Combining Platinums in Gastric Cancer

Abstract

The role for systemic treatment in gastric cancer has become more evident over the past years. Perioperative chemotherapy increases the cure rates in localized stages. At the same time, palliative chemotherapy has shown to prolong survival and maintain the patients' quality of life in advanced disease. Cisplatin in combination with 5-fluorouracil with or without an anthracycline now has a definite role in the treatment of patients with advanced disease. Newer studies support the addition of docetaxel to cisplatin plus 5-fluorouracil-based chemotherapy. The DCF regimen (docetaxel, cisplatin and 5-fluorouracil) is now a new reference regimen for the treatment of advanced stomach cancer. Recent studies suggest that oxaliplatin is as effective as cisplatin. Oxaliplatin was shown to be associated with slightly less toxicity, except sensory neuropathy which is more common with oxaliplatin. Therefore, oxaliplatin can replace cisplatin in combination chemotherapy regimens given in advanced disease. The role of cisplatin for the preoperative (neoadjuvant) treatment of gastric cancer in locally advanced stages has now been established. Two randomized trials have been published recently. Patients with stage II and stage III stomach cancer and carcinoma of the gastroesophageal junction who received 8-9 weeks of preoperative cisplatin-5-fluorouracil-based chemotherapy had a significantly better overall survival chances compared to surgery alone. The effectiveness and feasibility of chemotherapy in the postoperative (adjuvant) phase is less clear. There is no proven role for the use of cisplatin-containing combination chemotherapy in the postoperative setting. Studies employing platinum combinations in the adjuvant setting failed to show an improvement in survival.