Intensive Weekly Chemotherapy for Elderly Gastric Cancer Patients, Using 5-fluorouracil, Cisplatin, Epi-doxorubicin, 6S-leucovorin and Glutathione with the Support of G-CSF

Aims And Background: Elderly patients constitute the largest group of advanced gastric cancer patients. Since there is a widespread misconception that the elderly are poorly tolerant of chemotherapy, most of them are untreated or receive a less aggressive but also less efficacious chemotherapy. However, because tolerance and response to cancer seem to vary more with physiologic age than chronologic age, we evaluated the feasibility and activity of an intensive weekly chemotherapy in elderly gastric cancer patients.

Methods: 23 advanced gastric cancer patients (13 males and 10 females), older than 70 years, received weekly: cisplatin, 40 mg/m2 i.v.; epi-doxorubicin, 35 mg/m2 i.v.; 6S-leucovorin, 250 mg/m2 i.v.; 5-fluorouracil, 500 mg/m2 i.v.; and glutathione, 1.5 g/m2 G-CSF, at the dose of 5 micrograms/kg, was administered daily from the day after to the day before each chemotherapy administration.

Results: Toxicity was mild. The most common adverse effects were leukopenia (grade 3 in 2 patients); thrombocytopenia (grade 3 in 1 patient) and anemia (grade 3 in 3 patients). Five patients (20%) achieved a complete response and 9 (39%) a partial response, resulting in an overall response rate of 59% (95% CI, 40% to 78%). The median survival time was 13 months for all the patients and 15 months for patients with objective responses.

Conclusions: This regimen appears feasible also in elderly gastric cancer patients and, because of its activity, suitable for further studies.