Current Strategy of Chemotherapy for Advanced Gastric Cancer : The Differences between Western Countries and Japan Hiroya Takiuchi 1 , Masahiro Gotoh 1 , Shinichiro Kawabe 1 , Syunsuke Ohta 1 , Ken-ichi Katsu 1 1Second Department of Internal Medicine, Osaka Medical College Keyword: 胃癌化学療法 , 5-FU単剤 , 多剤併用療法 , 無作為化比較試験 , 日本臨床腫瘍研究グループ(JCOG) pp.977-985
Published Date 2005/6/25
DOI https://doi.org/10.11477/mf.1403100215
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Many combination regimens based on 5-FU have been studied clinically to further improve the objective response rate and the overall survival for unresectable advanced gastric cancer. The additive survival advantage yielded by these combination therapies appears to be marginal, however, so no standard regimen has yet been established. The Japan Clinical Oncology Group(JCOG)conducted a randomized phase III trial that compared 5-FU alone with 5-FU+cisplatin(JCOG 9205). Both regimens showed an equivalence not only in median survival time but also in one- and two-year survival rates. The toxicities were significantly lower with 5-FU alone than with 5-FU+cisplatin. For this reason, the JCOG steering committee determined that 5-FU alone should be the reference arm in the next study. But there were no randomized trials using 5-FU alone as a reference arm excluding NCCTG trials in western countries. JCOG is now conducting a 3-arm randomized controlled trial comparing 5-FU alone with CPT-11+CDDP and with S-1 alone(JCOG 9912). This study compares a single agent, 5-FU alone, with a toxic new combination, CPT-11+CDDP, which is a very popular regimen in Western countries. The result of JCOG 9912 is very important for an understanding of the best treatment strategy for gastric cancer. This will give us the chance to share the same treatment strategy for future trials with Western investigators in the near future.

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