Gastric cancer

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Perioperative chemotherapy

ECF

ECF: Epirubicin, Cisplatin, Fluorouracil

Regimen

• Epirubicin (Ellence) 50 mg/m2 IV on day 1
• Cisplatin (Platinol) 60 mg/m2 IV on day 1
• Fluorouracil (5-FU) 200 mg/m2/day IV continuous infusion on days 1-21
• Surgery is performed 3-6 weeks after the completion of cycle 3

21-day cycles x 3 cycles prior to surgery, then 3 cycles to begin 6-12 weeks after surgery

Supportive medications:

• Warfarin (Coumadin) 1 mg PO daily suggested as thrombosis prophylaxis

References

1. 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

Adjuvant chemotherapy

Fluorouracil (5-FU) & Folinic acid (Leucovorin)

Regimen

Cycles 1, 3, 4:

• Fluorouracil (5-FU) 425 mg/m2 IV bolus on days 1-5
• Folinic acid (Leucovorin) 20 mg/m2 IV bolus on days 1-5

28-day cycles x 3 total cycles, interrupted by cycle 2 as described below

Cycle 2:

• Fluorouracil (5-FU) 400mg/m2 IV bolus on days 1-4 and the last 3 days of radiation therapy
• Folinic acid (Leucovorin) 20 mg/m2 IV bolus on days 1-4 and the last 3 days of radiation therapy
• Concurrent radiation therapy starting cycle 2 day 1 with 180 cGy, 5 days per week; 25 fractions given over 5 weeks for a total of 4500 cGy

35-day cycle x 1 cycle, to be followed by cycle 3 as described above

References

1. 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