Chemotherapy for Advanced Gastric Carcinoma

To the Editor.— We read with considerable interest and some concern the article by Cullinan et al 1 comparing the efficacy of three chemotherapeutic regimens, in particular the FAM combination (fluorouracil, Adriamycin [doxorubicin hydrochloride], and mitomycin C) in advanced gastric and pancreatic cancer. Although we agree that the literature does not fully support the use of doxorubicin-containing regimens for patients with pancreatic cancer, we believe that Cullinan's report is deficient in describing the potential benefits of combination chemotherapy in gastric cancer reported in other published trials. The authors fail to cite the later (1980) Georgetown University experience utilizing FAM chemotherapy, in which 62 patients with advanced, measurable gastric cancer were treated and a 42% response rate, which was shown to correlate well with increased survival, was obtained. 2 The comparative trial of four chemotherapy combinations from the Gastrointestinal Tumor Study Group (1982) is not referenced. 3 This study, in which