Gastric cancer - historical

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The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only. As a general rule, this includes the inferior arm(s) of a randomized study, unless said regimens continue to be recommended by trustworthy sources such as the NCCN Guidelines. Is there a regimen missing from this list? See the main gastric cancer page for current regimens.

8 regimens on this page
9 variants on this page


Adjuvant therapy

Doxifluridine & Mitomycin

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Kang et al. 2013 (AMC0101) 2001-2007 Phase 3 (C) iceMFP Seems to have inferior OS
Kang et al. 2013 (AMC0201) 2002-2006 Phase 3 (C) MFP Did not meet primary endpoint of RFS36

Preceding treatment

Chemotherapy

28-day course, then 3-month course

References

  1. AMC0201: Kang YK, Chang HM, Yook JH, Ryu MH, Park I, Min YJ, Zang DY, Kim GY, Yang DH, Jang SJ, Park YS, Lee JL, Kim TW, Oh ST, Park BK, Jung HY, Kim BS. Adjuvant chemotherapy for gastric cancer: a randomised phase 3 trial of mitomycin-C plus either short-term doxifluridine or long-term doxifluridine plus cisplatin after curative D2 gastrectomy (AMC0201). Br J Cancer. 2013 Apr 2;108(6):1245-51. Epub 2013 Feb 28. link to original article link to PMC article contains dosing details in manuscript PubMed NCT00296335
  2. AMC0101: Kang YK, Yook JH, Chang HM, Ryu MH, Yoo C, Zang DY, Lee JL, Kim TW, Yang DH, Jang SJ, Park YS, Lee YJ, Jung HY, Kim JH, Kim BS. Enhanced efficacy of postoperative adjuvant chemotherapy in advanced gastric cancer: results from a phase 3 randomized trial (AMC0101). Cancer Chemother Pharmacol. 2014 Jan;73(1):139-49. Epub 2013 Oct 27. link to original article PubMed NCT00296322

FA

FA: Fluorouracil & Adriamycin (Doxorubicin)

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Youn et al. 1990 NR Randomized (C) FA & poly A:U Seems to have inferior OS

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT in this context, prior to becoming a standard comparator arm.

Preceding treatment

Chemotherapy

21-day cycles

References

  1. Youn JK, Kim BS, Min JS, Lee KS, Choi HJ, Lee YB, Lee DW, Park IS, Roh JK, Chung JB, Koh EH, Park YJ, Kim HI, Lee JB. Adjuvant treatment of operable stomach cancer with polyadenylic-polyuridylic acid in addition to chemotherapeutic agents: a preliminary report. Int J Immunopharmacol. 1990;12(3):289-95. link to original article contains dosing details in abstract PubMed
    1. Update: Jeung HC, Moon YW, Rha SY, Yoo NC, Roh JK, Noh SH, Min JS, Kim BS, Chung HC. Phase III trial of adjuvant 5-fluorouracil and adriamycin versus 5-fluorouracil, adriamycin, and polyadenylic-polyuridylic acid (poly A:U) for locally advanced gastric cancer after curative surgery: final results of 15-year follow-up. Ann Oncol. 2008 Mar;19(3):520-6. Epub 2007 Nov 20. link to original article PubMed

FAM

FAM: Fluorouracil, Adriamycin (Doxorubicin), Mitomycin

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Kim et al. 1998 1988-1991 Phase 3 (C) FAM-P Seems to have inferior OS

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT in this context, prior to becoming a standard comparator arm.

Preceding treatment

Chemotherapy

8-week cycle for 5 cycles

References

  1. Kim SY, Park HC, Yoon C, Yoon HJ, Choi YM, Cho KS. OK-432 and 5-fluorouracil, doxorubicin, and mitomycin C (FAM-P) versus FAM chemotherapy in patients with curatively resected gastric carcinoma: a randomized Phase III trial. Cancer. 1998 Nov 15;83(10):2054-9. link to original article contains dosing details in manuscript PubMed

Fluorouracil monotherapy

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Chang et al. 2002 1990-1993 Phase 3 (C) 1. 5-FU & Mitomycin
2. 5-FU, Doxorubicin, Mitomycin 		Did not meet primary endpoint of OS
Lee et al. 2004a 1996-1999 Phase 3 (C) PELF Did not meet primary endpoint of DFS60

Preceding treatment

Chemotherapy

21-day cycle for 6 cycles

References

  1. Lee JJ, Kim SY, Shin IS, Cho KS, Joo HZ, Yoon C, Kim YW, Yoon HJ. Randomized phase III trial of cisplatin, epirubicin, leucovorin, 5-fluorouracil (PELF) combination versus 5-fluorouracil alone as adjuvant chemotherapy in curative resected stage III gastric cancer. Cancer Res Treat. 2004 Apr;36(2):140-5. Epub 2004 Apr 30. link to original article link to PMC article contains dosing details in manuscript PubMed
  2. Chang HM, Jung KH, Kim TY, Kim WS, Yang HK, Lee KU, Choe KJ, Heo DS, Bang YJ, Kim NK. A phase III randomized trial of 5-fluorouracil, doxorubicin, and mitomycin C versus 5-fluorouracil and mitomycin C versus 5-fluorouracil alone in curatively resected gastric cancer. Ann Oncol. 2002 Nov;13(11):1779-85. link to original article PubMed

Fluorouracil & Mitomycin

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Allum et al. 1989 1976-NR Phase 3 (E-esc) Observation Did not meet primary endpoint of OS
Nakazato et al. 1994 1985-1987 Phase 3 (C) 5-FU, Mitomycin, PSK Seems to have inferior OS

Preceding treatment

Chemotherapy

21-day cycle for up to 35 cycles (2 years)

References

  1. Allum WH, Hallissey MT, Kelly KA; British Stomach Cancer Group. Adjuvant chemotherapy in operable gastric cancer: 5 year follow-up of first British Stomach Cancer Group trial. Lancet. 1989 Mar 18;1(8638):571-4. link to original article contains dosing details in manuscript PubMed
  2. Nakazato H, Koike A, Saji S, Ogawa N, Sakamoto J; Study Group of Immunochemotherapy with PSK for Gastric Cancer. Efficacy of immunochemotherapy as adjuvant treatment after curative resection of gastric cancer. Lancet. 1994 May 7;343(8906):1122-6. link to original article PubMed

Metastatic or locally advanced disease, first-line

FAM

FAM: Fluorouracil, Adriamycin (Doxorubicin), Mitomycin

Regimen variant #1, "Georgetown regimen"

Study Dates of enrollment Evidence Comparator Comparative Efficacy
MacDonald et al. 1979 1974-1977 Phase 2
Cullinan et al. 1985 NR Phase 3 (C) 1. 5-FU
2. FA 		Did not meet primary endpoint of OS
Wils et al. 1991 NR-1989 Phase 3 (C) FAMTX Inferior OS

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT in this context, prior to becoming a standard comparator arm.

Chemotherapy

8-week cycles


Regimen variant #2

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Kim et al. 1993 1986-1990 Phase 3 (C) 1. 5-FU
2. FP 		Did not meet endpoint of OS

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT in this context, prior to becoming a standard comparator arm.

Chemotherapy

4-week cycles

References

  1. MacDonald JS, Woolley PV, Smythe T, Ueno W, Hoth D, Schein PS. 5-fluorouracil, adriamycin, and mitomycin-C (FAM) combination chemotherapy in the treatment of advanced gastric cancer. Cancer. 1979 Jul;44(1):42-7. link to original article contains dosing details in manuscript PubMed
  2. Cullinan SA, Moertel CG, Fleming TR, Rubin JR, Krook JE, Everson LK, Windschitl HE, Twito DI, Marschke RF, Foley JF, Pfeifle DM, Barlow JF. A comparison of three chemotherapeutic regimens in the treatment of advanced pancreatic and gastric carcinoma: fluorouracil vs fluorouracil and doxorubicin vs fluorouracil, doxorubicin, and mitomycin. JAMA. 1985 Apr 12;253(14):2061-7. link to original article contains dosing details in manuscript PubMed
  3. Wils JA, Klein HO, Wagener DJ, Bleiberg H, Reis H, Korsten F, Conroy T, Fickers M, Leyvraz S, Buyse M, Duez N; European Organisation for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. Sequential high-dose methotrexate and fluorouracil combined with doxorubicin--a step ahead in the treatment of advanced gastric cancer: a trial of the European Organisation for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. J Clin Oncol. 1991 May;9(5):827-31. link to original article contains dosing details in manuscript PubMed
  4. Kim NK, Park YS, Heo DS, Suh C, Kim SY, Park KC, Kang YK, Shin DB, Kim HT, Kim HJ, Kang WK, Suh CI, Bang YJ. A phase III randomized study of 5-fluorouracil and cisplatin versus 5-fluorouracil, doxorubicin, and mitomycin C versus 5-fluorouracil alone in the treatment of advanced gastric cancer. Cancer. 1993 Jun 15;71(12):3813-8. link to original article contains dosing details in manuscript PubMed

FAMTX

FAMTX: Fluorouracil, Adriamycin (Doxorubicin), MTX (Methotrexate)

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Wils et al. 1991 NR-1989 Phase 3 (E-switch-ic) FAM Superior OS
Kelsen et al. 1992 1988-1990 Randomized (E-switch-ic) EAP Did not meet secondary endpoint of OS
Vanhoefer et al. 2000 (EORTC 40902) 1991-1995 Phase 3 (C) 1. ELF
2. FP 		Did not meet primary endpoint of ORR
Webb et al. 1997 1992-1995 Randomized (C) ECF Inferior OS

Note: Vanhoefer et al. 2000 stated that cycles were repeated every 29 days which is likely a mistake.

Chemotherapy

28-day cycles

References

  1. Wils JA, Klein HO, Wagener DJ, Bleiberg H, Reis H, Korsten F, Conroy T, Fickers M, Leyvraz S, Buyse M, Duez N; European Organisation for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. Sequential high-dose methotrexate and fluorouracil combined with doxorubicin--a step ahead in the treatment of advanced gastric cancer: a trial of the European Organisation for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. J Clin Oncol. 1991 May;9(5):827-31. link to original article PubMed
  2. Kelsen D, Atiq OT, Saltz L, Niedzwiecki D, Ginn D, Chapman D, Heelan R, Lightdale C, Vinciguerra V, Brennan M. FAMTX versus etoposide, doxorubicin, and cisplatin: a random assignment trial in gastric cancer. J Clin Oncol. 1992 Apr;10(4):541-8. link to original article PubMed
  3. Webb A, Cunningham D, Scarffe JH, Harper P, Norman A, Joffe JK, Hughes M, Mansi J, Findlay M, Hill A, Oates J, Nicolson M, Hickish T, O'Brien M, Iveson T, Watson M, Underhill C, Wardley A, Meehan M. Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer. J Clin Oncol. 1997 Jan;15(1):261-7. link to original article PubMed
    1. Update: Waters JS, Norman A, Cunningham D, Scarffe JH, Webb A, Harper P, Joffe JK, Mackean M, Mansi J, Leahy M, Hill A, Oates J, Rao S, Nicolson M, Hickish T. Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: results of a randomized trial. Br J Cancer. 1999 Apr;80(1-2):269-72. link to original article link to PMC article PubMed
  4. EORTC 40902: Vanhoefer U, Rougier P, Wilke H, Ducreux MP, Lacave AJ, Van Cutsem E, Planker M, Santos JG, Piedbois P, Paillot B, Bodenstein H, Schmoll HJ, Bleiberg H, Nordlinger B, Couvreur ML, Baron B, Wils JA; European Organisation for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. Final results of a randomized phase III trial of sequential high-dose methotrexate, fluorouracil, and doxorubicin versus etoposide, leucovorin, and fluorouracil versus infusional fluorouracil and cisplatin in advanced gastric cancer: a trial of the European Organisation for Research and Treatment of Cancer Gastrointestinal Tract Cancer Cooperative Group. J Clin Oncol. 2000 Jul;18(14):2648-57. link to original article contains dosing details in manuscript PubMed

FEMTX

FEMTX: Fluorouracil, Epirubicin, MTX (Methotrexate)

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Pyrhönen et al. 1995 1986-1992 Phase 3 (E-esc) Best supportive care Superior OS

Chemotherapy

Supportive therapy

28-day cycles

References

  1. Pyrhönen S, Kuitunen T, Nyandoto P, Kouri M. Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer. 1995 Mar;71(3):587-91. link to original article link to PMC article contains dosing details in manuscript PubMed

Fluorouracil & RT

5-FU & RT: 5-FluoroUracil & Radiation Therapy

Regimen

Study Dates of enrollment Evidence
Moertel et al. 1969 NR Non-randomized

Chemotherapy

Radiotherapy

References

  1. Moertel CG, Childs DS Jr, Reitemeier RJ, Colby MY Jr, Holbrook MA. Combined 5-fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet. 1969 Oct 25;2(7626):865-7. link to original article PubMed

Metastatic or locally advanced disease, subsequent lines of therapy

Apatinib monotherapy

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Kang et al. 2024 (ANGEL) 2017-03-14 to 2018-10-31 Phase 3 (E-esc) Placebo Did not meet primary endpoint of OS

Note: ANGEL included patients with GEJ malignancy

Targeted therapy

28-day cycles

References

  1. ANGEL: Kang YK, Ryu MH, Di Bartolomeo M, Chau I, Yoon H, Kim JG, Lee KW, Oh SC, Takashima A, Kryzhanivska A, Chao Y, Evesque L, Schenker M, McGinn A, Zhao Y, Lee J, Wyrwicz L, Boku N. Rivoceranib, a VEGFR-2 inhibitor, monotherapy in previously treated patients with advanced or metastatic gastric or gastroesophageal junction cancer (ANGEL study): an international, randomized, placebo-controlled, phase 3 trial. Gastric Cancer. 2024 Mar;27(2):375-386. Epub 2024 Jan 28. link to original article link to PMC article PubMed NCT03042611
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