Capecitabine or 5fu for Gastroesophageal Cancer

Globally, gastric and esophageal cancers are, respectively, the 2nd and 6th most common causes of cancer-related deaths; they are also an important cause of cancer-related morbidity 1. Surgical resection remains the definitive curative treatment for earlystage disease; however, most patients present with inoperable or metastatic disease. Consequently, overall 5-year survival rates are in the range 15%–25% 2. In advanced disease, palliative chemotherapy holds proven benefit in both survival and quality of life (qol) outcomes when compared with best supportive care alone 3–5, with the 3-drug regimen ecf [epirubicin 50 mg/m2 and cisplatin 60 mg/m2 every 3 weeks, plus infusional 5-fluorouracil (5fu) 200 mg/m2 daily] being a treatment standard 6,7. Challenges in the successful delivery of the ecf regimen include the need for a central venous access and an ambulatory infusion pump for administration of the 5fu, and the potential complications that the access and pump present. Capecitabine (Xeloda: Hoffmann–La Roche, Basel, Switzerland) is an orally administered prodrug of fluorouracil that generates 5fu predominantly within tumour cells by thymidine phosphorylase 8. Substitution of capecitabine for infusional 5fu avoids the inconvenience of central venous access and the need for an infusion pump. In addition, in the setting of similar efficacy, most patients prefer oral to intravenous cytotoxic therapy regimens 9. Substitution of oral for infusional therapy can reduce the time and travel burden for patients and can ease the burden on limited hospital resources. The phase iii Randomized ECF for Advanced and ABSTRACT