Prescrire Int. 2013 May;22(138):122.
Patients with advanced-stage gastric cancer and inoperable locoregional extension rarely survive more than a few months. Chemotherapy based on intravenous fluorouracil or oral capecitabine slightly prolongs overall survival. An oral fixed-dose combination of tegafur + gimeracil + oteracil (Teysuno degrees, Nordic) has been approved in the European Union for the treatment of advanced gastric cancer. Like capecitabine, tegafur is a metabolic precursor of fluorouracil. It is combined with gimeracil in order to increase its bioavailability and with oteracil to try to reduce its gastrointestinal toxicity. In two randomised, controlled but unblinded trials including 91 and 129 patients with advanced gastric cancer, there was no significant difference in median overall survival times between patients who received the tegafur + gimeracil + oteracil combination and those who received oral capecitabine alone (about 9 and 13 months, respectively). However, the study populations were too small to rule out a noteworthy difference in survival between the 2 treatments. Another randomised, unblinded trial compared tegafur + gimeracil + oteracil versus flurorouracil monotherapy in 1029 patients with gastric cancer, which was often metastastic. However, the dose of concomitantly administered cisplatin was lower in the tegafur group, therefore skewing the results. Median overall survival was about 8 months in both groups, and median progression-free survival was about 5 months. Neither outcome differed significantly between the 2 treatments. Compared to capecitabine, the tegafur + gimeracil + oteracil combination appears to cause fewer cases of severe palmoplantar dysaesthesia but more serious gastrointestinal disorders. Like capecitabine, the tegafur + gimeracil + oteracil combination is administered orally twice daily. In practice, when oral therapy is preferred for a patient with advanced gastric cancer, capecitabine is still the best option because it carries a lower risk of serious gastrointestinal adverse effects.
晚期胃癌且伴有无法手术切除的局部区域扩展的患者很少能存活超过几个月。基于静脉注射氟尿嘧啶或口服卡培他滨的化疗可略微延长总生存期。替吉奥胶囊（替加氟+吉美嘧啶+奥替拉西钾，商品名：泰素帝，北欧）的口服固定剂量组合已在欧盟获批用于治疗晚期胃癌。与卡培他滨一样，替加氟是氟尿嘧啶的代谢前体。它与吉美嘧啶联合以提高其生物利用度，并与奥替拉西联合以试图降低其胃肠道毒性。在两项随机、对照但非盲法的试验中，分别纳入了91例和129例晚期胃癌患者，接受替加氟+吉美嘧啶+奥替拉西组合治疗的患者与单独接受口服卡培他滨治疗的患者相比，中位总生存时间无显著差异（分别约为9个月和13个月）。然而，研究人群规模过小，无法排除两种治疗在生存方面存在显著差异。另一项随机、非盲法试验在1029例常伴有转移的胃癌患者中比较了替加氟+吉美嘧啶+奥替拉西与氟尿嘧啶单药治疗。然而，替加氟组中同时给予的顺铂剂量较低，因此结果存在偏差。两组的中位总生存期约为8个月，中位无进展生存期约为5个月。两种治疗的这两个结果均无显著差异。与卡培他滨相比，替加氟+吉美嘧啶+奥替拉西组合似乎导致严重手足感觉异常的病例较少，但胃肠道紊乱更严重。与卡培他滨一样，替加氟+吉美嘧啶+奥替拉西组合每日口服两次。在实际应用中，当晚期胃癌患者更倾向于口服治疗时，卡培他滨仍是最佳选择，因为它发生严重胃肠道不良反应的风险较低。
