Chemotherapy drugs used for stomach cancer

Doctors most often use combinations of chemotherapy drugs together. Which drugs you have will depend on why you are having the treatment. You should be given written information about the drugs you are to have by your chemotherapy nurse or doctor.

The most commonly used standard drug combinations for stomach cancer before or after surgery are ECF and ECX.

ECF contains the drugs epirubicin, cisplatin and fluorouracil. There is a page on the specific side effects of ECF in our section on cancer drugs.

You have ECF by injection and through a pump. You will need a central line. This is a tube that goes into a main blood vessel in your neck. The end of the tube comes out of your chest. It is this that attaches to the pump. You may have 4 to 6 months of treatment depending on how your cancer responds.

ECX contains the drugs epirubicin, cisplatin and capecitabine (Xeloda). There is a page about the side effects of ECX in our section on cancer drugs. You have the epirubicin and cisplatin into a vein but the capecitabine is taken as a tablet.

Chemotherapy is used to try to shrink and control advanced stomach cancers. Doctors are always trying to find combinations of chemotherapy drugs that work better than current treatments. So they test new drugs and new combinations of drugs.

A clinical trial called REAL 2 looked at 4 different combinations of chemotherapy drugs used for stomach and oesophageal cancer that had already spread. The drug combinations were

• ECF - epirubicin, cisplatin and fluorouracil
• EOF - epirubicin, oxaliplatin and fluorouracil
• ECX - epirubicin, cisplatin and capecitabine (Xeloda)
• EOX - epirubicin, oxaliplatin (Eloxatin), and capecitabine

This trial showed that capecitabine tablets worked as well as fluorouracil through a pump, and oxaliplatin worked as well as cisplatin when given with epirubicin and fluorouracil or capecitabine. And the quality of life of people on the different chemotherapy combinations was similar.

Capecitabine is licensed to treat advanced stomach cancer in combination with a platinum chemotherapy drug, such as cisplatin. Capecitabine is licensed to treat advanced stomach cancer in combination with a platinum chemotherapy drug, such as cisplatin. The National Institute for Health and Clinical Excellence (NICE) and the Scottish Medicines Consortium (SMC) have recommended that capecitabine should be available in the NHS for people with advanced stomach cancer who cannot have surgery as first line treatment in combination with a platinum-based chemotherapy regimen.

Other chemotherapy combinations that may be used include

• MCX (mitomycin, cisplatin and 5FU)
• FAMTX (doxorubicin, and methotrexate)
• FEMTX (5FU, epirubicin and methotrexate

A new trial called REAL 3 has now started and is testing whether adding a biological therapy called panitumumab (Vectibix) to chemotherapy makes it work better.

Some other chemotherapy drugs being tested here and abroad in trials for advanced stomach cancer include

• Irinotecan
• Gemcitabine
• Paclitaxel

Click on the above links to find out more about the specific side effects of any of these drugs. You can read about other chemotherapy combinations in research trials on our page about what's new in stomach cancer.

Chemotherapy side effects vary, depending on the particular drugs you are having. The most common side effects are

• A drop in your blood counts, causing increased risk of infection
• Feeling or being sick
• Hair loss or thinning
• Diarrhoea
• A sore mouth or mouth ulcers

Not everyone has the same side effects, or gets them to the same extent. You won't know exactly how the treatment affects you until you start.

We have specific pages on the side effects of fluorouracil, methotrexate, cisplatin, epirubicin, doxorubicin, mitomycin, irinotecan, gemcitabine, paclitaxel and capecitabine in the cancer drugs section of CancerHelp UK.

If your cancer can be seen clearly on a scan, your doctor will take a note of its size before your treatment starts. Then, after about 3 or 4 cycles of chemo, you'll have another scan. Your doctor can measure the tumour again and see how much it has shrunk. In some people, the chemotherapy does not shrink the cancer. If your tumour doesn't appear to be shrinking, your doctor may suggest stopping the chemotherapy. There is no point in you having the side effects if the chemotherapy isn't working.

Your doctor may then suggest another combination of drugs or a different type of treatment. If your cancer comes back more than 6 months after your initial chemotherapy treatment, you might have the same combination of chemotherapy drugs again.