Skip to main content
SpringerLink
Log in

Neoadjuvant Chemotherapy with FLEP Regimen for Incurable Gastric Cancer

  • Chapter
Multimodality Therapy for Gastric Cancer

  • 96 Accesses

Abstract

Although the results of treatment for gastric cancer in Japan have improved, the prognosis of advanced stage disease remains poor [1,2]. Neither chemotherapy nor surgery alone has produced long-term survivors among patients with advanced disease. Our database of gastric cancer cases (11489 cases treated in our hospital from 1946 to 1994) shows that median survival time was 6 months for patients with noncurative surgery and 4 months for nonsurgically treated cases [3]. Our conventional strategy for advanced gastric cancer (including extended radical surgery followed by postoperative chemotherapy) yielded a plateau in the survival benefit. However, recent chemotherapy regimens with high response rates [4–9] seem to allow radical surgery for initially unresectable disease. Since 1989 at the Cancer Institute Hospital, Tokyo, we have attempted to treat advanced unresectable gastric cancer patients with a four-drug combination chemotherapy with systemic and regional delivery followed by radical gastrectomy. The treatment results have been reported elsewhere [10].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Nakajima T, Nishi M, Kajitani T (1991) Improvement in treatment results of gastric cancer with surgery and chemotherapy: experience of 9700 cases in the Cancer Institute Hospital, Tokyo. Semin Surg Oncol 7:365–372

    Article  PubMed  CAS  Google Scholar 

  2. Nakajima T, Ota K, Ishihara S, Yamada H, Nishi M (1993) Extended radical surgery for advanced gastric cancer. Surg Oncol Clin North Am 2:467–481

    Google Scholar 

  3. Nakajima T (1994) Tabular analysis of 10000 cases of gastric cancer (in Japanese). Jpn J Cancer Chemother 21:1813–1897

    Google Scholar 

  4. Klein HO, Wickrammanayake PD, Farrokh GR (1986) 5-Fluorouracil, adriamycin and methotrexate-a combination protocol (FAMTX) for treatment of metastasized stomach cancer. Proc Am Soc Clin Oncol 5:84

    Google Scholar 

  5. Moertel CG, Ribin J, O’Connell MJ, Schutt AJ (1986) A phase II study of combined 5-fluorouracil, doxorubicin, and cisplatin in the treatment of advanced upper gastrointestinal adenocarcinoma. J Clin Oncol 4:1053–1057

    PubMed  CAS  Google Scholar 

  6. Levi JA, Fox RM, Tattersall MH, Woods RL, Thomson D, Gill G, Sydney Cooperative Oncology Group (1986) Analysis of a prospectively randomized comparison of doxorubicin versus 5-fluorouracil, doxorubicin, and BCNU in advanced gastric cancer: implications for future studies. J Clin Oncol 4:1348–1355

    PubMed  CAS  Google Scholar 

  7. Preusser P, Wilke H, Achterrath W, Fink U, Lenaz L, Heinicke A, Meyer J, Meyer HJ, Beunte H (1989) Phase II study with the combination etoposide, doxorubicin, and cisplatin in advanced measurable gastric cancer. J Clin Oncol 7:1310–1317

    PubMed  CAS  Google Scholar 

  8. Wilke H, Preusser P, Fink U, Achterrath W, Meyer H-J, Stahl M, Lenaz L, Meyer J, Siewert JR, Geerlings H, Köhne-Wömpner CH, Könne-Wömpner CH, Harstrick AC, Schmoll HJ (1990) New developments in the treatment of gastric carcinoma. Semin Oncol 17:61–70

    PubMed  CAS  Google Scholar 

  9. Bruckner HW, Chesser MR, Wong H, Mandeli J (1991) Folate biochemical modulation regimen for the treatment of gastric cancer. J Clin Gastroenterol 13:384–389

    Article  PubMed  CAS  Google Scholar 

  10. Nakajima T, Ota K, Ishihara S, Oyama S, Nishi M, Ohashi Y, Yanagisawa A (1997) Combined inductive chemotherapy and radical surgery for incurable gastric cancer. Ann Surg Oncol 4:203–208

    Article  PubMed  CAS  Google Scholar 

  11. Collins JM (1984) Pharmacological rationale for regional drug delivery. J Clin Oncol 2:498–504

    PubMed  CAS  Google Scholar 

  12. Buchwald H, Grage TB, Vassilopoulos PR Rhode TD, Varco RL, Blackshear PJ (1980) Intraarterial infusion chemotherapy for hepatic carcinoma using a totally implantable infusion pump. Cancer 45:866–869

    Article  PubMed  CAS  Google Scholar 

  13. Lee Y-TM (1987) Regional infusion for metastatic liver tumors. In: Lokich JJ (ed) Cancer chemotherapy by infusion. Precept Press, Chicago, pp 415–434

    Chapter  Google Scholar 

  14. Stephens FO, Adams BG, Crea P (1986) Intra-arterial chemotherapy given preoperatively in the management of carcinoma of the stomach. Surg Gynecol Obstet 162: 370–374

    PubMed  CAS  Google Scholar 

  15. Aigner KR, Benthin F, Müller H (1991) Celiac axis infusion (CAI) chemotherapy for advanced gastric cancer. In: Sugarbaker PH (ed) Management of gastric cancer. Kluwer, Boston, pp 357–362

    Chapter  Google Scholar 

  16. Ajani JA, Ota DM, Jessup JM, Ames FC, McBride C, Boddie A, Levin B, Jackson DE, Roh M, Hohn D (1991) Resectable gastric carcinoma: an evaluation of preoperative and postoperative chemotherapy. Cancer 68:1501–1506

    Article  PubMed  CAS  Google Scholar 

  17. Kerr DJ (1989) 5-Fluorouracil and folinic acid: interesting biochemistry of effective treatment? Br J Cancer 60:807–808

    Article  PubMed  CAS  Google Scholar 

  18. O’Connell MJ (1989) A phase III trial of 5-fluorouracil and leucovorin in the treatment of colorectal cancer. Cancer 63:1026–1030

    Article  CAS  Google Scholar 

  19. Petrelli N, Douglass HO Jr, Herrera L, Russel D, Stablein D, Bruckner H, Mayer R, Schinella R, Green MD, Muggia FM, Megibow A, Greenwald ES, Bukowski RM, Harris J, Levin B, Gayner E, Louth A, Kaiser MH, Barkin JS, Benedetto P, Woolley PV, Nauta R, Weaver DW, Leichman LP (1989) The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. J Clin Oncol 7:1419–1426

    PubMed  CAS  Google Scholar 

  20. Kremer B, Henne-Bruns D, Weh HJ, Effenberger T (1989) Advanced gastric cancer: a new combined surgical and oncological approach. J Hepatogastroenterol 36:23–26

    CAS  Google Scholar 

  21. Kurihara M, Izumi T, Yoshida S, Ohkubo T, Suga S, Kiyohashi A, Yaosaka T, Takahashi H, Ito T, Sasai T, Akiya T, Akazawa S, Betsuyaku T, Taguchi S (1991) A cooperative randomized study on tegafur plus mitomycin C, versus combined tegafur and uracil plus mitomycin C in the treatment of advanced gastric cancer. Jpn J Cancer Res 82:613–620

    Article  PubMed  CAS  Google Scholar 

  22. Wils JA, Klein HO, Wagener DJT, Bleiberg H, Reis H, Korsten F, Conroy T, Fickers M, Leyvraz S, Buyse M, Duez N (1991) Sequential high-dose methotrexate and fluorouracil combined with doxorubicin: a step ahead in the treatment of advanced gastric cancer: a trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. J Clin Oncol 9:827–831

    PubMed  CAS  Google Scholar 

  23. Anderson H, Scarffe JH, Ranson M, Kamthan AG, Dougal M, Russell SA, Wilkinson MJS, Ostick DG (1991) MMAF for advanced gastric cancer. Eur J Cancer 27:1234–1238

    Article  PubMed  CAS  Google Scholar 

  24. Ohtsu A, Yoshida S, Saito D, Shimada Y, Miyamoto K, Fujii T, Yoshino M, Yoshimori M (1991) An early phase II study of 5-fluorouracil combined with cisplatinum as a second line chemotherapy against metastatic gastric cancer. Jpn J Clin Oncol 21:120–124

    PubMed  CAS  Google Scholar 

  25. Taguchi T (1989) Combination chemotherapy with etoposide, adriamycin (A), and cisplatin (P) (EAP) for advanced gastric cancer. Proc Am Soc Clin Oncol 8:108–108

    Google Scholar 

  26. Rath U, Flechtner H, Selbach J, Harjung H, Manegold C, Kabelitz K, Trux FA, Edler L, Schlag P, Queisser W (1990) Etoposide, adriamycin, and cisplatinum (EAP) combination chemotherapy for advanced gastric cancer: a phase II trial by the “Chemotherapiegruppe Gastrointestinaler Tumoren (CGT).” Onkologie 13:194–197

    Article  PubMed  CAS  Google Scholar 

  27. Lerner A, Gonin B, Steele GDJ, Mayer RJ (1992) Etoposide, doxorubicin, and cisplatin chemotherapy for advanced gastric adenocarcinoma: results of a phase II trial. J Clin Oncol 10:536–540

    PubMed  CAS  Google Scholar 

  28. Kelsen D, Atig OT, Saltz L, Niedzwiecki D, Ginn D, Chapman D, Heelan R, Lightdale C, Vinciguerra V, Brennan M (1992) FAMTX versus etoposide, doxorubicin, and cisplatin: a random assignment trial in gastric cancer. J Clin Oncol 10:541–548

    PubMed  CAS  Google Scholar 

  29. Hansen RM (1991) 5-Fluorouracil by protracted venous infusion: a review of recent clinical studies. Cancer Invest 9:637–642

    Article  PubMed  CAS  Google Scholar 

  30. Pinedo HM, Peters GF (1988) Fluorouracil: biochemistry and pharmacology. J Clin Oncol 6:1653–1664

    PubMed  CAS  Google Scholar 

  31. Sugarbaker PH, Cunliffe WJ, Belliveau J, Bruijn EA, Graves T, Mullins RE, Schlag P (1989) Rationale for integrating early postoperative intraperitoneal chemotherapy into the surgical treatment of gastrointestinal cancer. Semin Oncol 16:83–97

    PubMed  CAS  Google Scholar 

  32. Leichman L, Silberman H, Leichman C, Spears C, Ray M, Muggia F, Kiyabu M, Radin R, Laine L, Stain S, Fuerst S, Groshen S, Donovan A (1992) Preoperative systemic chemotherapy followed by adjuvant postoperative intraperitoneal therapy for gastric cancer: a University of Southern California pilot program. J Clin Oncol 10:1933–1942

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Cancer Institute Hospital, 1-37-1 Kamiikebukuro, Toshima-ku, Tokyo, 170-8455, Japan

    Toshifusa Nakajima, Keiichiro Ohta, Shou Ishihara, Shigekazu Ohyama & Mitsumasa Nishi

  2. Division of Medical Oncology, Cancer Institute Hospital, 1-37-1 Kamiikebukuro, Toshima-ku, Tokyo, 170-8455, Japan

    Yasuhiko Ohashi

  3. Division of Pathology, Cancer Institute, 1-37-1 Kamiikebukuro, Toshima-ku, Tokyo, 170-8455, Japan

    Akio Yanagisawa & Yo Kato

Authors
  1. Toshifusa Nakajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keiichiro Ohta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shou Ishihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shigekazu Ohyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mitsumasa Nishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yasuhiko Ohashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akio Yanagisawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yo Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Cancer Institute Hospital, 1-37-1 Kamiikebukuro, Toshima-ku, Tokyo, 170-8455, Japan

    Toshifusa Nakajima M.D., Ph.D. (Vice Director) (Vice Director)

  2. The First Department of Surgery, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-0841, Japan

    Toshiharu Yamaguchi M.D., Ph.D. (Associate Professor) (Associate Professor)

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer Japan

About this chapter

Cite this chapter

Nakajima, T. et al. (1999). Neoadjuvant Chemotherapy with FLEP Regimen for Incurable Gastric Cancer. In: Nakajima, T., Yamaguchi, T. (eds) Multimodality Therapy for Gastric Cancer. Springer, Tokyo. https://doi.org/10.1007/978-4-431-67927-1_13

Download citation

  • DOI: https://doi.org/10.1007/978-4-431-67927-1_13

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-68009-3

  • Online ISBN: 978-4-431-67927-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation