Combination chemotherapy has been shown to be superior to single-agent therapy in gastric and gastroesophageal cancers. However, there is no consensus regarding the optimal regimen. Epirubicin-containing regimens are considered standard in parts of Europe, but the role of anthracyclines remains debatable. In this Viewpoint, we question the continued use of anthracyclines in the treatment of gastroesophageal cancers and discuss why we feel that it is time to move on.

Anthracyclines are associated with serious toxic effects including alopecia, myelosuppression, febrile neutropenia, stomatitis, arrhythmias, and congestive heart failure. These toxic effects must be carefully weighed against expected treatment benefits. Although epirubicin-containing regimens have shown improvement in survival for both resectable and advanced gastroesophageal cancers, the exact contribution of epirubicin has never been demonstrated in a head-to-head comparison with a comparable nonanthracycline-containing arm in any phase III randomized trial. Evidence supporting anthracycline use is mostly derived from small uncontrolled phase II studies, comparisons against no chemotherapy,¹ trials comparing widely dissimilar regimens where the exact contribution of the anthracycline cannot be established,² or a meta-analysis with its own limitations.³

在胃癌和胃食管癌中，联合化疗已被证明优于单药治疗。但是，关于最佳方案尚无共识。在欧洲部分地区，含表柔比星的治疗方案被认为是标准方案，但蒽环类药物的作用仍有待商bat。在这种观点下，我们对蒽环类药物在胃食管癌治疗中的持续使用提出质疑，并讨论了为什么我们认为现在该继续前进了。

蒽环类药物与严重的毒性作用有关，包括脱发，骨髓抑制，发热性中性粒细胞减少，口腔炎，心律不齐和充血性心力衰竭。必须仔细权衡这些毒性作用与预期的治疗益处。尽管含表柔比星的方案在可切除和晚期胃食管癌中均显示出生存率的改善，但在任何III期随机试验中，与含非蒽环类药物的同类药物进行正面对比时，都未证明表柔比星的确切作用。支持使用蒽环类药物的证据主要来自小型的非对照II期研究，未进行化学疗法的比较，¹项比较广泛不同方案而无法确定蒽环类药物确切作用的试验，²或具有自身局限性的荟萃分析。³