The role of oral fluoropyrimidines in the treatment of advanced gastric cancer

Although the incidence of gastric cancer is declining during the second half of the 20th century, it remains the second leading cause of cancer death worldwide. The majority of patients with gastric cancer will require pallia- tive treatment at some point in the course of their disease. Approximately 50% of patients already have advanced incurable disease at the time of initial presentation, and even those who undergo potentially curative resection have high rates of distant as well as local recurrence. Chemotherapy in advanced gastric cancer demonstrated a sig- nificant survival benefit over best supportive care alone. Median overall survival increased from 3-5 to 8-12 months. Today, a platinum based regimen is considered as first-line treatment in advanced gastric cancer. Different regimens are investigated and used in routine practice. Similarly to fluorouracil, capecitabine is well tolerated in combi- nation with a range of cytotoxic drugs. As a single agent, it has not undergone large scale randomised studies. S-1, another oral fluo- ropyrimidine, is a potential challenger to the role of capecitabine, but is lacking phase III data in Western population. (Acta gastro- enterol. belg., 2008, 71, 361-366).