MMAF FOR ADVANCED GASTRIC-CANCER

65 patients with metastatic gastric carcinoma were treated with a combination of methotrexate 1.5 g/m2 with 5-fluorouracil 1.5 g/m2 on day 1 and doxorubicin 30 mg/m2 with mitomycin 4 mg/m2 on day 14. Cycles of chemotherapy were repeated every 4 weeks. The overall response rate was 29% with 6% complete responses and 23% partial responses. Prognostic factors that individually affected response were Karnofsky performance (P < 0.002), and site of the primary tumour (P < 0.007). Multivariate analysis showed that only increasing Karnofsky performance (P = 0.01) and disease status (P < 0.02) (patients with recurrent tumours responding better than patients with postoperative residual disease and those with inoperable disease) were important in predicting response to therapy. The overall median survival was 7 months. All 4 patients with a complete response are alive in remission at 13, 28, 48 and 52 months from the date of starting chemotherapy. Univariate analysis identified increasing Karnofsky performance (P < 0.0001), response to chemotherapy (P < 0.02) and higher serum albumin (P < 0.03) as prognostic indicators for survival. Multivariate analysis, of pretreatment factors and day 14 full blood count showed that only Karnofsky performance (P < 0.0001) and day 14 platelet count (P < 0.03) were shown to predict survival, higher platelet values being associated with decreased survival.