VEGFR Inhibitors  an effort to provide a more simple regimen with a similar antitumor activity for elderly patients, in the present study, we assessed the XELOX regimen. Given the elderly patient population, the dose of capecitabine used here was twice daily in order to reduce toxicity without compromising the efficacy. Jatoi Diarrhea is one of the main side effects of capecitabine. In a randomized phase III trial with XELOX in advanced colorectal cancer, grade 3/4 diarrhea occurred in 20% of patients and was a main factor resulting in dose reductions of capecitabine. In this study, though all the patients were elderly, with capecitabine administered at twice daily, only 4.3% of them experienced grade 3 diarrhea. The data were lower than the 13.6% reported in the study by Dong  in which the elderly AGC patients received XELOX treatment with capecitabine. Besides the lower dosing of capecitabine, another potential reason for the lower incidence of grade 3/4 diarrhea in our study may be due to the Asian patients enrolled.

A recent meta-analysis has demonstrated that regional differences exist in the tolerability profiles of fluoropyrimidines, with East Asian patients having the lowest and US patients the highest relative risk of toxicity. We noticed that safety data from the XELOX regimen in the treatment of AGC also confirmed the conclusions above. The incidences of grade 3/4 diarrhea were reported ranging from 2 to 13.6% in Asian patients, whereas it was as high as 30% in US patients. In the present study, grade 3 HFS was observed in none of the patients, while it occurred in 9.1% of patients in the study by Dong . The considerably  Elesclomol lower incidence of HFS should be attributed to the lower dosing of capecitabine. In randomized phase III trials, up to 16–18% of metastatic colorectal cancer patients experienced grade 3 HFS when capecitabine was given as a monotherapy at twice daily. In this study, with a median of 6 treatment cycles for each patient, oxaliplatin did not cause severe neurological toxicity. Grade 1–2 neuropathy occurred in 56.6% of patients, and grade 3 only in 2.2%. In addition, nausea and vomiting toxicities were also mild and occurred less frequently as compared with cisplatin-based regimens. In summary, this study shows that the XELOX regimen was active, fairly tolerable and conveniently delivered as first-line chemotherapy in elderly patients with AGC.

Comparative trials with other active regimens should be performed. Targeted agents are also expected to be incorporated to optimize the efficacy. Pancreatic cancer patients have one of the worst prognoses among all cancer types with an overall survival rate of less than 5%. Since the publication of Burris in 1997 gemcitabine is still considered as the standard treatment for most patients with pancreatic cancer. Several randomized clinical trials comparing gemcitabine in combination with other chemotherapeutic drugs have not resulted in survival improvement. Moving away from the paradigm that combination  dukes  therapy must be gemcitabine based, a strategy that has invariably failed, Conroy  recently demonstrated in a randomized clinical trial a significant survival advantage.