Chemotherapy for Stomach Cancer

Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth as pills. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread to organs beyond where it started.

Chemo can be used in different ways to help treat stomach cancer:

  • Chemo can be given before surgery for stomach cancer. This, known as neoadjuvant treatment, can shrink the tumor and possibly make surgery easier. It may also help keep the cancer from coming back and help patients live longer. For some stages of stomach cancer, neoadjuvant chemo is one of the standard treatment options. Often, chemo is then given again after surgery.
  • Chemo may be given after surgery to remove the cancer. This is called adjuvant treatment. The goal of adjuvant chemo is to kill any cancer cells that may have been left behind but are too small to see. This can help keep the cancer from coming back. Often, for stomach cancer, chemo is given with radiation therapy after surgery. This combination is called chemoradiation. This may be especially helpful for cancers that could not be removed completely by surgery.
  • Chemo may be given as the primary (main) treatment for stomach cancer that has spread (metastasized) to distant organs. It may help shrink the cancer or slow its growth, which can relieve symptoms for some patients and help them live longer.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each cycle typically lasts for a few weeks.

A number of chemo drugs can be used to treat stomach cancer, including:

  • 5-FU (fluorouracil), often given along with leucovorin (folinic acid)
  • Capecitabine (Xeloda)
  • Carboplatin
  • Cisplatin
  • Docetaxel (Taxotere)
  • Epirubicin (Ellence)
  • Irinotecan (Camptosar)
  • Oxaliplatin (Eloxatin)
  • Paclitaxel (Taxol)
  • Trifluridine and tipiracil (Lonsurf), a combination drug in pill form

Depending on the situation (including the stage of the cancer, the person’s overall health, and whether chemo is combined with radiation therapy), these drugs may be used alone or combined with other chemotherapy or targeted drugs.

Some common drug combinations used when surgery is planned include:

  • ECF (epirubicin, cisplatin, and 5-FU),which may be given before and after surgery
  • Docetaxel or paclitaxel plus either 5-FU or capecitabine, combined with radiation as treatment before surgery
  • Cisplatin plus either 5-FU or capecitabine, combined with radiation as treatment before surgery
  • Paclitaxel and carboplatin, combined with radiation as treatment before surgery

When chemo is given with radiation after surgery, a single drug such as 5-FU or capecitabine may be used.

To treat advanced stomach cancer, ECF may be used, but other combinations may also be helpful. Some of these include:

  • DCF (docetaxel, cisplatin and 5-FU)
  • Irinotecan plus cisplatin
  • Irinotecan plus 5-FU or capecitabine
  • Oxaliplatin plus 5-FU or capecitabine
  • Trifluridine and tipiracil (Lonsurf), a combination drug in pill form

Many doctors prefer to use combinations of 2 chemo drugs to treat advanced stomach cancer. Three-drug combinations can have more side effects, so they are usually reserved for people who are in very good health and who can be followed closely by their doctor.

Side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells can also be affected by chemo, which can lead to side effects. The type of side effect depends on the type of drugs, the amount taken, and the length of treatment. Short-term side effects common to most chemotherapy drugs can include:

  • Nausea and vomiting
  • Loss of appetite
  • Hair loss
  • Diarrhea
  • Mouth sores
  • Increased chance of infection (from a shortage of white blood cells)
  • Bleeding or bruising after minor cuts or injuries (from a shortage of platelets)
  • Fatigue and shortness of breath (from a shortage of red blood cells)

These side effects are usually short-term and go away once treatment is finished. For example, hair will usually grow back after treatment ends. Be sure to tell your cancer care team about any side effects you have because there are often ways to lessen them. For example, you can be given drugs to prevent or reduce nausea and vomiting.

Some chemotherapy drugs have specific side effects. You should be given specific information about each drug you are receiving and you should review it before you start treatment.

Neuropathy: Cisplatin, oxaliplatin, docetaxel, and paclitaxel can damage nerves outside the brain and spinal cord. This can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most cases this goes away once treatment is stopped, but it may be long-lasting in some patients. Oxaliplatin can also affect nerves in the throat, causing throat pain that is worse when trying to eat or drink cold liquids or foods. This pain can lead to trouble swallowing or even breathing, and can last a few days after treatment.

Heart damage: Doxorubicin, epirubicin, and some other drugs may cause permanent heart damage if used for a long time or in high doses. For this reason, doctors carefully control the doses and use heart tests such as echocardiograms or MUGA scans to monitor heart function. Treatment with these drugs is stopped at the first sign of heart damage.

Hand-foot syndrome can occur during treatment with capecitabine or 5-FU (when given as an infusion). This starts out as redness in the hands and feet, which can then progress to pain and sensitivity in the palms and soles. If it worsens, blistering or skin peeling can occur, sometimes leading to open, painful sores. There is no specific treatment, although some creams may help. These symptoms gradually get better when the drug is stopped or the dose is decreased. The best way to prevent severe hand-foot syndrome is to tell your doctor when early symptoms come up, so that the drug dose can be changed.

To learn more, see Chemotherapy.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Cunningham D, Allum W, Stenning S et al. Perioperative chemotherapy vs surgery alone for resectable gastroesophageal cancer. N Eng J Med. 2006;355:11–20.

Jeung H, Moon Y, Rha S, et al. Phase III trial of adjuvant 5-flourouracil and adriamycin versus 5-flourouracil and adriamycin and polyadenylic-polyuridylic acid (poly a:u) for locally advanced gastric cancer after curative surgery: Final results of 15 year follow-up. Annals of Oncology. 2008;19:520–526.

Kang YK, Yook JH, Chang HM, Ryu MH, Yoo C, Zang DY, Lee JL, Kim TW, Yang DH, Jang SJ, Park YS, Lee YJ, Jung HY, Kim JH, Kim BS. Enhanced efficacy of postoperative adjuvant chemotherapy in advanced gastric cancer: results from a phase 3 randomized trial (AMC0101). Cancer Chemother Pharmacol. 2014 Jan;73(1):139-49. Epub 2013 Oct 27.

Kappas AM, Roukos DH. Quality of surgery determinant for the outcome of patient with gastric cancer. Ann Surg Oncol. 2002;9:828–830.

MacDonald JS, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. New Engl J Med. 2001;345:725–730.

National Cancer Institute. Physician Data Query (PDQ). Gastric Cancer Treatment. 2/2/2017. Accessed at: on November 20, 2017.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Gastric Cancer. v.3.2017. Accessed at on November 20, 2017.

Pozzo C, Barone C. Is there an optimal chemotherapy regimen for the treatment of advanced gastric cancer that will provide a platform for the introduction of new biological agents? Oncologist. 2008;13:794–806.

Last Revised: February 27, 2019

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.