***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and aims : oxaliplatin in combination with folinic acid ( FA ) and infusional 5-fluorouracil ( 5-FU ) has shown significant anti-tumor activity in gastric cancer patients ( FOLFOX ) . Previous studies have shown that gemcitabine ( GEM ) , a new fluorinated anti-metabolite , enhances the individual anti-tumor activity of either 5-FU or oxaliplatin . We have therefore design ed a multi-center phase II trial in order to test a novel GEM + FOLFOX-4 regimen in patients with metastatic gastric cancer . Methods : we enrolled 36 patients , 28 males and 8 females , with an average age of 64.4 years ( range 37–78 ) , who received bi-weekly treatment with GEM ( 1,000 mg/m2 on day 1 ) ,  levo-FA ( 100 mg/m2 on days 1 and 2 ) , a 5-FU ( 400 mg/m2 ) bolus injection followed by 22-h continuous infusion ( 800 mg/m2 ) on days 1 and 2 , and oxaliplatin 85 mg/m2 in a 4–6 h intravenous ( i.v . ) infusion before the second FUFA administration on day 2 . Results : the most frequent side effect was grade 1–2 hematological toxicity and late sensorial neurotoxicity . Two patients developed hypersensitivity to oxaliplatin while another developed an aseptic eosinophilic pneumonitis . Two patients refused to continue the treatment after two cycles of chemotherapy and were lost at the follow-up . Among the remaining 34 patients four achieved a complete response , 15 a partial response , 12 had a stable disease and three progressed . Conclusions : these results may grant the rationale to evaluate this multi-drug combination in r and omized phase III trials in advanced gastric cancer PURPOSE To evaluate the toxicity and activity of infusional fluorouracil ( FU ) , folinic acid ( FA ) , and oxaliplatin , administered every 2 weeks in patients with metastatic gastric cancer . PATIENTS AND METHODS Forty-one previously untreated patients with measurable adenocarcinoma of the stomach were eligible for the study . Patients received FU 2.6 g/m(2 ) ( 24-hour continuous infusion ) , FA 500 mg/m(2 ) ( 2-hour intravenous infusion ) , and oxaliplatin 85 mg/m(2 ) ( 2-hour intravenous infusion ) every 2 weeks for 6 weeks . Treatment was continued until progression of disease was observed . RESULTS All patients were assessable for toxicity and 37 of 41 patients were assessable for response . Patient characteristics were : sex ( male , 28 ; female,13 ) , median age 60 years ( range , 20 to 77 years ) , and median Eastern Cooperative Oncology Group performance status of 1 . Response was evaluated every 6 weeks . Of 37 assessable patients , one complete and 15 partial remissions were observed ( overall response rate , 43 % ) . Stable disease was observed in 12 patients ( 32 % ) and progressive disease in nine patients ( 24 % ) . The median overall survival was 9.6 months . WHO grade 3 or 4 hematologic toxicities included neutropenia in two patients ( 4.9 % ) and thrombocytopenia in one patient ( 2.4 % ) . Other WHO grade 3 or 4 toxicities included diarrhea in three patients ( 7.3 % ) and vomiting in two patients ( 4.9 % ) . There were no cases of grade 3 peripheral neuropathy and no treatment-related deaths . CONCLUSION Biweekly fluorouracil , folinic acid , and oxaliplatin is active and well-tolerated in patients with advanced gastric cancer .  Response rates , time to progression , and overall survival were comparable to those achieved with other combination chemotherapy regimens , including FOLFOX6 , with significantly less toxicity PURPOSE Data concerning the prevalence of and outcomes related to thromboembolic events ( TEs ) in patients with advanced gastroesophageal cancer who are undergoing chemotherapy are limited . PATIENTS AND METHODS This was a prospect i ve , exploratory analysis of TEs in a r and omized , controlled trial of 964 patients recruited between 2000 and 2005 and treated with epirubicin/platinum/fluoropyrimidine combination chemotherapy for advanced/locally advanced gastroesophageal cancer . Regimens were epirubicin ( E ) , cisplatin ( C ) , fluorouracil ( F ; ECF ) ; E , C , capecitabine ( X ; ECX ) ; E , F , oxaliplatin ( O ; EOF ) ; and EOX . Continuously infused F was administered via a central venous access device ( CVAD ) with 1 mg of warfarin for thromboprophylaxis . The principal outcome was the incidence of TEs ( venous and arterial ) in the whole treated patient cohort , according to chemotherapy , associated with CVADs and TE-related prognoses . RESULTS The incidences of any , of venous , and of arterial TEs among 964 treated patients were 12.1 % ( 95 % CI , 10.7 to 14.3 ) , 10.1 % ( 95 % CI , 8.3 to 12.3 ) , and 2.2 % ( 95 % CI , 1.4 to 3.4 ) respectively . There were fewer TEs in the O compared with the cisplatin groups ( EOF/EOX v ECF/ECX : 7.6 % v 15.1 % ; P = .0003 ) . C was identified as a risk factor for TE in multivariate analysis ( hazard ratio [ HR ] , 0.51 ; 95 % CI , 0.34 to 0.76 ; P = .001 ) . There was no difference in the incidence of TEs for the F group compared with the capecitabine groups . The incidence of CVAD-related thrombosis was 7.0 % ( ECF/EOF arms ) . Overall survival was worse for patients who experienced TEs versus no TEs ( median survival , 7.4 v 10.5 months ; HR , 0.8 ; 95 % CI , 0.64 to 0.99 ; P = .043 ) . CONCLUSION This analysis has prospect ively quantified the incidence/pattern of TEs among patients with advanced gastroesophageal cancer who were treated with four triplet regimens , has demonstrated a differential thrombogenic effect according to platinum use , and has noted a poorer outcome associated with TE during treatment . Chemotherapy-related TE should contribute to the risk/benefit assessment of treatment 4540 Background : Up to now the value of 2nd-line therapy for metastatic gastric cancer is unclear . So far there are no r and omized phase III data comparing 2nd-line chemotherapy to BSC . Irinotecan has proven activity in 1st-line therapy . In this r and omized phase III study we compared irinotecan to BSC to evaluate the value of 2nd- line chemotherapy for gastric cancer . METHODS Prospect i ve multicenter r and omized phase III study , open label . Eligibility : Metastatic or locally advanced gastro-esophageal junction or gastric adenocarcinoma . Objective tumor progession ( PD ) within 6 months after 1st- line chemotherapy . ECOG PS 0 - 2 . STATISTICS Primary endpoint : Overall survival ( OS ) . HYPOTHESIS H1 : OS(Irinotecan)>OS(BSC ) . Calculated number of pts needed ( power 80 % , alpha error 5 % ) : 60 pts per arm . Stratification for a ) PD less versus ( vs ) more than 3 months after 1st line chemotherapy , b ) ECOG PS 0/1 vs 2 . TREATMENT Arm A : Irinotecan 250mg/m2 q3w ( 1st cycle ) to be increased to 350 mg/m2 , depending on toxicity . Arm B : BSC Results : Between Oct 2002 and Dec 2006 40 pts were r and omized . The study was closed prematurely due to poor accrual . Arm A:21 pts , arm B 19 pts . Median age A : 58 yrs ( 43 - 73 ) , B : 55 yrs ( 35 - 72 ) ; PD less vs more than 3 months after 1st-line chemotherapy : A : 18 / 3 , B : 17 / 2pts . ECOG PS 0/1 vs 2 : A : 17/ 4 , B : 14/ 5pts . Pre-treatment with cisplatin : A : 21 , B:19 pts . Arm A : 68 cycles administered in 21 pts . TOXICITY ( main CTC grade 3/ 4 ) : Nausea 1 pt , vomiting 1 pt , diarrhoea : 5 pts , neutropenic fever : 2 pts , data incomplete 6 pts . In 37 % of 19 evaluable pts irinotecan dose was escalated to 350mg/m2 . Response ( 19 pts evaluable ) : No objective responses , SD 58 % , PD 42 % . Improvement of tumor related symptoms : 44 % of pts in arm A , 5 % in arm B. Survival : ( evaluable pts arm A 21 , arm B 18 ) : median survival arm A : 123 days ( 95%CI 95 - 216 ) , arm B 72.5 days ( 95%CI 41 - 106 ) ; OS : HR=2.85 ( 95%CI 1.41 - 5.79 ) , Logrank test ( two-sided ) : p=0.0027 . CONCLUSIONS To our knowledge this is the first r and omized phase III study investigating 2nd- line chemotherapy in gastric cancer . Irinotecan as 2nd-line chemotherapy significantly prolongs overall survival compared to BSC . 2nd-line chemotherapy can now be considered as a proven option in gastric cancer . [ Table : see text ] BACKGROUND Oxaliplatin shows pre clinical activity in many cancer cell lines that are resistant to cisplatin , and also has synergism with 5-fluorouracil ( 5-FU ) . We undertook this study to evaluate the efficacy and toxicities of a combined oxaliplatin , 5-FU and leucovorin ( LV ) continuous infusion regimen in patients with advanced gastric cancer who progressed during or after treatment with 5-FU and platinum compounds . PATIENTS AND METHODS Twenty-six patients with advanced gastric cancer , whose disease progressed while receiving , or after discontinuing , chemotherapy with a 5-FU and platinum regimen , were enrolled in this study . Treatment comprised oxaliplatin ( 85 mg/m2 on day 1 ) as a 2-h infusion followed by bolus 5-FU ( 400 mg/m2 on day 1 ) , and 48-h infusion of 5-FU 2.4 - 3.0 g/m2 concurrently with LV 150 mg/m2 . Cycles were repeated at 2-week intervals . RESULTS Of the 23 evaluable patients , there were six partial responses ( response rate 26 % ) . All responding patients were among those who entered into this trial immediately after failure of previous chemotherapy with 5-FU and cisplatin . The median time to progression was 4.3 months and the median overall survival was 7.3 months . The most common hematologic toxicity was grade 1 - 2 anemia in 39 cycles ( 39 % ) . No grade 4 leukopenia or thrombocytopenia were observed . The most common non-hematologic toxicity was nausea/vomiting ( 33 % ) . Peripheral neuropathy of grade 1 or 2 was noted ( 27 % ) , but there was no grade 3 or 4 neurotoxicity . CONCLUSIONS This phase II study of oxaliplatin , 5-FU and LV continuous infusion showed activity in previously platinum-treated patients with advanced gastric cancer , with acceptable toxicities BACKGROUND A regimen of epirubicin , cisplatin , and infused fluorouracil ( ECF ) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma . We assessed whether the addition of a perioperative regimen of ECF to surgery improves outcomes among patients with potentially curable gastric cancer . METHODS We r and omly assigned patients with resectable adenocarcinoma of the stomach , esophagogastric junction , or lower esophagus to either perioperative chemotherapy and surgery ( 250 patients ) or surgery alone ( 253 patients ) . Chemotherapy consisted of three preoperative and three postoperative cycles of intravenous epirubicin ( 50 mg per square meter of body-surface area ) and cisplatin ( 60 mg per square meter ) on day 1 , and a continuous intravenous infusion of fluorouracil ( 200 mg per square meter per day ) for 21 days . The primary end point was overall survival . RESULTS  ECF-related adverse effects were similar to 
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Conclusions Our results support the existence of a small but significant survival benefit of oxaliplatin over cisplatin .
Oxaliplatin is associated with less toxicity and better tolerability , especially in older patients and when used in two-drug , bi-weekly regimens