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Chemotherapy in advanced gastric cancer achieves response rates of less than 30% to 40% and a median survival of less than 1 year. Standard regimens combining a platinum agent and a fluorinated pyrimidine with or without a third agent (epirubicin or a taxane) have significant toxicities. But whether the use of two or three cytotoxic agents is optimal remains controversial.
Now, investigators in France have conducted a multicenter, randomized, phase III trial to compare first-line use of FOLFIRI, including two chemotherapy agents (fluorouracil and irinotecan) plus leucovorin, versus ECX, consisting of three chemotherapy agents (epirubicin, cisplatin, and capecitabine) in 416 patients with metastatic gastric and gastroesophageal junction adeno…