Etoposide, doxorubicin (Adriamycin) and cisplatin chemotherapy (EAP) for advanced gastric cancer - Results of a phase II study and final review

Background. A phase II, single centre study was performed to evaluate the efficacy and toxicity of a combination of etoposide, doxorubicin (Adriamycin) and cisplatin in the treatment of advanced adenocarcinoma of the stomach or gastro-eosophageal junction, Methods. 71 patients with inoperable or recurrent, histologically proven gastric or gastro-oesophageal adenocarcinoma were treated with doxorubicin 20 mg/m(2) intravenous (IV) bolus an days 1 and 8, cisplatin 40 mg/m(2) TV infusion on days 1 and 8 and etoposide 200 mg/m(2) orally on days 4, 5 and 6 every 28 days for up to six cycles, Results. Objective responses were achieved in 14 of the 71 patients (19.7%), All of these were partial responses, no complete responses were seen. Of the remaining 57 patients, 29 (40.8%) had stable disease. Median duration of response was 135 days and median overall survival for all patients was 156 days (5 months). Toxicity was predominantly haematologic with 45 (63%) patients developing at least one infective episode, Non-haematologic toxicity of WHO grade 3 or greater included nausea and vomiting in 36%, mucositis in 6% and alopecia in 45%, Chemotherapy was delayed in 45 out of a total number of 257 cycles given (17.5%) due to toxicity or inadequate bone marrow recovery. 1 death due to toxicity occured. Conclusions. The EAP chemotherapeutic regimen appears to have only modest efficacy. Given the high incidence of moderate to severe myelotoxicity and poor tolerability in this and other studies, it cannot be considered as a standard therapy for patients with advanced gastric or gastro-oesophageal adenocarcinoma.