Metastatic Gastric Cancer FFCD 03-07

To compare the effectiveness of two different sequences of polychemotherapy among carrying patients of a adenocarcinoma of the stomach or cardia locally advanced or metastatic.

Inclusion criteria

• age = 18 years old
• patients carrying a adenocarcinoma of the stomach or cardia histologically proven
• locally advanced tumour which may not be treated surgically or metastatic tumour
• the patients having a stenosante tumour responsible for a disphagy had to have a tumoral ablation or a prosthesis or a probe of food,
• measurable lesions according to criteria RECIST (specify measurement by spiral scanner of largest diameter of with less the one lesion of size higher than 1 cm) or appraisable but nonmeasurable (lesions < 1 cm, ascite, pleural effusion...)
• general state WHO < 2
• absence of insufficiency cardiac or coronary symptomatic
• absence of previous chemotherapy other that auxiliary stopped since more than 6 months
• filled questionnaires QLQ C30 and STO-22
• PNN = 1500/mm3, haemoglobin ≥ 10g/dl, plates= 100 000/mm3
• creatinin ≤ 110 micromol/l
• bilirubin ≤ 35 micromol/l

Exclusion criteria

• disphagy or intestinal obstruction incompatible with a treatment per os or by a probe of food
• pregnant or nursing woman
• previous of cardiac toxicity to the 5FU or to the anthracyclines
• radiotherapy less than 3 weeks before inclusion, whatever the site
• other evolutionary cancer threatening the short-term life
• metastasis cerebral or méningée known (without obligation to seek it)
• impossibility of regular follow-up for psychological, social, family or geographical reasons