Adjuvant chemoradiation for stage IB, II, III and non-metastatic IV cancer

5-FU + LV + RT
5-FU 425 mg/m2/d iv d1-5
Leucovorin 20 mg/m2/d iv d1-5
One month later
5-FU 400 mg/m2/d d1-4 and last 3 days of RT
Leucovorin 20 mg/m2/d iv d1-4 and last 3 days of RT
Radiotherapy 1.8 Gy/d to 45 Gy
One month after completion of RT
5-FU 425 mg/m2/d iv d1-5 q4w x 2 cycles
Leucovorin 20 mg/m2/d iv d1-5 q4w x 2 cycles

Macdonald, JS et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001; 345:725 (link to the article).

Chemotherapy for locally advanced unresectable and metastatic cancer

Epirubicin + Cisplatin + 5-FU (ECF)
Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles
Cisplatin (CDDP) 60 mg/m2 iv d1 q3w x 8 cycles
5-FU 200 mg/m2/d civi x 6 months

Cunningham D et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Eng J Med 2008; 358:36 (link to the article). 

Roth AD et al. Docetaxel, cisplatin; and fluorouracil; docetaxel and cisplatin; and epirubicin, cisplatin, and fluorouracil as systemic treatment for advanced gastric carcinoma: a randomized phase II trial of the Swiss Group for Clinical Cancer Research. J Clin Oncol 2007; 25:3217 (link to the article).

Webb, A et al. Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer. J Clin Oncol 1997; 15:261 (link to the article).

Epirubicin + Cisplatin + Capecitabine (ECX)
Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles
Cisplatin (CDDP) 60 mg/m2 iv d1 q3w x 8 cycles
Capecitabine (Xeloda) 625 mg/m2 po bid x 6 months

Cunningham D et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Eng J Med 2008; 358:36 (link to the article).

Epirubicin + Oxaliplatin + 5-FU (EOF)
Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles
Oxaliplatin (Eloxatin) 130 mg/m2 iv over 2 hours d1 q3w x 8 cycles
5-FU 200 mg/m2/d civi x 6 months

Cunningham D et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Eng J Med 2008; 358:36 (link to the article).

Epirubicin + Oxaliplatin + Capecitabine (EOX)
Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles
Oxaliplatin (Eloxatin) 130 mg/m2 iv over 2 hours d1 q3w x 8 cycles
Capecitabine (Xeloda) 625 mg/m2 po bid x 6 months

Cunningham D et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Eng J Med 2008; 358:36 (link to the article). 

5-FU + LV + Oxaliplatin (FLO)
Oxaliplatin (Eloxatin) 85 mg/m2 iv over 2 hours d1
Leucovorin 200 mg/m2 iv over 2 hours d1
5-FU 2600 mg/m2 civi over 24 hours
Q2w until progression or limiting toxicity

Al-Batran SE et al. Phase III trial of metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: a study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol 2008; 26:1435 (link to the article). 

Al-Batran, SE et al. Phase II trial of biweekly infusional fluorouracil, folinic acid, and oxaliplatin in patients with advanced gastric cancer. J Clin Oncol 2004; 22:658 (link to the article).

Cisplatin + 5-FU
Cisplatin (CDDP) 100 mg/m2 iv d1
5-FU 1000 mg/m2/d civi d1-5
Q4w

Ajani JA et al. Clinical benefit with docetaxel plus fluorouracil and cisplatin compared with cisplatin and fluorouracil in a phase III trial of advanced gastric or gastroesophageal cancer adenocarcinoma: The V-325 Study Group. J Clin Oncol 2007; 25:3205 (link to the article). 

Ajani JA et al. Quality of life with docetaxel plus cisplatin and fluorouracil compared with cisplatin and fluorouracil from a phase III trial for advanced gastric or gastroesophageal adenocarcinoma: The V-325 Study Group. J Clin Oncol 2007; 25:3210 (link to the article). 

Custem EV et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 study group. J Clin Oncol 2006; 24:4991 (link to the article).

Cisplatin + Capecitabine
Cisplatin (CDDP) 80 mg/m2 iv over 3 hrs d1
Capecitabine (Xeloda) 1000 mg/m2 po bid d1-14
Q3w

Kang Y et al.  Randomized phase III trial of capecitabine/cisplatin (XP) vs. continous infusion of 5-FU/cisplatin (FP) as first-line therapy in patients (pts) with advanced gastric cancer (AGC): efficacy and safety results. 2006 ASCO Annual Meeting. Abstract LBA4018 (link to the abstract).  

Cisplatin + Irinotecan
Cisplatin (CDDP) 30 mg/m2 iv d1
Irinotecan (Camptosar, CPT-11) 65 mg/m2 iv d1
Qw for 4 wks every 6 wks

Ajani, JA et al. CPT-11 plus cisplatin in patients with advanced, untreated gastric or gastroesophageal junction carcinoma: results of a phase II study. Cancer 2002; 94:641 (link to the article).

Cisplatin + Paclitaxel
Cisplatin (CDDP) 60 mg/m2 iv d1
Paclitaxel (Taxol) 160 mg/m2 iv d1
Q2w

Kornek, GV et al. Effective combination chemotherapy with paclitaxel and cisplatin with or without human granulocyte colony-stimulating factor and/or erythropoietin in patients with advanced gastric cancer. Br J Cancer 2002; 86:1858 (link to the article).

Cisplatin + Docetaxel
Cisplatin (CDDP) 75 mg/m2 iv d1
Docetaxel (Taxotere) 75-85 mg/m2 iv d1
Q3w

Roth AD et al. Docetaxel, cisplatin; and fluorouracil; docetaxel and cisplatin; and epirubicin, cisplatin, and fluorouracil as systemic treatment for advanced gastric carcinoma: a randomized phase II trial of the Swiss Group for Clinical Cancer Research. J Clin Oncol 2007; 25:3217 (link to the article).

Ajani JA et al. Phase II multi-institutional randomized trial of decetaxel plus cisplatin with or without fluorouracil in patients with untreated, advanced gastric, or gastroesophageal adenocarcinoma. J Clin Oncol 2005; 23:5660 (link to the article).

Ridwelski, K et al. Combination chemotherapy with docetaxel and cisplatin for locally advanced and metastatic gastric cancer. Ann Oncol 2001; 12:47 (link to the article).

5-FU + LV + Irinotecan
Regimen 1
Irinotecan (Camptosar, CPT-11) 180 mg/m2 iv d1
Leucovorin 200 mg/m2 iv over 2 hrs d1 and  2
5-FU 400 mg/m2 iv bolus followed by 600 mg/m2 civi over 22 hrs d1 and 2
Q2w

Bouche, O et al. Randomized multicenter phase II trial of a biweekly regimen of fluorouracil and leucovorin (LV5FU2), LV5FU2 plus cisplatin, or LV5FU2 plus irinotecan in patients with previously untreated metastatic gastric cancer: a Federation Francophone de Cancerologie Digestive Group Study--FFCD 9803. J Clin Oncol 2004; 22:4319 (link to the article).

Regimen 2
Irinotecan (Camptosar, CPT-11) 80 mg/m2 iv over 30 min d1
Leucovorin 500 mg/m2 iv over 2 hrs d1
5-FU 2000 mg/m2 iv over 22 hrs d1
Qw x 6 wks every 7 wks

Dank M et al. Randomized phase 3 trial of irinotecan (CPT11) + 5FU/folinic acid (FA) versus CDDP + 5-FU in 1st-line advanced gastric cancer patients. 2005 ASCO Annual Meeting. Abstract 4003 (link to the abstract).

5-FU + Cisplatin + Docetaxel
Cisplatin (CDDP) 75 mg/m2 iv d1
Docetaxel (Taxotere) 75 mg/m2 iv d1
5-FU 750 mg/m2/d civi d1-5
Q3w

Ajani JA et al. Clinical benefit with docetaxel plus fluorouracil and cisplatin compared with cisplatin and fluorouracil in a phase III trial of advanced gastric or gastroesophageal cancer adenocarcinoma: The V-325 Study Group. J Clin Oncol 2007; 25:3205 (link to the article).

Ajani JA et al. Quality of life with docetaxel plus cisplatin and fluorouracil compared with cisplatin and fluorouracil from a phase III trial for advanced gastric or gastroesophageal adenocarcinoma: The V-325 Study Group. J Clin Oncol 2007; 25:3210 (link to the article).

Roth AD et al. Docetaxel, cisplatin; and fluorouracil; docetaxel and cisplatin; and epirubicin, cisplatin, and fluorouracil as systemic treatment for advanced gastric carcinoma: a randomized phase II trial of the Swiss Group for Clinical Cancer Research. J Clin Oncol 2007; 25:3217 (link to the article).

Custem EV et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 study group. J Clin Oncol 2006; 24:4991 (link to the article).

Ajani JA et al. Phase II multi-institutional randomized trial of decetaxel plus cisplatin with or without fluorouracil in patients with untreated, advanced gastric, or gastroesophageal adenocarcinoma. J Clin Oncol 2005; 23:5660 (link to the article).

Irinotecan + Docetaxel + Oxaliplatin
Irinotecan (Camptosar, CPT-11) 150 mg/m2 iv d1
Docetaxel (Taxotere) 60 mg/m2 iv d1
Oxaliplatin (Eloxatin) 85 mg/m2 iv d2
Q3w

Lauro LD et al. Irinotecan, docetaxel and oxaliplatin combination in metastatic gastric or gastroesophageal junction adenocarcinoma. Br J Cancer 2007; 97:593 (link to the article). 

FAMTX
Methotrexate (MTX) 1500 mg/m2 iv d1
5-FU 1500 mg/m2 iv bolus d1 1 hour after MTX
Doxorubicin (Adriamycin) 30 mg/m2 iv bolus d15
Q4w

Cocconi G et al. Cisplatin, Epirubicin, leucovorin and 5-fluorouracil (PELF) is more active than 5-fluorouracil, doxorubicin and methotrexate (FAMTX) in advanced gastric cancer. Ann Oncol 2003; 14:1258 (link to the article). 

Vanhoefer U et al. Final results of a randomized phase III trial of sequential high-dose methotrexate, flourouracil, and doxorubicin versus etopodise, leucovorin, and fluorouracil versus infusional flourouracil and cisplatin in advanced gastric caner: a trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cancer Cooperative Group. J Clin Oncol 2000; 18:2648 (link to the article).  

Webb A et al. Randomized trial comparing epirubicin, cisplatin, and fluorouracil versu fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer. J Clin Oncol 1997; 15:261 (link to the article). 

Wils JA et al. Sequential high-dose methotrexate and fluorouracil combined with doxorubicin-a step ahead in the treatmet of advanced gastric cancer: a trial of European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. J Clin Oncol 1991; 9:837 (link to the article).

Capecitabine
Capecitabine (Xeloda) 1000 mg/m2 po bid for 2wks
Q3w

Hong, YS et al. A phase II trial of capecitabine in previously untreated patients with advanced and/or metastatic gastric cancer. Ann Oncol 2004; 15:1344 (link to the article).

Cisplatin + Irinotecan + Bevacizumab
Cisplatin (CDDP) 30 mg/m2 iv over 30 min d1,  8
Irinotecan (Camptosar, CPT-11) 65 mg/m2 iv over 30 min d1, 8
Bevacizumab (Avastin) 15 mg/kg iv d1
Q3w

Shah MA et al. Multicenter phase II study of irinotecan, cisplatin, and bevacizumab in patients with metastatic gastric or gastroesophageal junction adenocarcinoma. J Clin Oncol 2006; 24: 5201 (link to the article). 

FUFOX + Cetuximab
5-FU 2000 mg/m2 iv d1, 8, 15, 22 q36d
Leucovorin 200 mg/m2 iv d1, 8, 15, 22 q36d
Oxaliplatin (Eloxatin) 50 mg/m2 iv d1, 8, 15, 22 q36d
Cetuximab (Erbitux) 400 mg/m2 iv loading, then 250 mg/m2 iv qw

Lordick F et al. Cetuximab plus weekly oxaliplatin/5FU/FA (FUFOX) in 1st line metastatic gastric cancer. Final results from a multicenter phase II study of the AIO upper GI study group. 2007 ASCO annual meeting. Abstract 4526 (link to the abstract).