Tegafur/Leucovorin calcium/Gimeracil/Oteracil Potassium

A review.Practices are changing overtime,and geog. differences in the treatment of localised and metastatic gastric cancer are becoming increasingly less pronounced,even though some medications are not available or are not reimbursed equally in all countries.Regarding the use of fluoropyrimidines,capecitabine or S-1 can be used as an alternative to infusional fluorouracil in doublet regimens.In addition ciplatin or oxaliplatin are viewed as platinum agents with similar effectiveness when incorporated in doublet or triplet regimens although this aspect remains a matter of debate.S-1 plus cisplatin has been widely used in eastern Asia,whereas infusional fluorouracil (plus leucovorin) or capecitabine,combined with oxaliplatin or cisplatin,are standard practices in Europe and North America.As a conclusion to the SOLAR study,Kang and colleagues suggest that the combination of TAS-118 plus oxaliplatin could be a new first-line standard chemotherapy for advanced gastric cancer,in Asian patients.First,it would have been reasonable to the added value of leucovorin to S-1,by comparing TAS-118 (S-1 plus leucovorin) plus oxaliplatin with S-1 plus oxaliplatin (rather than S-1 plus cisplatin).Second,as the TAS-118 plus oxalipaltin combination appears effective in patients with Lauren's diffuse-type histol. and poor prognosis,we suggest clin. research should focus on this group.Third,TAS-118 plus oxaliplatin deserves to also be tested in non-Asian patients,although it is known that S-1 is not equally tolerated in non-Asian patients and Asian patients.Finally,ongoing phase 3 trials will elucidate the role of many promising compounds such as trifluridine-tipiracil,anti-CLDN18.2 monoclonal antibodies (zolbetuximab), or checkpoint inhibitors, in other clin. relevant subsets of patients with advanced HER2-neg. gastric cancer ,including frail or fit patients, with diffuse type histol., and CLDN18.2-pos. or microsatellite-unstable tumors.