ECF with Infusional Fluorouracil for 5 Days in Locally Advanced and Metastatic Gastric Cancer, Is It Better than the Standard?

The ECF (Epirubcin/Cisplatin/5-fluorouracil) first therapy in metastatic gastric is the optimal therapeutic option but its complexity limits its utility in many communities. We investigated a more convenient modification of the standard approach, "5 days CIV 5-fluorouracil 1000mg/m2". A total of 115 patients with advanced and metastatic adenocarcinoma of the stomach and gastroesophageal cancer were reviewed retrospectively to compare the efficacy of modified ECF N=41 with the reference protocols FAM N=32 and ELF N=42. The overall response rate was 36.5% with ECF, 16.6% with ELF, and 15.6% with FAM, with significant differences p=0.001. No one achieved a complete tumor regression. However, 4 patients with locally advanced stomach were able to have total gastrectomy in ECF arm only with p=0.000. Hematologic toxicities were more common in ECF p= 0.01. On the other hand, there was no significant difference in progression free survival or overall survival between the three regimens. Modified ECF showed significant overall response than FAM and FLF. However survival benefit is very small. So we recommend using this regimen as neoadjuvant treatment.