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The use of chemotherapy in the treatment of advanced gastric and pancreas cancer.

Patients with advanced adenocarcinomas of the stomach and pancreas have an exceptionally poor prognosis. Curative surgery in these patients is either impossible (metastatic disease) or exceedingly difficult (locally advanced tumors). In gastric cancer, single-agent chemotherapy with drugs like 5-fluorouracil (5-FU), mitomycin, doxorubicin, and cisplatin has achieved overall response rates of 19% to 30%; slightly higher response rates have been reported in single-arm trials of 5-FU-containing combinations. However, random assignment trials, with rare exceptions, failed to demonstrate a survival advantage for combination therapy. Overall survival in this disease remains poor. In pancreatic cancer, only modest activity has been demonstrated with single agents (response rates of 25% and 24% at best, respectively, with 5-FU and mitomycin), and combination chemotherapy has not yielded better results. Modest improvements in the palliation of locally advanced pancreatic cancer have been achieved by combining 5-FU with radiation therapy. New, more effective treatment strategies are clearly indicated for both gastric and pancreatic cancer.