ||
| + | ====Chemotherapy, part 1==== | ||
| + | *[[Fluorouracil (5-FU)]] 425 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5 | ||
| + | *[[Folinic acid (Leucovorin)]] 20 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5 | ||
| − | + | '''28-day cycle for 1 cycle, followed by:''' | |
| − | |||
| − | |||
| − | '''28-day cycle | ||
====Chemoradiation==== | ====Chemoradiation==== | ||
| − | *[[Fluorouracil (5-FU)]] 400mg/ | + | *[[Fluorouracil (5-FU)]] 400mg/m<sup>2</sup> IV bolus once per day on days 1 to 4 and the last 3 days of radiation therapy |
| − | *[[Folinic acid (Leucovorin)]] 20 mg/ | + | *[[Folinic acid (Leucovorin)]] 20 mg/m<sup>2</sup> IV bolus once per day on days 1 to 4 and the last 3 days of radiation therapy |
*Concurrent radiation therapy starting on day 1 with 180 cGy, 5 days per week; 25 fractions given over 5 weeks for a total of 4500 cGy | *Concurrent radiation therapy starting on day 1 with 180 cGy, 5 days per week; 25 fractions given over 5 weeks for a total of 4500 cGy | ||
'''35-day course, followed by:''' | '''35-day course, followed by:''' | ||
| − | *[[Fluorouracil (5-FU)]] 425 mg/ | + | ====Chemotherapy, part 2==== |
| − | *[[Folinic acid (Leucovorin)]] 20 mg/ | + | *[[Fluorouracil (5-FU)]] 425 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5 |
| + | *[[Folinic acid (Leucovorin)]] 20 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5 | ||
| − | '''28-day cycle | + | '''28-day cycle for 2 cycles''' |
===References=== | ===References=== | ||
# Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001 Sep 6;345(10):725-30. [http://www.nejm.org/doi/full/10.1056/NEJMoa010187 link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/11547741 PubMed] | # Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001 Sep 6;345(10):725-30. [http://www.nejm.org/doi/full/10.1056/NEJMoa010187 link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/11547741 PubMed] | ||
=Chemotherapy for metastatic or locally advanced disease (non-radiation/surgery candidate)= | =Chemotherapy for metastatic or locally advanced disease (non-radiation/surgery candidate)= | ||
| − | ==CX | + | ==CX; XP {{#subobject:2bd34d|Regimen=1}}== |
{| class="wikitable" style="float:right; margin-left: 5px;" | {| class="wikitable" style="float:right; margin-left: 5px;" | ||
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| − | *[[Cisplatin (Platinol)]] 80 mg/ | + | ====Chemotherapy==== |
| − | *[[Capecitabine (Xeloda)]] 1000 mg/ | + | *[[Cisplatin (Platinol)]] 80 mg/m<sup>2</sup> IV over 2 hours once on day 1 |
| − | **Lordick et al. 2013 gave [[Capecitabine (Xeloda)]] 1000 mg/ | + | *[[Capecitabine (Xeloda)]] 1000 mg/m<sup>2</sup> PO BID on days 1 to 14 |
| + | **Lordick et al. 2013 gave [[Capecitabine (Xeloda)]] 1000 mg/m<sup>2</sup> PO BID from the evening of day 1 to the morning of day 15 (28 doses per cycle) | ||
| + | |||
| + | ====Supportive medications==== | ||
| + | *(per Kang et al. 2009): | ||
| + | *"Hyperhydration" for [[Cisplatin (Platinol)]] | ||
'''21-day cycles, given until progression of disease or unacceptable toxicity''' | '''21-day cycles, given until progression of disease or unacceptable toxicity''' | ||
| − | |||
| − | |||
| − | |||
===References=== | ===References=== | ||
| Line 195: | Line 200: | ||
|} | |} | ||
''Eligibility criteria for patients in RAINBOW included: "documented objective radiological or clinical disease progression during or within 4 months of the last dose of first-line platinum and fluoropyrimidine doublet with or without anthracycline."'' | ''Eligibility criteria for patients in RAINBOW included: "documented objective radiological or clinical disease progression during or within 4 months of the last dose of first-line platinum and fluoropyrimidine doublet with or without anthracycline."'' | ||
| − | + | ====Chemotherapy==== | |
| − | *[[Paclitaxel (Taxol)]] 80 mg/ | + | *[[Paclitaxel (Taxol)]] 80 mg/m<sup>2</sup> IV once per day on days 1, 8, 15 |
'''28-day cycles, given until progression of disease or unacceptable toxicity''' | '''28-day cycles, given until progression of disease or unacceptable toxicity''' | ||
| Line 252: | Line 257: | ||
border-width:2px; | border-width:2px; | ||
border-style:solid;">Phase III</span> | border-style:solid;">Phase III</span> | ||
| − | |3% | + | |3% |
|[[Gastric_cancer#Placebo|Placebo]] | |[[Gastric_cancer#Placebo|Placebo]] | ||
| − | |3% | + | |3% |
|Chemo exposed | |Chemo exposed | ||
|- | |- | ||
|} | |} | ||
''Patients in REGARD previously had "disease progression within 4 months of the last dose of first-line platinum-containing or fluoropyrimidine-containing chemotherapy for metastatic disease, or within 6 months of the last dose of platinum-containing or fluoropyrimidine-containing adjuvant treatment."'' | ''Patients in REGARD previously had "disease progression within 4 months of the last dose of first-line platinum-containing or fluoropyrimidine-containing chemotherapy for metastatic disease, or within 6 months of the last dose of platinum-containing or fluoropyrimidine-containing adjuvant treatment."'' | ||
| + | ====Chemotherapy==== | ||
*[[Ramucirumab (Cyramza)]] 8 mg/kg IV once every 2 weeks | *[[Ramucirumab (Cyramza)]] 8 mg/kg IV once every 2 weeks | ||
| Line 287: | Line 293: | ||
border-width:2px; | border-width:2px; | ||
border-style:solid;">Phase III</span> | border-style:solid;">Phase III</span> | ||
| − | |28% (95% CI 23 - 33) | + | |28% (95% CI 23-33%) |
|[[#Paclitaxel_.28Taxol.29|Paclitaxel]] | |[[#Paclitaxel_.28Taxol.29|Paclitaxel]] | ||
| − | |16% (95% CI 13 - 20) | + | |16% (95% CI 13-20%) |
|Chemo exposed | |Chemo exposed | ||
|- | |- | ||
|} | |} | ||
''Eligibility criteria for patients in RAINBOW included: "documented objective radiological or clinical disease progression during or within 4 months of the last dose of first-line platinum and fluoropyrimidine doublet with or without anthracycline."'' | ''Eligibility criteria for patients in RAINBOW included: "documented objective radiological or clinical disease progression during or within 4 months of the last dose of first-line platinum and fluoropyrimidine doublet with or without anthracycline."'' | ||
| + | ====Chemotherapy==== | ||
*[[Ramucirumab (Cyramza)]] 8 mg/kg IV once per day on days 1 & 15 | *[[Ramucirumab (Cyramza)]] 8 mg/kg IV once per day on days 1 & 15 | ||
| − | *[[Paclitaxel (Taxol)]] 80 mg/ | + | *[[Paclitaxel (Taxol)]] 80 mg/m<sup>2</sup> IV once per day on days 1, 8, 15 |
'''28-day cycles, given until progression of disease or unacceptable toxicity''' | '''28-day cycles, given until progression of disease or unacceptable toxicity''' | ||
Revision as of 17:55, 7 August 2016
- ***Since there is significant overlap between regimens for gastric cancer and esophageal cancer, please check that page to see if there is a suitable reference listed in esophageal cancer for your desired regimen.***
Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.
Is there a regimen missing from this list? Would you like to share a different dosage/schedule or an additional reference for a regimen? Have you noticed an error? Do you have an idea that will help the site grow to better meet your needs and the needs of many others? You are invited to contribute to the site.
71 regimens on this page
108 variants on this page
|
Perioperative chemotherapy
ECF
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ECF: Epirubicin, Cisplatin, Fluorouracil
Regimen
| Study | Evidence | Comparator |
| Cunningham et al. 2006 (MAGIC) | Phase III | Surgery alone |
Chemotherapy
- Epirubicin (Ellence) 50 mg/m2 IV once on day 1
- Cisplatin (Platinol) 60 mg/m2 IV once on day 1
- Fluorouracil (5-FU) 200 mg/m2/day IV continuous infusion on days 1 to 21
- Surgery is performed 3 to 6 weeks after the completion of cycle 3
Supportive medications
- Warfarin (Coumadin) 1 mg PO once per day suggested as thrombosis prophylaxis
21-day cycle for 3 cycles prior to surgery, then 3 more cycles to begin 6 to 12 weeks after surgery
References
- Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, Scarffe JH, Lofts FJ, Falk SJ, Iveson TJ, Smith DB, Langley RE, Verma M, Weeden S, Chua YJ, MAGIC Trial Participants. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006 Jul 6;355(1):11-20. link to original article contains protocol PubMed
Cisplatin & 5-FU
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Regimen
| Study | Evidence | Comparator |
| Ychou et al. 2011 | Phase III | Surgery alone |
Chemotherapy
- Cisplatin (Platinol) 100 mg/m2 IV as a 1 hour infusion once on day 28
- Fluorouracil (5-FU) 800 mg/m2/day IV continuous infusion on days 1 to 5
28-day cycle for 2 to 3 cycles prior to surgery, then 3 to 4 more cycles after surgery, for a total of 6 cycles
References
- Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G, Ducourtieux M, Bedenne L, Fabre JM, Saint-Aubert B, Genève J, Lasser P, Rougier P. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011 May 1;29(13):1715-21. link to original article contains protocol PubMed
Adjuvant chemoradiotherapy
5-FU & Leucovorin -> 5-FU, Leucovorin, RT -> 5-FU & Leucovorin
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RT: Radiation Therapy
Regimen
| Study | Evidence | Comparator |
| Macdonald et al. 2001 | Phase III | Surgery alone |
Treatment is to start 20 to 40 days after surgery.
Chemotherapy, part 1
- Fluorouracil (5-FU) 425 mg/m2 IV bolus once per day on days 1 to 5
- Folinic acid (Leucovorin) 20 mg/m2 IV bolus once per day on days 1 to 5
28-day cycle for 1 cycle, followed by:
Chemoradiation
- Fluorouracil (5-FU) 400mg/m2 IV bolus once per day on days 1 to 4 and the last 3 days of radiation therapy
- Folinic acid (Leucovorin) 20 mg/m2 IV bolus once per day on days 1 to 4 and the last 3 days of radiation therapy
- Concurrent radiation therapy starting on day 1 with 180 cGy, 5 days per week; 25 fractions given over 5 weeks for a total of 4500 cGy
35-day course, followed by:
Chemotherapy, part 2
- Fluorouracil (5-FU) 425 mg/m2 IV bolus once per day on days 1 to 5
- Folinic acid (Leucovorin) 20 mg/m2 IV bolus once per day on days 1 to 5
28-day cycle for 2 cycles
References
- Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001 Sep 6;345(10):725-30. link to original article contains protocol PubMed
Chemotherapy for metastatic or locally advanced disease (non-radiation/surgery candidate)
CX; XP
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CX: Cisplatin, Xeloda (Capecitabine)
XP: Xeloda (Capecitabine), Platinol (Cisplatin)
Regimen
| Study | Evidence | Comparator |
| Kang et al. 2009 | Phase III | Cisplatin & Fluorouracil |
| Lordick et al. 2013 (EXPAND) | Phase III | Capecitabine, Cetuximab, Cisplatin |
Chemotherapy
- Cisplatin (Platinol) 80 mg/m2 IV over 2 hours once on day 1
- Capecitabine (Xeloda) 1000 mg/m2 PO BID on days 1 to 14
- Lordick et al. 2013 gave Capecitabine (Xeloda) 1000 mg/m2 PO BID from the evening of day 1 to the morning of day 15 (28 doses per cycle)
Supportive medications
- (per Kang et al. 2009):
- "Hyperhydration" for Cisplatin (Platinol)
21-day cycles, given until progression of disease or unacceptable toxicity
References
- Kang YK, Kang WK, Shin DB, Chen J, Xiong J, Wang J, Lichinitser M, Guan Z, Khasanov R, Zheng L, Philco-Salas M, Suarez T, Santamaria J, Forster G, McCloud PI. Capecitabine/cisplatin versus 5-fluorouracil/cisplatin as first-line therapy in patients with advanced gastric cancer: a randomised phase III noninferiority trial. Ann Oncol. 2009 Apr;20(4):666-73. Epub 2009 Jan 19. link to original article contains verified protocol PubMed content property of HemOnc.org
- Lordick F, Kang YK, Chung HC, Salman P, Oh SC, Bodoky G, Kurteva G, Volovat C, Moiseyenko VM, Gorbunova V, Park JO, Sawaki A, Celik I, Götte H, Melezínková H, Moehler M; Arbeitsgemeinschaft Internistische Onkologie (AIO) and EXPAND Investigators. Capecitabine and cisplatin with or without cetuximab for patients with previously untreated advanced gastric cancer (EXPAND): a randomised, open-label phase 3 trial. Lancet Oncol. 2013 May;14(6):490-9. Epub 2013 Apr 15. link to original article contains verified protocol PubMed
Paclitaxel (Taxol)
| back to top |
Regimen
| Study | Evidence | Comparator |
| Wilke et al. 2014 (RAINBOW) | Phase III | Ramucirumab & Paclitaxel |
Eligibility criteria for patients in RAINBOW included: "documented objective radiological or clinical disease progression during or within 4 months of the last dose of first-line platinum and fluoropyrimidine doublet with or without anthracycline."
Chemotherapy
- Paclitaxel (Taxol) 80 mg/m2 IV once per day on days 1, 8, 15
28-day cycles, given until progression of disease or unacceptable toxicity
References
- Wilke H, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, Hironaka S, Sugimoto N, Lipatov O, Kim TY, Cunningham D, Rougier P, Komatsu Y, Ajani J, Emig M, Carlesi R, Ferry D, Chandrawansa K, Schwartz JD, Ohtsu A; RAINBOW Study Group. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol. 2014 Oct;15(11):1224-35. link to original article contains verified protocol PubMed
Placebo
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Regimen
| Study | Evidence | Comparator |
| Fuchs et al. 2014 (REGARD) | Phase III | Ramucirumab |
Patients in REGARD previously had "disease progression within 4 months of the last dose of first-line platinum-containing or fluoropyrimidine-containing chemotherapy for metastatic disease, or within 6 months of the last dose of platinum-containing or fluoropyrimidine-containing adjuvant treatment."
No active antineoplastic treatment.
References
- Fuchs CS, Tomasek J, Yong CJ, Dumitru F, Passalacqua R, Goswami C, Safran H, dos Santos LV, Aprile G, Ferry DR, Melichar B, Tehfe M, Topuzov E, Zalcberg JR, Chau I, Campbell W, Sivanandan C, Pikiel J, Koshiji M, Hsu Y, Liepa AM, Gao L, Schwartz JD, Tabernero J; REGARD Trial Investigators. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2014 Jan 4;383(9911):31-9. link to original article contains verified protocol PubMed
Ramucirumab (Cyramza)
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Regimen
| Study | Evidence | ORR | Comparator | Comparator ORR | Pt Population |
| Fuchs et al. 2014 (REGARD) | Phase III | 3% | Placebo | 3% | Chemo exposed |
Patients in REGARD previously had "disease progression within 4 months of the last dose of first-line platinum-containing or fluoropyrimidine-containing chemotherapy for metastatic disease, or within 6 months of the last dose of platinum-containing or fluoropyrimidine-containing adjuvant treatment."
Chemotherapy
- Ramucirumab (Cyramza) 8 mg/kg IV once every 2 weeks
Given until progression of disease, unacceptable toxicity, or death
References
- Fuchs CS, Tomasek J, Yong CJ, Dumitru F, Passalacqua R, Goswami C, Safran H, dos Santos LV, Aprile G, Ferry DR, Melichar B, Tehfe M, Topuzov E, Zalcberg JR, Chau I, Campbell W, Sivanandan C, Pikiel J, Koshiji M, Hsu Y, Liepa AM, Gao L, Schwartz JD, Tabernero J; REGARD Trial Investigators. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2014 Jan 4;383(9911):31-9. link to original article contains verified protocol PubMed
Ramucirumab & Paclitaxel
| back to top |
Regimen
| Study | Evidence | ORR | Comparator | Comparator ORR | Pt Population |
| Wilke et al. 2014 (RAINBOW) | Phase III | 28% (95% CI 23-33%) | Paclitaxel | 16% (95% CI 13-20%) | Chemo exposed |
Eligibility criteria for patients in RAINBOW included: "documented objective radiological or clinical disease progression during or within 4 months of the last dose of first-line platinum and fluoropyrimidine doublet with or without anthracycline."
Chemotherapy
- Ramucirumab (Cyramza) 8 mg/kg IV once per day on days 1 & 15
- Paclitaxel (Taxol) 80 mg/m2 IV once per day on days 1, 8, 15
28-day cycles, given until progression of disease or unacceptable toxicity
References
- Wilke H, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, Hironaka S, Sugimoto N, Lipatov O, Kim TY, Cunningham D, Rougier P, Komatsu Y, Ajani J, Emig M, Carlesi R, Ferry D, Chandrawansa K, Schwartz JD, Ohtsu A; RAINBOW Study Group. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol. 2014 Oct;15(11):1224-35. link to original article contains verified protocol PubMed