The role of chemotherapy in the management of gastric and pancreatic carcinomas.

Gastric and pancreatic carcinomas are important worldwide health problems, typically diagnosed late in the disease process when symptoms of pain and weight loss signify the presence of locally advanced or metastatic tumor. During the past decade, new regimens of combination chemotherapy have, in general, produced increased response rates for patients with advanced gastric cancer, with evidence of improved survival in several controlled trials. For patients with locally advanced gastric cancer, combined-modality therapy has resulted in long-term survival for approximately 15% of cases. The role of adjuvant therapy is now being defined in several randomized control trials of doxorubicin-based chemotherapy regimens. The position of combination chemotherapy for advanced pancreatic carcinoma is less well defined, but present data favor a regimen of streptozotocin, mitomycin-C, and 5-fluorouracil. Combined-modality therapy has resulted in modest improvements in disease-free survival for patients with locally advanced and resected tumors. The search for more effective drugs for gastrointestinal cancer represents the highest priority in the development of treatment strategies for this important group of tumors.