Oral fluoropyrimidine–cisplatin is a standard treatment of advanced gastric cancer (AGC). However, patients with severe peritoneal metastasis often cannot tolerate this regimen. In clinical practice, 5-FU-based or Taxanes-based treatment has been adopted for such patients. Recently, 5FU–leucovorin (FL therapy) is carried out in our institute. But there are few reports of effects and clinical course with FL therapy.Method
Ten AGC patients with severe ascites or inadequate oral intake who were treated with FL therapy as first-line chemotherapy between September 2002 and March 2011 in our institute were analyzed. We clarified the effects with FL therapy and clinical course that was observed after failure of FL therapy. The definitions of severe ascites and inadequate oral intake were as follows: severe ascites, ascites that continued from pelvis cavity to upper abdomen and inadequate oral intake, poor ingestion needed intravenous feeding.Results
The patients characteristics were as follows: median age, 61.5 (34–83) years; PS (1/2/3), 3/5/2; number of metastatic organ (1/2/3), 5/3/2 (peritoneal metastasis: nine cases); severe ascites, six cases; inadequate oral intake, nine cases. The rates of patient with improvement of ascites and oral intake were 37.5 and 44.4%, respectively. Median progression-free survival and overall survival were 2.9 and 5.0 months. Frequencies of major grade 3 adverse events were neutropenia (10%), anemia (10%) and diarrhea (10%). Weekly TXL regimen was carried out on six cases as second-line chemotherapy. However, we discontinued the chemotherapy within three times of admission. The median survival time after termination of second-line chemotherapy was 26 (23–88) days.Conclusion
The FL therapy as first-line in AGC patients with severe ascites or inadequate oral intake was feasible. But, these results were not enough. We need to think more effective total-therapy strategy including FLTAX (FL + paclitaxel) therapy.