Treatment of metastatic or recurrent gastric cancer with weekly 24-hour infusion of cisplatin and high-dose 5-fluorouracil/leucovorin in an outpatient setting

Objective: There is no general agreement over a standard chemotherapy regimen for metastatic or recurrent gastric cancer. We evaluated, retrospectively, the activity and toxicity of weekly 24-hour infusion of cisplatin with high-dose 5-fluorouracil/leucovorin (P-HDFL) in an outpatient setting. Materials and Methods: Patients with metastatic or recurrent gastric cancer, treated in an outpatient setting from May 2001 to July 2005, were analyzed retrospectively. The regimen consisted of continuous infusion cisplatin 25 mg/m2, 5-fluorouracil 2000 mg/m2 and leucovorin 200 mg/m2 on day 1, 8 and 15 every 4 weeks. The treatment was continued for a maximum of six cycles unless the disease progressed or intolerable toxicities occurred. Results: Twenty-one patients received this regimen: 16 men and 5 women, median age 56 years (range 27-71). A median of 4.3 cycles was administered. Seven of 21 patients (33.3%) achieved an objective partial response. Stable disease was observed in 6 patients (28.6%) and progressive disease in 8 patients (38.1%). The median survival was 7.7 months (95% confidence interval, 6.2-12.8 months). Digestive and hematological toxicities were low and no severe renal insufficiency was observed. The most common toxicity was elevated liver enzymes (11 patients, 52%), of whom three had ≥ grade 3 toxicity: 1 of them died of hepatic failure. Conclusion: Our results show that outpatient P-HDFL therapy leads to a fairly comparable outcome with various regimens of 5-fluorouracil/cisplatin. This outpatient regimen could be a reasonable alternative that combines advantages in respect of patient activity, mild to moderate toxicity, convenience of dosing and minor expenditure.