1
|
Moriwaki T, Hirai S, Hironaka S, Amagai K, Soeda A, Sato M, Nihei T, Hirose M, Matsuda K, Ohkawara A, Yamaguchi T, Ozeki M, Mamiya T, Murashita T, Hyodo I. A randomized phase II study comparing S-1 plus weekly split-dose cisplatin with S-1 plus standard-dose cisplatin as first-line chemotherapy for advanced gastric cancer. Gastric Cancer 2014; 17:354-61. [PMID: 23852397 DOI: 10.1007/s10120-013-0284-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 06/27/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND S-1 plus weekly split-dose cisplatin demonstrated promising results in previous phase I and II studies for advanced gastric cancer (AGC) patients. METHODS In this randomized phase II study, the efficacy and safety of S-1 plus weekly split-dose cisplatin (SWP, S-1 daily oral dose of 80-120 mg according to body surface area on days 1-14, and cisplatin 20 mg/m(2) i.v. on days 1 and 8 every 3 weeks) were compared with those of S-1 plus standard-dose cisplatin (SP) as first-line chemotherapy for AGC patients. The primary endpoint was 1-year survival rate. RESULTS Patients were randomized into two groups: 18 in the SWP arm and 19 in the SP arm. This trial was terminated early because of low patient enrollment. The 1-year survival rate was 61 % [95 % confidence interval (CI), 36-86 %] and 53 % (95 % CI, 30-75 %) in the SWP and SP arms, respectively. However, the median survival time was 12.3 months (9.9-14.6 months) and 15.7 months (4.0-27.4 months), respectively (P = 0.064). Progression-free survival was significantly shorter in the SWP arm than in the SP arm (P = 0.047). Toxicity tended to be milder in the SWP arm than in the SP arm. For approximately 40 % of patients in the SWP arm, cisplatin was omitted on day 8 and treatment delayed because of prolonged myelosuppression. CONCLUSIONS No clear benefits of adding cisplatin to S-1 in the SWP arm were demonstrated in this study. At this point, split-dose cisplatin combined with S-1 cannot be recommended for use in clinical practice.
Collapse
Affiliation(s)
- Toshikazu Moriwaki
- Division of Gastroenterology, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-0006, Japan,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Alternating treatment with S-1 plus low-dose cisplatin and S-1 alone for advanced gastric cancer. J Gastrointest Surg 2011; 15:791-6. [PMID: 21512899 DOI: 10.1007/s11605-011-1476-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 02/23/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study was to investigate the efficacy and safety of an alternating regimen of S-1 plus low-dose cisplatin and S-1 alone as adjuvant therapy in patients with advanced gastric cancer. PATIENTS AND METHODS The study group comprised 100 patients with stage IIIA, stage IIIB, or stage IV. Patients postoperatively received three 5-week cycles of chemotherapy. In the first cycle, S-1 (80 mg/m(2)) was given daily for 3 weeks, followed by 2 weeks of rest, and low-dose cisplatin (10 mg) was given on days 1 to 5 and 8 to 12. In the second and third 5-week cycles, S-1 alone was given. The primary endpoints were median survival time, and survival at 1 and 3 years. Secondary endpoints were safety and overall response rates. RESULTS Median survival time was 18 months in stage IV and 32 months in stage IIIB. The rates of survival at 1 and 3 years were 68.7% and 30.6% in stage IV, 100% and 68.4% in stage IIIA, and 100% and 46.6% in stage IIIB, respectively. Adverse events of grade 3 or 4 occurred in 14% of the patients. The overall response rate of target lesions was 54%. CONCLUSION Our regimen is effective and safe for adjuvant therapy in patients with curatively resected stage III gastric cancer.
Collapse
|
3
|
Nakata B, Tsuji A, Mitachi Y, Taenaka N, Kamano T, Oikawa K, Onoda N, Kambe M, Takahashi M, Shirasaka T, Morita S, Sakamoto J, Tanaka Y, Saji S, Hirakawa K. Phase II trial of S-1 plus low-dose cisplatin for unresectable and recurrent gastric cancer (JFMC27-9902 Step2). Oncology 2011; 79:337-42. [PMID: 21430401 DOI: 10.1159/000323286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 11/02/2010] [Indexed: 11/19/2022]
Abstract
AIMS The efficacy and the toxicity of oral fluorouracil derivative S-1 plus low-dose cisplatin in unresectable or recurrent gastric cancer were evaluated by a phase II study. METHODS S-1 was administered orally for 28 days following 14 days' rest at 80-120 mg/body/day, depending on body surface area. During administration of S-1, cisplatin was given twice a week at the recommended dose (10 mg/m(2)), which was determined by a phase I study. Data from 34 patients in phase II and 8 patients treated with the recommended dose of cisplatin in phase I were analyzed. The primary endpoint was objective response. RESULTS The response rate was 47.1%. The median survival time was 11.0 months and the median progression-free survival was 6.9 months. The grade 3/4 toxicities observed in 10% or more of the treated patients were neutropenia (16.7%), anemia (16.7%) and anorexia (11.9%). The serum concentration of cisplatin was 794 ± 341 ng/ml at day 25 of the first course. CONCLUSIONS S-1 plus low-dose cisplatin may be a clinically useful regimen for unresectable or recurrent gastric cancer because of its infrequent adverse events in spite of considerable efficacy and its convenience of no hydration and no hospitalization.
Collapse
Affiliation(s)
- Bunzo Nakata
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Phase I/II and pharmacokinetic study of S-1 and oxaliplatin in previously untreated advanced gastric cancer. Cancer Chemother Pharmacol 2009; 65:473-80. [PMID: 19551382 DOI: 10.1007/s00280-009-1052-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 06/08/2009] [Indexed: 01/16/2023]
Abstract
BACKGROUND We aimed to determine the maximum-tolerated dose (MTD) of S-1 when given with oxaliplatin, to evaluate S-1 pharmacokinetics, and to determine the efficacy and safety of this regimen as a first-line treatment for advanced gastric cancer (AGC). METHODS Oxaliplatin was fixed at a dose of 130 mg/m2 on day 1 (D1). S-1 was administered from D1 to D14 of a 3-week cycle, and escalated by 10 mg/m2 per day from 70 mg/m2 per day up to 100 mg/m2 per day. Pharmacokinetic analyses were performed following a single dose of S-1 on D-5 and D1 of the first cycle. RESULTS In phase I (n=18), MTD was not defined. In phase II (n=47) with the planned maximum dose, partial response was achieved in 26 patients (55.3%) and stable disease in 14 patients (29.8%). The median time to progression was 6.6 months (95% CI 4.0-9.2 months) and the median overall survival was 12.5 months (95% CI 9.2-15.9 months). Frequent grade 3/4 toxicities included thrombocytopenia (39%), neutropenia (28%), anemia (17%), and leukopenia (13%). There was one grade 5 febrile neutropenia during the first cycle. CONCLUSIONS The pharmacokinetics of S-1 was not influenced by oxaliplatin. S-1/Oxaliplatin combination therapy is highly active against AGC and has a favorable toxicity profile.
Collapse
|
5
|
Ozawa Y, Inui N, Naitoh T, Yasuda K, Nagayama M, Shirai T, Suganuma H, Fujii M, Nakamura H, Suda T, Chida K. Phase II study of combination chemotherapy with S-1 and weekly cisplatin in patients with previously untreated advanced non-small cell lung cancer. Lung Cancer 2008; 63:68-71. [PMID: 18513824 DOI: 10.1016/j.lungcan.2008.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 04/10/2008] [Accepted: 04/17/2008] [Indexed: 10/22/2022]
Abstract
We aimed to evaluate the efficacy and safety of combination chemotherapy with S-1 and low-dose weekly cisplatin in patients with advanced non-small cell lung cancer (NSCLC). In this phase II trial, previously untreated patients with stage IIIB/IV NSCLC were treated with oral administration of S-1 at 80 mg/m(2) for 21 days and three consecutive weekly low doses of cisplatin (25 mg/m(2)) followed by a 2-week rest period. Twenty-six patients were eligible for the assessment of efficacy and safety. Six partial responses were observed with an overall response rate of 23.1% (95% confidence interval: 12.3-31.6%). The median survival time and median progression-free survival were 13.4 months and 5.4 months, respectively. Grade 3/4 hematologic toxicities were observed in 9 patients (34.6%), including one grade 4 neutropenia and thrombocytopenia. As for non-hematologic adverse reactions, although grade 3 events were observed in 4 patients (15.3%), no severe renal toxicity or vomiting was found. S-1 and weekly low-dose cisplatin combination chemotherapy in patients with advanced NSCLC showed an acceptable response rate, overall survival time, and toxicity. Because this regimen can be performed in an outpatient setting, it might be an alternative useful and convenient option. Further investigations with a large population are required to confirm our results.
Collapse
Affiliation(s)
- Yuichi Ozawa
- The Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
Although the role of systemic chemotherapy has been established for the treatment of advanced gastric cancer, the prognosis of these patients remains poor, with a median overall survival of less than 1 year. Based on the results of several randomized Phase III trials, 5-fluorouracil continuous infusion plus cisplatin, with or without epirubicin, has become the global reference regimen for this patient population. However, treatment with fluorouracil infusion requires either frequent hospitalizations or the use of a central venous access device, harboring potential complications. Capecitabine, a tumor-activating oral prodrug of fluorouracil, may be more advantageous in terms of patient convenience, safety and efficacy. Two recent randomized Phase III trials have shown that capecitabine could replace infusional fluorouracil in cisplatin-based regimens. Furthermore, Phase II trials have shown that many other capecitabine-based doublet or triplet chemotherapy regimens incorporating newer cytotoxic agents are active and well tolerated. Many promising biological agents are now being tested in Phase III trials, incorporating capecitabine combinations as control arms, in patients with advanced gastric cancer.
Collapse
Affiliation(s)
- Jae-Lyun Lee
- University of Ulsan College of Medicine, Division of Oncology, Department of Internal Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Yoon-Koo Kang
- University of Ulsan College of Medicine, Division of Oncology, Department of Internal Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea
| |
Collapse
|
7
|
Kim YJ, Im SA, Kim HG, Oh SY, Lee KW, Choi IS, Oh DY, Lee SH, Kim JH, Kim DW, Kim TY, Kim SW, Heo DS, Yoon YB, Bang YJ. A phase II trial of S-1 and cisplatin in patients with metastatic or relapsed biliary tract cancer. Ann Oncol 2008; 19:99-103. [PMID: 17846018 DOI: 10.1093/annonc/mdm439] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Optimal chemotherapy for advanced biliary tract cancer (BTC) is yet to be defined. We carried out this study to evaluate the efficacy and toxicity of combination chemotherapy with S-1 and cisplatin in metastatic or relapsed BTC. PATIENTS AND METHODS Patients with pathologically proven BTC were eligible. The chemotherapy regimen consisted of S-1 (40 mg/m(2) p.o. b.i.d. from D1-14) and cisplatin (60 mg/m(2) on D1), repeated every 3 weeks. RESULTS Fifty-one BTC patients (metastatic:relapsed = 37:14, Gall-bladder:intrahepatic bile ducts:extrahepatic bile ducts = 16:25:10) were enrolled from January 2005 to December 2006. Median age was 57 years (range, 31-71) and most patients had a good performance status. The overall response rate was 30% [95% confidence interval (CI), 17.3-42.7] and complete response was observed in two patients (4%), partial response in 13 (26%), stable disease in 21 (42%), and progressive disease in 9 (18%). With a median follow-up of 12.4 months, the median time to progression was 4.8 months (95% CI, 3.3-6.3) and median overall survival was 8.7 months (95% CI, 6.0-11.4). Major toxic effects were grade 3/4 neutropenia (8.9% of all cycles) and febrile neutropenia was observed in six cycles (2.7% of all cycles). CONCLUSION Combination chemotherapy with S-1 and cisplatin was a moderately effective outpatient-based regimen in BTC patients. Toxic effects were moderate but manageable.
Collapse
Affiliation(s)
- Y J Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Takayama T, Sato Y, Sagawa T, Okamoto T, Nagashima H, Takahashi Y, Ohnuma H, Kuroiwa G, Miyanishi K, Takimoto R, Matsunaga T, Kato J, Yamaguchi K, Hirata K, Niitsu Y. Phase I study of S-1, docetaxel and cisplatin combination chemotherapy in patients with unresectable metastatic gastric cancer. Br J Cancer 2007; 97:851-6. [PMID: 17848958 PMCID: PMC2360407 DOI: 10.1038/sj.bjc.6603957] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The aim of this dose escalation study was to determine the maximum-tolerated dose (MTD), dose-limiting toxicities (DLTs) and preliminary efficacy of docetaxel, S-1 and cisplatin combination chemotherapy in patients with unresectable metastatic gastric cancer. Seventeen patients received oral S-1 (40 mg m−2 bid) on days 1–14, intravenous cisplatin (60 mg m−2) and docetaxel (60, 70 or 80 mg m−2 depending on DLT) on day 8 every 3 weeks. The MTD of this combination was presumed to be docetaxel 70 mg m−2. At this dose level, 40% of the patients (two of five) developed grade 4 neutropenia and 20% (one of five) exhibited grade 3 nausea during the first course. Therefore, the recommended dose of docetaxel was defined as 60 mg m−2. The DLT was neutropenia. The response rate (RR) was 88.2% (15 of 17), consisting of one complete response and 14 partial responses. There were two stable diseases but no progressive disease. Of these 15 responders, four (23.5%) with high VEGF expression showed rapid tumour regression and achieved downstaging, leading to subsequent curative gastrectomy. Three of these have been disease free for about 3 years, suggesting a complete cure. In conclusion, this regimen was tolerable and showed a quite high RR, with an appreciable downstaging rate in metastatic gastric cancer.
Collapse
Affiliation(s)
- T Takayama
- Fourth Department of Internal Medicine, Sapporo Medical University, School of Medicine, Sapporo, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Takahashi N, Nimura H, Aoki H, Koyama T, Mitsumori N, Aiba K, Kashiwagi H, Yanaga K. Successful Preoperative Chemotherapy with S-1 plus Low-Dose Cisplatin for Advanced Gastric Cancer with Synchronous Liver Metastases: Report of 2 Cases. Chemotherapy 2007; 53:378-82. [DOI: 10.1159/000107726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 07/21/2006] [Indexed: 01/11/2023]
|
10
|
Nakamura R, Saikawa Y, Kumagai K, Kiyota T, Ohashi M, Yoshida M, Kubota T, Kumai K, Kitajima M. A patient with gastric cancer and liver metastases successfully treated with combination chemotherapy including S-1. Int J Clin Oncol 2007; 12:295-9. [PMID: 17701010 DOI: 10.1007/s10147-006-0648-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Accepted: 12/13/2006] [Indexed: 10/23/2022]
Abstract
We report the case of a 62-year-old man with advanced gastric cancer and multiple liver metastases who was successfully treated with combined chemotherapy including S-1. The patient was clinically diagnosed with stage IV (T3 N2 H1 P0) disease and was initially treated with 100 mg/body per day S-1 administered orally for 21 days and 10 mg/body per day cisplatin (CDDP) infused on days 1-5, 8-12, and 15-19. This chemotherapy resulted in significant reduction of the liver and gastric tumors. After receiving additional CDDP/S-1 administration as an outpatient, the patient's liver masses disappeared as shown on abdominal computed tomography (CT). With the patient's desire and informed consent, he underwent curative surgery with total gastrectomy, D1+alpha lymph node dissection, and partial resection of liver S4. After discharge without any surgical complication, CT revealed regrowth of the S4 liver mass, and combined docetaxel and CDDP was selected as second-line chemotherapy with local radiation therapy against the hepatic metastasis. Additionally, a third regimen with irinotecan and S-1 was given. At 2 years 7 months after the initial treatment, no sign of cancer (including liver metastasis and peritoneal dissemination) has been identified by radiological follow-up examinations.
Collapse
Affiliation(s)
- Rieko Nakamura
- Department of Surgery, School of Medicine, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Lee JL, Kang HJ, Kang YK, Ryu MH, Chang HM, Kim TW, Sohn HJ, Kim H, Lee JS. Phase I/II study of 3-week combination of S-1 and cisplatin chemotherapy for metastatic or recurrent gastric cancer. Cancer Chemother Pharmacol 2007; 61:837-45. [PMID: 17579864 DOI: 10.1007/s00280-007-0541-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 06/01/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE To define the maximum-tolerated dose (MTD) of S-1, given daily for 2 weeks followed by a 1-week rest, with a fixed dose of cisplatin on the initial day, and to determine the activity and safety of this regimen at the recommended dose (RD) when used as first line treatment of advanced gastric cancer (AGC). PATIENTS AND METHODS Cisplatin was fixed at a dose of 60 mg/m2 on day 1 (D1) and the starting dose of S-1 was 60 mg/m2/day (30 mg/m2 bid) (level I) on D1 to D14, every 3 weeks. The dose of S-1 was increased by 5 mg/m2 bid up to 100 mg/m2/day (level V) unless the MTD was achieved. RESULTS Sixty-two eligible patients were enrolled. MTD was set at level V with two of three patients developing grade 3 diarrhea or febrile neutropenia. The RD was determined at level IV (90 mg/m2/day). After the first 20 patients were enrolled in phase II, the protocol was amended; the S-1 dose was reduced to 80 mg/m2/day (N=23) because of poor bone marrow recovery. The objective response was observed in 20 of 42 evaluable patients (48%). SD was achieved in 15 (36%). The median PFS was 5.3 months (95% CI, 4.6-6.0 months) with a median OS of 10.0 months (95% CI, 5.1-14.8 months). Grade 3-4 toxicities included neutropenia (33%), anemia (31%), and anorexia (24%). CONCLUSIONS The 3-week combination of cisplatin plus S-1 is active against AGC with favorable toxicitiy profiles. The phase II schedule or doses may need further refinements.
Collapse
Affiliation(s)
- Jae-Lyun Lee
- Division of Oncology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Nakajo A, Natsugoe S, Hokita S, Ishigami S, Takatori H, Arigami T, Uenosono Y, Aridome K, Aikou T. Successful treatment of advanced gastric cancer by surgical resection following combination chemotherapy with oral S-1 and biweekly paclitaxel. Gastric Cancer 2007; 10:58-62. [PMID: 17334720 DOI: 10.1007/s10120-006-0394-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Accepted: 07/26/2006] [Indexed: 02/07/2023]
Abstract
We report on the successful treatment of advanced gastric cancer by surgical resection following neoadjuvant chemotherapy. A 67-year-old man was referred to our hospital with a diagnosis of pancreatic cancer. Meticulous examination, however, revealed the presence of gastric cancer with ascites and large lymph node metastasis adjacent to the pancreas. We selected combination chemotherapy with oral S-1 and biweekly paclitaxel. After two courses, both the primary tumor and metastatic lymph nodes were greatly reduced, and the ascites had disappeared. Using laparoscopy, there was no evidence of peritoneal metastases, and the cytological examination was negative. The patient underwent distal gastrectomy with D2 lymph node dissection. Histological examination revealed that the cancer cells were still present in part, but no lymph node metastases were found. The tumor was pathologically diagnosed as pT2, pN0, P0, M0, CY0, and p-stage II. The patient is healthy over 4 years after surgery without recurrence.
Collapse
Affiliation(s)
- Akihiro Nakajo
- Department of Digestive Surgery and Surgical Oncology, Kagoshima University Graduate School of Medical & Dental Science, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Hara T, Yoshihiro S, Ito H, Nagao K, Ohmi C, Sakano S, Matsuyama H, Naito K. Metronomic Outpatient-Based Chemotherapy with 5′-DFUR and Low-Dose Cisplatin for Conventional Platinum-Based Chemotherapy-Resistant Advanced Urothelial Cancer. Clin Med Oncol 2007. [DOI: 10.4137/cmo.s304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BackgroundMetronomic chemotherapy is aimed at lessening the adverse effects of treatment while rendering cancer cells cytostatic. The oral 5-fluorouracil prodrug “5′-DFUR” has been shown to inhibit angiogenesis and is regarded as a good candidate agent for metronomic chemotherapy. Moreover, cisplatin and 5′-DFUR have been shown to synergistic cytotoxic effects.MethodsWe evaluated the safety and efficacy of metronomic chemotherapy using daily oral 5′-DFUR at the dose of 600 mg/day and biweekly cisplatin infusion at the dose of 20 mg/person in 23 patients with urothelial cancer resistant to conventional platinum-based chemotherapy.ResultsTwenty-three patients were enrolled between August 2000 and December 2004. The median survival time after the initiation of metronomic chemotherapy was 15.2 months. The 1-year, 2-year and 3-year survival rates were 55.1%, 45.1% and 5.9%, respectively. Grade 3 fatigue was observed as severe toxicity in one patient. No cases showed nephrotoxicity and adverse effects necessitating medical intervention.ConclusionsAlthough a large-scale prospective study would be necessary before the therapy is established as a standard, our metronomic chemotherapy regimen appears to be a potentially useful palliative treatment alternative for patients with advanced urothelial cancer resistant to conventional platinum-based chemotherapy.AbbreviationsM-VAC: methotrexate, vinblastine, doxorubicin, and cisplatin; GC: gemcitabine and carboplatin; 5′-DFUR: 5′-deoxy-5-fluorouridine; 5-FU: 5-fluorouracil; CDDP: cisplatin; TCC: transitional cell carcinoma; ECOG: Eastern Cooperative Oncology Group; PS: performance status; UICC: Union International Contre le Cancer; WHO: World Health Organization; NCI-CTC: National Cancer Institute Common Toxicity Criteria; CI: confidence interval; PR: partial response; NC: no change; PD: progressive disease; TP: thymidine phosphorylase; AUC: areas under the curve.
Collapse
Affiliation(s)
- Tomohiko Hara
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Satoru Yoshihiro
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Hideaki Ito
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuhiro Nagao
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Chietaka Ohmi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Shigeru Sakano
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Katsusuke Naito
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| |
Collapse
|
14
|
Nakata B, Tsuji A, Mitachi Y, Yamamitsu S, Hirata K, Takeuchi T, Shirasaka T, Hirakawa K. Moderate Neutropenia with S-1 Plus Low-dose Cisplatin May Predict a More Favourable Prognosis in Advanced Gastric Cancer. Clin Oncol (R Coll Radiol) 2006; 18:678-83. [PMID: 17100153 DOI: 10.1016/j.clon.2006.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIMS The effects of haematological adverse events on the prognosis of patients with gastric cancer were investigated. MATERIALS AND METHODS We retrospectively analysed the association between haematological adverse events and prognosis in 23 patients with far advanced or recurrent gastric cancer treated with a JFMC27-9902 regimen consisting of an oral fluorouracil derivative S-1 plus low-dose cisplatin. RESULTS The patients who suffered grade 2-3 neutropenia (n = 10; median survival time [MST] 679 days) were found to have significantly more favourable prognoses than patients who developed grade 0-1 (n = 10; MST 271 days) or grade 4 neutropenia (n = 3; MST 408 days) (P = 0.0039 and 0.0112, respectively), although no significant differences were found among the clinicopathological factors of any grade groups. With respect to anaemia or thrombocytopenia, there were no significant differences among the MSTs of the groups stratified by toxicity grade. Multivariate survival analysis revealed that grade 2-3 neutropenia is an independent predictor of a more favourable prognosis (hazard ratio = 38.693, P = 0.0004). CONCLUSIONS These results suggest that S-1 plus low-dose cisplatin against gastric cancer may contribute to long survival when it induces moderate neutropenia.
Collapse
Affiliation(s)
- B Nakata
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Kobayashi K, Tsuji A, Morita S, Horimi T, Shirasaka T, Kanematsu T. A phase II study of LFP therapy (5-FU (5-fluorourasil) continuous infusion (CVI) and Low-dose consecutive (Cisplatin) CDDP) in advanced biliary tract carcinoma. BMC Cancer 2006; 6:121. [PMID: 16677397 PMCID: PMC1483897 DOI: 10.1186/1471-2407-6-121] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Accepted: 05/06/2006] [Indexed: 11/14/2022] Open
Abstract
Background Unresectable biliary tract carcinoma is known to demonstrate a poor prognosis. We conducted a single arm phase II study of LFP therapy (5-FU (5-fluorourasil) continuous infusion (CVI) and Low-dose consecutive (Cisplatin) CDDP) for advanced biliary tract malignancies basically on an outpatient basis. Methods Between February 1996 and September 2003, 42 patients were enrolled in this trial. LFP therapy By using a total implanted CV-catheter system, 5-FU (160 mg/m2/day) was continuously infused over 24 hours for 7 consecutive days and CDDP (6 mg/m2/day) was infused for 30 minutes twice a week as one cycle. The administration schedule consisted of 4 cycles as one course. RESIST criteria (Response evaluation criteria for solid tumors) and NCI-CTC (National Cancer Institute-Common Toxicity Criteria) (ver.3.0) were used for evaluation of this therapy. The median survival time (MST) and median time to treatment failure (TTF) were calculated by the Kaplan-Meier method. Results Patients characteristics were: mean age 66.5(47–79): male 24 (54%): BDca (bile duct carcinoma) 27 GBca (Gallbladder carcinoma) 15: locally advanced 26, postoperative recurrence 16. The most common toxicity was anemia (26.2%). Neither any treatment related death nor grade 4 toxicity occurred. The median number of courses of LFP Therapy which patients could receive was two (1–14). All the patients are evaluable for effects with an over all response rates of 42.9% (95% confidence interval C.I.: 27.7–59.0) (0 CR, 18 PR, 13 NC, 11 PD). There was no significant difference regarding the anti tumor effects against both malignant neoplasms. Figure 2 Shows the BDca a longer MST and TTF than did GBca (234 vs 150, 117 vs 85, respectively), but neither difference was statistically significant. The estimated MST and median TTF were 225 and 107 days, respectively. The BDca had a longer MST and TTF than GBca (234 vs 150, 117 vs 85, respectively), but neither difference was statistically significant. Conclusion LFP therapy appears to be useful modality for the clinical management of advanced biliary tract malignancy.
Collapse
Affiliation(s)
- Kazuma Kobayashi
- Internal medicine, Clinical Oncology Group, Kochi Municipal Central Hospital, Kochi, Japan
- Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihito Tsuji
- Department of Clinical Oncology, Kochi Health Science Center, Kochi, Japan
| | - Sojiro Morita
- Radiology, Clinical Oncology Group, Kochi Municipal Central Hospital, Kochi, Japan
| | - Tadashi Horimi
- Surgery, Clinical Oncology Group, Kochi Municipal Central Hospital, Kochi, Japan
| | | | - Takashi Kanematsu
- Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
16
|
Shimoyama S, Imamura K, Hiki N, Yamaguchi H, Mafune KI, Kaminishi M. Performance of outpatient regimen of S-1 in combination with fractional cisplatin for advanced or recurrent gastric cancers: a phase I study. Int J Clin Oncol 2005; 10:251-5. [PMID: 16136370 DOI: 10.1007/s10147-005-0505-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Accepted: 05/13/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND We designed an outpatient regimen consisting of fractional cisplatin in combination with S-1, a novel oral fluoropyrimidine derivative for the treatment of recurrent or advanced gastric cancer and conducted a phase I study to determine the dose limiting toxicities (DLTs) and recommended dose (RD). METHODS Escalating dosages of cisplatin (15, 20, and 25 mg/m(2), as levels 1, 2, and 3, respectively) were administered over 2 h on days 1, 8, and 15, with a fixed dose of S-1 for 3 consecutive weeks (days 1-21), repeated every 5 weeks. National Cancer Institute common toxicity criteria(NCI-CTC) grade 2 toxicities required treatment delay. Primary first cycle DLTs were defined as NCI-CTC grade 3 or 4 toxicities (except for hemoglobin levels, nausea, and vomiting). RESULTS Nine patients were initially enrolled, and DLTs did not appear; however, one level-3 patient experienced grade 3 anemia. An additional three patients were enrolled in level 3 to confirm the toxicity profiles, and none experienced DLTs. Toxicity evaluations throughout a total of 62 cycles revealed that grade 1 or 2 hematological toxicities were common, although mostly transient, with recovery without specific treatment. One patient each in levels 1 and 3 required hospitalization due to grade 3 toxicities in the later cycles. Mean dose intensities for S-1 and cisplatin were both more than 91%. There were no treatment-related deaths. The preliminary response rate was 44%. CONCLUSIONS It was concluded that the RD of cisplatin in this regimen was 25 mg/m(2) (level 3). S-1 in combination with fractional cisplatin is a promising regimen that allows repeated drug administration, in an outpatient setting, for advanced or recurrent gastric cancers. A phase II study of the RD is now under way.
Collapse
Affiliation(s)
- Shouji Shimoyama
- Department of Gastrointestinal Surgery, University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan.
| | | | | | | | | | | |
Collapse
|
17
|
Koizumi W. Available options in chemotherapy for advanced gastric cancer: the current developments in Japan. Expert Opin Pharmacother 2005; 6:225-31. [PMID: 15757419 DOI: 10.1517/14656566.6.2.225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although techniques for early diagnosis and treatment of gastric cancer have been established, standard treatment for advanced gastric cancer has not. 5-Flourouracil (5-FU) plus cisplatin containing regimens, including 5-FU plus cisplatin, epirubicin plus cisplatin and 5-FU, and docetaxel plus cisplatin and 5-FU, are considered to be the most effective regimens for advanced gastric cancer in US, Europe and Korea. In Japan, oral fluoropyrimidine S-1 is currently considered to be the first-line treatment for advanced gastric cancer. S-1-based combination therapies with other promising drugs, including cis-platin, irinotecan and taxanes, are expected to yield good results. Above all, S-1 plus cisplatin therapy showed high efficacy and expected to be a standard therapy for advanced gastric cancer. Further evaluation by well-controlled clinical trials is still required.
Collapse
Affiliation(s)
- Wasaburo Koizumi
- Kitasato University School of Medicine, 2-1-1 Asamizodai, Sagamihara city, Kanagawa 228-8520, Japan.
| |
Collapse
|