Phase II trial of etoposide in adenocarcinomas of the upper gastrointestinal tract
Although declining in incidence, gastric cancer remains a major therapeutic problem in the United States. In the presence of metastatic disease, median survival among patients who do not respond to chemotherapy is usually 3-4 months in duration. Although newer combinations of conventional agents (such as 5-FU, doxorubicin, and mitomycin) have been reported to induce remissions in 35%-45% of patients, this still means that most patients with gastric cancer do not respond to the most effective drug combinations. Clearly, newer active systemic agents are needed. VP-16-213 was chosen for phase II testing because of the encouraging activity seen in gastric cancer during its phase I trial. Modest antitumor activity in previously untreated patients was noted in the current study. The mode of action of VP-16-213 is different from that of other agents commonly used in the treatment of gastric cancer, suggesting a role for the drug in combination therapy. Recent studies in gastric cancer have also noted modest activity for cisplatin; a combination using VP-16-213 and cisplatin may be an attractive one for future studies in adenocarcinoma of the upper gastrointestinal tract.