Amnia, I Need Your Expertise.

I have posted many times about my 57 year old husband who was diagnosed with gastric cancer on May 31 of this year.
He did amazingly well on chemo (ECF) and we were looking forward to the results of his CT scan and the possibility of a gastrectomy.
Unfortunately the CT scan showed shrinkage to gastic tumor, but extensive infiltration in bone (from scapula to legs). Today we learned that his breathing difficutly is not just fluid build up but cancer in the right lung. He has been off chemo for almost two weeks now (initially due to low counts, most recently for oncologist to get permission from ministry of health to administer cisplatin and another chemo drug {starts with letter T}.)
Amnia you have always been such a remarkable source of information...what have you got for me now? Thank you and kindest regards-Darlene

The conventional chemotherapy regimens for gastric cancer are better now than they were 30 years ago, but they still have a long way to go.

If I had gastric cancer myself I might try the best conventional regimen (I think it is a tie between ECF and DCF right now) or I might venture into the unknown and try a clinical trial.

Docetaxel (Taxotere®)
Irinotecan (Campto® or Camptosar® or CPT-11)
Bevacizumab (Avastin®)
Erlotinib (Tarceva®)

These all seem promising in gastric cancer and are being studied in clinical trials. I would guess your husband's oncologist is considering one of them right now. (There are actually quite a few more drugs being studied in gastric cancer, i just listed the ones that seemed to me to be the most promising. you can visit them all at www.clinicaltrials.com, just type in gastric cancer.)

Some of the newer experimental regimens use these drugs in combination with established drugs and have increased average "time to progression (TTP)" from the standard of 5 months (such as the ECF your husband got) to 10 months (for example, see [1] below).

The problem with many of these regimens is they also use drugs your husband may have already gotten the maximal lifetime dose of, or drugs that may exclude him from a particular study, and in any case most are still in phase II trials.

Perhaps after your husband finishes this next regimen of drugs that his oncologist has recommended, some of the newer regimens will be in phase III or IV trials, and your husband would have better access to them.

-Amnia

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[1](ASCO 2006) irinotecan, cisplatin, and bevacizumab phase II results:
http://tinyurl.com/ybgd6y
[2] phase II trial of TCPA in gastric cancer:
http://clinicaltrials.gov/show/NCT00394433