Is oxaliplatin the optimal platinum agent in gastric cancer?

Epirubicin-cisplatin-5-fluorouracil (ECF) is commonly used to treat advanced gastric cancer. Two new cytotoxic agents: the platinum, oxaliplatin, and the oral fluoropyrimidine, capecitabine, have the potential to replace the cisplatin and 5-fluorouracil (5-FU) components of ECF, respectively. Oxaliplatin showed anti-tumour activity in human gastric cancer cell lines and was active in Phase II studies in advanced gastric cancer. Using ECF as a reference regimen, the Phase III REAL-2 study compared oxaliplatin with cisplatin, and capecitabine with 5-FU in patients with previously untreated, locally advanced or metastatic cancer of the oesophagus, gastro-oesophageal junction or stomach. The results of this study indicate that oxaliplatin and capecitabine could replace the platinum and fluoropyrimidine components of ECF, with no adverse effect on efficacy, improved convenience and favourable safety. Further trials of oxaliplatin in combination with other cytotoxics may result in novel active regimens in this disease.