Three patients with advanced nonresectable and recurrent gastric cancer responding to chronomodulation chemotherapy with tegafur + cisplatin + isovorin followed by CPT-11 administration

Today, no effective chemotherapy regimen has been established for non-resectable or postoperative recurrent gastric cancer, and most such therapy seems to be palliative. Thus, a highly effective chemotherapy that allows good patient QOL is desired. We report three gastric cancer patients responding to chronomodulation chemotherapy (tegafur + cisplatin + Isovorin) based on circadian rhythms plus a new antitumor drug, CPT-11. The treatment protocol was tegafur 1,200 mg/body, days 1-12 (continuing 16 h, intravenously with 800 mg/body from 16 to 24 h, 400 mg/body from 24-8 h, for non-uniform administration), cisplatin 10 mg/body, days 1-5, 8-12, (16 h, one shot infusion), Isovorin 25 mg/body, days 1-5, 8-12 (16 h, one shot infusion), followed by CPT-11 100 mg/body, days 13 (one shot infusion). We performed 1 or 2 courses, and with 2 courses the CPT-11 dose was increased to 150 mg/body. The first patient was a 54-year-old female with advanced type 3 gastric cancer with liver metastasis (H3). After chemotherapy (2 courses), there was a 30% reduction in the advanced gastric cancer and a 95% reduction in the liver metastasis. The second patient was a 73-year-old male with recurrent type 1 gastric cancer in the remnant stomach 24 months after partial gastrectomy. After chemotherapy (1 course), there was a 45% reduction in advanced gastric recurrent cancer. The third patient was a 67-year-old male with advanced type 2 plus 3 gastric cancers with liver (H3) and abdominal lymph node metastases. After chemotherapy (1 course), there was a 70% reduction in the type 2 and 55% reduction in the type 3 advanced gastric cancer, and a 50% reduction in the liver metastasis and 35% reduction in the abdominal lymph node metastasis. The only adverse effect was grade 2 pancytopenia, gastrointestinal disorder, and alopecia. In conclusion, this regimen resulted in good intrachemotherapeutic QOL and was highly effective in advanced gastric cancer patients.