Sequential methotrexate and 5-fluorouracil therapy for gastric cancer patients with bone metastasis

Abstract

Background. Patients with bone metastasis of gastric cancer occasionally experience disseminated intravascular coagulation (DIC), with a very poor prognosis. Methods. We treated 18 gastric cancer patients with hone metastasis with sequential methotrexate and 5-fluorouracil (sequential MTX/5-FU therapy). The treatment schedule comprised weekly administration of methotrexate (MTX; 100mg/m2, i.v. bolus) followed by 5-fluorouracil (5-FU; 600mg/m2, i.v. bolus) after an interval of 3h. Calcium leucovorin (10mg/m2, p.o. or i.v.) was administered six times, every 6h starting 24h after the administration of MTX. Results. In 11 patients with measurable metastatic lesions, the response rate was 64% (7/11). Nine patients (50%) had DIC before the initiation of chemotherapy, and 8 of them (89%) recovered from it. Two of these 9 patients (22%) survived for more than 1 year. The median survival times for all patients and for the 9 with DIC were 186 and 113 days, respectively. Grade 4 leukopenia was observed in 3 patients (17%). No treatment-related deaths occurred. Conclusion. Sequential MTX/5-FU therapy may have tive potential and may be a feasible treatment for gastric pallia-cancer patients with bone metastasis with or without DIC.