PDGFR Inhibitors epidemiologic data indicate that the incidence of gastric cancer increases rapidly after the age of 60 years. However, elderly patients have often been excluded from or underrepresented in trials of new cancer therapies. Although systemic chemotherapy has demonstrated survival benefits in patients with advanced gastric cancer (AGC), few regimens were assessed in the setting of elderly patients. So far, no single standard regimen has been established worldwide.

Triple-drug schedules, such as ECF [epirubicin, cisplatin and 5-fluorouracil and DCF (docetaxel, cisplatin and 5-FU) have been confirmed to be highly effective in advanced disease. However, the severe hematological toxicity, particularly from DCF, made the administration in elderly patients difficult. In contrast, PF combination is a less toxic doubledrug regimen and seems more feasible in the elderly population. In 2003, Graziano et al.reported that weekly PLF chemotherapy was active and safe in elderly AGC patients. However, a drawback of PF is that cisplatin needs venous hydration, and continuous infusion of 5-FU requires chronic venous access by an indwelling catheter, which is inconvenient and associated with venous thrombosis and infections. Oxaliplatin is an  Tasocitinib alkylating agent inhibiting DNA replication by forming adducts between two adjacent guanines or guanine and adenine molecules.

The adducts of oxaliplatin appear to be more effective than cisplatin adducts with regard to the inhibition of DNA synthesis. In published phase II trials, the oxaliplatin-based regimens demonstrated a response rate ranging from 40 to 50% in chemotherapy-naive AGC patients. Also, oxaliplatin/ 5-FU/leucovorin combinations have proved to be active and tolerable in elderly AGC patients. Two randomized phase III trials showed that oxaliplatin was non-inferior to cisplatin in the treatment of advanced gastric or esophagogastric cancer. A recent metaanalysis demonstrated a small but significant survival benefit of oxaliplatin over cisplatin. Oxaliplatin is associated with a lower incidence of renal toxicity and nausea compared with cisplatin, and the dose-limiting toxicity is a cumulative sensory peripheral neuropathy. Capecitabine is an oral fluoropyrimidine, which is absorbed from the gastrointestinal tract as an intact molecule, metabolized primarily in the liver and  authority converted in tumor tissues to 5-FU by the enzyme thymidine phosphorylase. Capecitabine is an established oral alternative to 5-FU in the treatment of colorectal cancer both alone and in combination with oxaliplatin.

Capecitabine was also active as a single agent in previously untreated patients with AGC. Recently, both the ML17032 and REAL-2 study indicated that 5-FU can be replaced by capecitabine in the treatment of advanced gastric or esophagogastric cancer. Moreover, a meta-analysis based on those two trials showed that overall survival (OS) was superior in patients treated with capecitabine combinations compared with 5-FU combinations.a normal cardiac function, absence of second primary tumor other than non-melanoma skin cancer or in situ cervical carcinoma, no central nervous system involvement.