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dc.contributor.authorWebb, A
dc.contributor.authorCunningham, D
dc.contributor.authorScarffe, J Howard
dc.contributor.authorHarper, P
dc.contributor.authorNorman, A
dc.contributor.authorJoffe, J K
dc.contributor.authorHughes, M
dc.contributor.authorMansi, J
dc.contributor.authorFindlay, M
dc.contributor.authorHill, A
dc.contributor.authorOates, J
dc.contributor.authorNicolson, M
dc.contributor.authorHickish, T
dc.contributor.authorO'Brien, M
dc.contributor.authorIveson, T
dc.contributor.authorWatson, M
dc.contributor.authorUnderhill, C
dc.contributor.authorWardley, Andrew M
dc.contributor.authorMeehan, Marie
dc.date.accessioned2010-03-23T15:41:03Z
dc.date.available2010-03-23T15:41:03Z
dc.date.issued1997-01
dc.identifier.citationRandomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer. 1997, 15 (1):261-7 J. Clin. Oncol.en
dc.identifier.issn0732-183X
dc.identifier.pmid8996151
dc.identifier.urihttp://hdl.handle.net/10541/94717
dc.description.abstractPURPOSE: We report the results of a prospectively randomized study that compared the combination of epirubicin, cisplatin, and protracted venous infusion fluorouracil (5-FU) (ECF regimen) with the standard combination of 5-FU, doxorubicin, and methotrexate (FAMTX) in previously untreated patients with advanced esophagogastric cancer. PATIENTS AND METHODS: Two hundred seventy-four patients with adenocarcinoma or undifferentiated carcinoma were randomized and analyzed for survival, tumor response, toxicity, and quality of life (QL). RESULTS: The overall response rate was 45% (95% confidence interval [CI], 36% to 54%) with ECF and 21% (95% CI, 13% to 29%) with FAMTX (P = .0002). Toxicity was tolerable and there were only three toxic deaths. The FAMTX regimen caused more hematologic toxicity and serious infections, but ECF caused more emesis and alopecia. The median survival duration was 8.9 months with ECF and 5.7 months with FAMTX (P = .0009); at 1 year, 36% (95% CI, 27% to 45%) of ECF and 21% (95% CI, 14% to 29%) of FAMTX patients were alive. The median failure-free survival duration was 7.4 months with ECF and 3.4 months with FAMTX (P = .00006). The global QL scores were better for ECF at 24 weeks, but the remaining QL data showed no differences between either arm of the study. Hospital-based cost analysis on a subset of patients was similar for each arm and translated into an increment cost of $975 per life-year gained. CONCLUSION: The ECF regimen results in a survival and response advantage, tolerable toxicity, better QL and cost-effectiveness compared with FAMTX chemotherapy. This regimen should now be considered the standard treatment for advanced esophagogastric cancer.
dc.language.isoenen
dc.subjectOesophageal Canceren
dc.subjectStomach Canceren
dc.subject.meshAdenocarcinoma
dc.subject.meshAdult
dc.subject.meshAged
dc.subject.meshAntineoplastic Combined Chemotherapy Protocols
dc.subject.meshCarcinoma
dc.subject.meshCisplatin
dc.subject.meshCosts and Cost Analysis
dc.subject.meshDoxorubicin
dc.subject.meshDrug Costs
dc.subject.meshEpirubicin
dc.subject.meshEsophageal Neoplasms
dc.subject.meshFemale
dc.subject.meshFluorouracil
dc.subject.meshHumans
dc.subject.meshMale
dc.subject.meshMethotrexate
dc.subject.meshMiddle Aged
dc.subject.meshProspective Studies
dc.subject.meshQuality of Life
dc.subject.meshStomach Neoplasms
dc.subject.meshSurvival Rate
dc.titleRandomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer.en
dc.typeArticleen
dc.contributor.departmentCancer Research Campaign (CRC) Section of Medicine, Royal Marsden Hospital, Sutton, Surrey, United Kingdom.en
dc.identifier.journalJournal of Clinical Oncologyen
html.description.abstractPURPOSE: We report the results of a prospectively randomized study that compared the combination of epirubicin, cisplatin, and protracted venous infusion fluorouracil (5-FU) (ECF regimen) with the standard combination of 5-FU, doxorubicin, and methotrexate (FAMTX) in previously untreated patients with advanced esophagogastric cancer. PATIENTS AND METHODS: Two hundred seventy-four patients with adenocarcinoma or undifferentiated carcinoma were randomized and analyzed for survival, tumor response, toxicity, and quality of life (QL). RESULTS: The overall response rate was 45% (95% confidence interval [CI], 36% to 54%) with ECF and 21% (95% CI, 13% to 29%) with FAMTX (P = .0002). Toxicity was tolerable and there were only three toxic deaths. The FAMTX regimen caused more hematologic toxicity and serious infections, but ECF caused more emesis and alopecia. The median survival duration was 8.9 months with ECF and 5.7 months with FAMTX (P = .0009); at 1 year, 36% (95% CI, 27% to 45%) of ECF and 21% (95% CI, 14% to 29%) of FAMTX patients were alive. The median failure-free survival duration was 7.4 months with ECF and 3.4 months with FAMTX (P = .00006). The global QL scores were better for ECF at 24 weeks, but the remaining QL data showed no differences between either arm of the study. Hospital-based cost analysis on a subset of patients was similar for each arm and translated into an increment cost of $975 per life-year gained. CONCLUSION: The ECF regimen results in a survival and response advantage, tolerable toxicity, better QL and cost-effectiveness compared with FAMTX chemotherapy. This regimen should now be considered the standard treatment for advanced esophagogastric cancer.


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