[Patient with stomach cancer with metastases. What is the value of chemotherapy?]

In comparison with supportive measures alone, chemotherapy in advanced gastric carcinoma is associated with a significant increase in survival and improvement in quality of life. The following substances are considered to be effective and suitable for combination therapy: 5-FU +/- folic acid, cisplatin, irinotecan, etoposide, taxol, and taxotere. In contrast, the effect of doxorubicin and epidoxorubicin is only moderate. Although "second generation" combinations, such as FAMTX, ELF or cisplatin/5-FU, induced higher remission rates as the "first generation" combinations, they failed to improve survival times to any appreciable extent. Currently accepted standard treatment of metastatic gastric carcinoma is infusional 5-FU + cisplatin or ECF. The third generation combinations containing taxane, irinotecan, oxaliplatin appear to be at least equally effective.