Paliative chemotherapy based in etoposide Leucovorin and 5 Fluorouracil (ELF) using leucovorin in low dose in the treatment of patients with advanced gastric cancer

ABSTRACT

A great percentage of diagnosed gastric cancer cases are encountered in advanced stages with distant metastases. In these cases, the standard treatment is palliative chemotherapy. In the ELF chemotherapy regime, the dose of leucovorin (Lv) varies from 300 to 500mg/m2. However, there are no studies that demonstrate therapeutic equivalence between high and low doses of Lv. OBJECTIVE: Retrospectively analyze the response rates and toxicity profile of the ELF scheme with low doses of Lv offered to patients with metastatic gastric cancer. MATTERS AND METHODS: Evaluated were patients treated with etoposide (120mg/m2/day), Lv (20mg/m2/day) and 5-fluorouracil (500mg/m2/day), D1 and D3 cycles repeated every three weeks. RESULTS: Sixty-eight patients were treated, 69% men, with median age of 60.24 years. Occurred six complete responses (8.8%), five partial responses (7.4%) and 38.2% of the patients presented stable disease. The median overall survival was 9.15 months (IC95%, 6.06-12.95), while patients with overall response was 16.05 months (IC95%, 10.48-21.63) and in those that presented stable disease or progression was 9.01 months (IC95%, 4.71-13.31; p=0.669). Grade III and IV low frequency toxicity was observed. CONCLUSIONS: In the present sample, the ELF regime with low-dose leucovorin presented an excellent toxicity profile. In spite of the low response rate, the respondent patients presented an equivalent overall survival to the other regimens of the literature.