Investigational Combinations Some new combinations show promise. EAP, for example, was reported to have a 57 percent response rate with 15 percent complete responses. For metastatic disease, the response rate is about 40 percent with 8 percent complete response. The EAP response rate in recent studies has decreased to about 40 percent, with moderately severe toxicity. The average survival is about 12 to 17 months for those with a complete response.
EAP is considered effective for locally advanced cancer, since, if shrinkage occurs, it offers a surgical option to many who otherwise wouldn't have been able to have an operation.
Another effective and less toxic combination is ELF (etoposide + leucovorin + 5-FU). Response rates of 53 percent (12 percent complete) have been obtained for locally advanced disease, 49 percent (10 percent complete) for metastatic disease. Another combination EFP (etoposide + 5-FU + cisplatin) is being administered pre- and postoperatively with a reported increase in the surgical cure rate (including unresectable local/regional stomach cancers).
The combinations EAP, ELF, EFP and FAMtx have proven to be of greater value than 5-fluorouracil alone, and chemotherapy modulators such as leucovorin may have the potential of improving drug effectiveness. Trials are ongoing comparing EAP, FAMtx and other combinations, for advanced gastric cancer. Additional combinations being studied in clinical trials include methotrexate + leucovorin + platinum, infusions of 5-FU + carboplatin , and chemoimmunotherapy protocols ELFI (etoposide + leucovorin + 5-FU + interferon) or PALA + 5-FU + leucovorin. Unfortunately, there has been little improvement in the survival rate.
