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H metastatic gastric cancer with no clear consensus emerging as to the best management approach. A meta-analysis of these studies demonstrated an hazard ratio (hr) of 0. 83 for overall survival (os) (95% confidence interval [ci], 0. 74–0. 93) in favor of combination chemotherapy. [14] of all the combination regimens, ecf is often considered the reference standard in the united states and europe. In one european trial, 274 patients with metastatic esophagogastric cancer were randomly assigned to receive either ecf or famtx. [15] the group who received ecf had a significantly longer median survival (8. 9 vs. 5. cheap viagra free shipping 7 months, p =. 0009) than the famtx group. what's the difference between viagra and viagra [15][level of evidence: 1iia] in a second trial that compared ecf with mitomycin, cisplatin, and 5-fu (mcf), there was no statistically significant difference in median survival (9. 4 vs. 8. cheap viagra online 7 months, p =. viagra online 315). [5][level of evidence: 1iia] oxaliplatin and capecitabine are often substituted for cisplatin and 5-fu within the ecf regimen as a result of data from the real-2 trial (isrctn51678883). [6] this randomized trial of 1,002 patients with advanced esophageal, gastroesophageal junction, or gastric cancer utilized a 2 × 2 design to demonstrate noninferior median os in patients treated with capecitabine rather than 5-fu (hrdeath = 0. how long does it take viagra to start working 86; 95% ci, 0. 82–0. 99) and in patients treated with oxaliplatin in place of cisplatin (hrdeath = 0. 92; 95% ci, 0. 80–1. cheap viagra 10). An international collaboration of investigators randomly assigned 445 patients with metastatic gastric cancer to receive docetaxel, cisplatin, and 5-fu (dcf) or cf. [16] time-to-treatment progression (ttp) was the primary endpoint. Patients who received dcf experienced a significantly longer ttp (5. 6 months; 95% ci, 4. 9–5. 9; vs. 3. 7 months; 95% ci, 3. 4–4. 5; hr, 1. 47; 95% ci, 1. 19–1. 82; log-rank p <. 001; risk reduction 32%). The median os was significantly longer for patients who received dcf versus patients who received cf (9. 2 months; 95% ci, 8. 4–10. 6; vs. buy viagra 8. 6 months; 95% ci, 7. 2–9. 5; hr, 1. 29; 95% ci, 1. 0–1. 6; log-rank p =. 02; risk reduction = 23%). [16][level of evidence: 1iia] there were high toxicity rates in both arms. order viagra [17] febrile neutropenia was more common in patients who received dcf (29% vs. 12%), and the death rate on the study was 10. 4% for patients on the dcf arm and 9. 4% for patients on the cf arm. viagra online without prescription Whether the cf regimen should be considered as an index regimen for the treatment of patients with metastatic gastric cancer is the subject of debate. [17] the results of a study that randomly assigned 245 patients with metastatic gastric cancer to receive cf, famtx, or elf demonstrated no significant difference in response rate, progression-free survival, or os between the arms. [7] grades 3 and 4 neutropenia occurred in 35% to 43% of patients on all arms, but severe nausea and vomiting was more common in patients in the cf arm and occurred in 26% of. Development Service

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