Novel cytotoxic regimens in gastric cancer

The docetaxel-cisplatin-5-fluorouracil (TCF) triplet has demonstrated superiority over cisplatin-5-fluorouracil (CF) and subsequently gained approval in the USA and Europe for the treatment of advanced gastric cancer. While this is a major advancementin gastric cancer therapy, there is potential to further improve outcomes by optimizing and building of the TCF regimen. The availability of ‘new’ cytotoxic agents such as oxaliplatin, irinotecan, capecitabine and S-1, as well as the biological agents, provides many options for modifying the standard TCF regimen, as used in the TAX 325 study. Potential strategies to improve efficacy, tolerability and/or convenience include variations in the dosing schedule, the substitution of cisplatin with oxaliplatin, the substitution of 5-fluorouracil with oral fluoropyrimidines, and the addition of biological agents. Emerging data support the feasibility of these strategies and will be reviewed in this article.