Operable stomach cancer
For patients with operable stomach cancer in stage II–III, who are < 75 years and in good health, we recommend neoadjuvant and adjuvant chemotherapy with ECX (epirubicin, cisplatin, and capecitabine), or alternatively EOX (epirubicin, oxaliplatin, and capecitabine) (1).
Primary local inoperable cancer or advanced/metastatic illness
Chemotherapy is indicated for locally advanced stomach cancer with sign of invasion of other organs/structures which are not able to be removed surgically. Chemotherapy has been shown to be effecting for downstaging, sometimes with the possibility of a later resection with a curative intention. However, there are large differences in results.
Advanced stomach cancer with distant metastasis is not possible to cure and the purpose of all treatment is palliative. The illness becomes stabilized for many patients and symptoms are relieved. The treatment can also extend illness-free periods and survival time. In most, the illness will progrediate after a few months. There is no defined chemotherapy regimen, but patients with good health status and < 75 years should be informed of the possibility of chemotherapy.
For younger patients with good health status, we recommend the EOX or ECX regimen. For older patients (>70–75 years), or patients with reduced health status, we recommend ELF (etoposide, 5-FU, calcium folinate).