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Röver C, Ursino M, Friede T, Zohar S. A straightforward meta-analysis approach for oncology phase I dose-finding studies. Stat Med 2022; 41:3915-3940. [PMID: 35661205 DOI: 10.1002/sim.9484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/09/2022]
Abstract
Phase I early-phase clinical studies aim at investigating the safety and the underlying dose-toxicity relationship of a drug or combination. While little may still be known about the compound's properties, it is crucial to consider quantitative information available from any studies that may have been conducted previously on the same drug. A meta-analytic approach has the advantages of being able to properly account for between-study heterogeneity, and it may be readily extended to prediction or shrinkage applications. Here we propose a simple and robust two-stage approach for the estimation of maximum tolerated dose(s) utilizing penalized logistic regression and Bayesian random-effects meta-analysis methodology. Implementation is facilitated using standard R packages. The properties of the proposed methods are investigated in Monte Carlo simulations. The investigations are motivated and illustrated by two examples from oncology.
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Affiliation(s)
- Christian Röver
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Moreno Ursino
- Unit of Clinical Epidemiology, AP-HP, CHU Robert Debré, Université Paris Cité, Inserm CIC-EC 1426, Paris, France.,Inserm, Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, Paris, France.,HeKA, Inria Paris, Paris, France
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Sarah Zohar
- Inserm, Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, Paris, France.,HeKA, Inria Paris, Paris, France
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Zhao JJ, Lei XM. Meta-analysis of safety and efficacy of S-1-based regimens in treatment of metastatic colorectal cancer. Shijie Huaren Xiaohua Zazhi 2019; 27:1375-1382. [DOI: 10.11569/wcjd.v27.i22.1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, some studies have found that oral S-1-based regimens are more effective than intravenous FOLFOX4/FOLFIRI regimen in the treatment of metastatic colorectal cancer (mCRC).
AIM To systematically evaluate the clinical efficacy and safety of S-1-based regimens in the treatment of patients with refractory mCRC by meta-analysis, and to provide evidence-based medicine-related evidence.
METHODS Controlled trials evaluating S-1-based regimens for the treatment of mCRC from January 2009 to January 2019 were retrieved from VIP database, Wanfang Data, Chinese Biomedical Literature Database, CNKI database, The Cochrane Library, PubMed, and Embase. Meta-analysis of the included studies was conducted with Revman 5.3 software and estimated by odds ratio (OR) and 95% confidence interval (CI).
RESULTS The results of meta-analysis showed that the 3-year overall survival rate and 3-year recurrence-free survival rate were significantly higher in the study group (OR = 0.65, 95%CI: 0.47-0.89, P = 0.008; OR = 1.45, 95%CI: 1.03-2.06, P = 0.04). The study group had less adverse events than the control group (OR = 0.68, 95%CI: 0.53-0.87, P = 0.002). The incidence of bone marrow suppression, alopecia, nausea and vomiting, and skin reactions in the study group was significantly lower than that in the control group (P < 0.05)
CONCLUSION S-1-based regimens have better efficacy and adverse event profile in the treatment of refractory mCRC than FOLFOX4/FOLFIRI regimen.
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Affiliation(s)
- Juan-Juan Zhao
- Department of Anorectal Medicine, Yiwu City Central Hospital, Yiwu 322000, Zhejiang Province, China
| | - Xin-Ming Lei
- Department of Gastroenterology, Yiwu City Central Hospital, Yiwu 322000, Zhejiang Province, China
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Mabuchi S, Yokoi E, Shimura K, Komura N, Matsumoto Y, Sawada K, Isobe A, Tsutsui T, Kitada F, Kimura T. A phase II study of irinotecan combined with S-1 in patients with advanced or recurrent cervical cancer previously treated with platinum based chemotherapy. Int J Gynecol Cancer 2019; 29:474-479. [PMID: 30833436 DOI: 10.1136/ijgc-2018-000070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/25/2018] [Accepted: 11/02/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We conducted a phase II study to investigate the efficacy and toxicities of irinotecan plus oral S-1 in patients with advanced or recurrent uterine cervical cancer. METHODS Patients with advanced or recurrent cervical cancer previously treated with platinum based chemotherapy were enrolled. Irinotecan (150 mg/m2) was administered intravenously over the course of 90 min on day 1, and S-1 (80 mg/m2) was given orally in two divided doses from days 1 to 14 of a 21 day cycle. The primary endpoint of this phase II study was response rate. Secondary endpoints included safety, progression free survival, and overall survival. RESULTS A total of 19 patients were enrolled and treated. The response rate was 29.4%. Grade 3-4 hematologic toxicities were observed in three patients (15.7%). The only grade 3-4 non-hematologic toxicity observed was grade 3 diarrhea. The median progression free survival and overall survival were 3 months and 9 months, respectively. CONCLUSION S-1 plus irinotecan in a 3 weekly setting is safe and active in women with advanced or recurrent cervical cancer previously treated with platinum based chemotherapy. Future corroborative clinical studies are warranted.
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Affiliation(s)
- Seiji Mabuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eriko Yokoi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kotaro Shimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoko Komura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuri Matsumoto
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenjiro Sawada
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Aki Isobe
- Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan
| | - Tateki Tsutsui
- Department of Obstetrics and Gynecology, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Fuminori Kitada
- Department of Obstetrics and Gynecology, Suita Tokusyukai Hospital, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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Mabuchi S, Yokoi E, Owa T, Kozasa K, Yamashita M, Kobayashi E, Tomimatsu T, Yoki T, Tsutui T, Kimura T. Phase I Clinical Study of Irinotecan Plus S-1 in Patients With Advanced or Recurrent Cervical Cancer Previously Treated With Platinum-Based Chemotherapy. Int J Gynecol Cancer 2016; 26:1281-7. [PMID: 27643650 DOI: 10.1097/IGC.0000000000000769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study aimed to determine the maximum tolerated dose and acute dose-limiting toxicities (DLTs) of intravenous irinotecan plus oral S-1 in patients with advanced or recurrent uterine cervical cancer. METHODS Irinotecan was administered intravenously over the course of 90 minutes on day 1, and S-1 was given orally in 2 divided doses from days 1 to 14 of a 21-day cycle. The dose of S-1 was escalated in a stepwise fashion from 40 (level 1) to 60 mg/m (level 2) and then 80 mg/m (level 3), whereas the dosage of irinotecan remained the same (150 mg/m). The primary end point for the escalation study was acute DLT that occurred within 2 cycles of chemotherapy. RESULTS Twelve patients were enrolled and treated over 3 dose levels. Their median age was 47 years (range, 28-48 years). At level 1, one episode of grade 3 anemia and a grade 3 fatigue were observed, but no DLT developed. At level 2, the first patient experienced febrile neutropenia, which was considered to be a DLT. To evaluate the toxicity of this dose level, 5 more patients were evaluated. However, no DLT developed in these patients. At level 3, although grade 1 to 2 hematological and nonhematological toxicities developed, no DLT occurred. CONCLUSIONS In women with advanced or recurrent cervical cancer previously treated with platinum-based chemotherapy, S-1 plus irinotecan in a triweekly setting is a reasonable treatment regimen with an acceptable toxicity profile. The recommended doses of S-1 and irinotecan for this regimen are 80 and 150 mg/m, respectively.
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Miyamoto Y, Tsuji A, Tanioka H, Maekawa S, Kawanaka H, Kitazono M, Oki E, Emi Y, Murakami H, Ogata Y, Saeki H, Shimokawa M, Natsugoe S, Akagi Y, Baba H, Maehara Y. S-1 and irinotecan plus bevacizumab as second-line chemotherapy for patients with oxaliplatin-refractory metastatic colorectal cancer: a multicenter phase II study in Japan (KSCC1102). Int J Clin Oncol 2016; 21:705-12. [DOI: 10.1007/s10147-015-0943-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
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7
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Inoue M, Takahashi S, Soeda H, Shimodaira H, Watanabe M, Miura K, Sasaki I, Kato S, Ishioka C. Gene-expression profiles correlate with the efficacy of anti-EGFR therapy and chemotherapy for colorectal cancer. Int J Clin Oncol 2015; 20:1147-55. [PMID: 25990448 DOI: 10.1007/s10147-015-0841-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Comprehensive gene-expression analysis is very useful for classifying specific cancers into subgroups on the basis of their biological characteristics; it is used both prognostically and predictively. The purpose of this study was to classify unresectable advanced or recurrent colorectal cancer (CRC) by gene-expression profiling of formalin-fixed paraffin-embedded tissues and to correlate CRC subgroups with clinicopathological and molecular features and clinical outcomes. METHODS One hundred patients with advanced or recurrent CRC were enrolled. RNA extracted from FFPE tissues was subjected to gene-expression microarray analysis. RESULTS The patients were stratified into four subgroups (subtypes A1, A2, B1, and B2) by unsupervised hierarchical clustering. By use of principle-components analysis (PCA), the patients were divided into subtypes A and B on the basis of component 1 and into subtypes 1 and 2 on the basis of component 2. Subtype A was significantly enriched among patients without the KRAS mutation and with an earlier clinical stage at diagnosis. With regard to anti-EGFR therapy, progression-free survival (PFS) was better for patients in subtype A without the KRAS mutation than for those with the KRAS mutation (P = 0.047). PFS for patients without the KRAS mutation in subtype B was comparable with that for patients with the KRAS mutation (P = 0.55). Similar results were observed in a validation set. CONCLUSION We found that gene-expression profiles enabled stratification of CRC patients into four subgroups. The efficacy of anti-EGFR therapy was correlated with component 1 from PCA. This comprehensive study may explain the heterogeneity of unresectable advanced or recurrent CRC and could be useful for identifying novel biomarkers for CRC treatment.
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Affiliation(s)
- Masahiro Inoue
- Department of Clinical Oncology, Institute of Development, Aging and Cancer Tohoku University, 4-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan.,Department of Clinical Oncology, Tohoku University Hospital, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan
| | - Shin Takahashi
- Department of Clinical Oncology, Institute of Development, Aging and Cancer Tohoku University, 4-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan.,Department of Clinical Oncology, Tohoku University Hospital, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan
| | - Hiroshi Soeda
- Department of Clinical Oncology, Institute of Development, Aging and Cancer Tohoku University, 4-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan.,Department of Clinical Oncology, Tohoku University Hospital, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan
| | - Hideki Shimodaira
- Department of Clinical Oncology, Institute of Development, Aging and Cancer Tohoku University, 4-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan.,Department of Clinical Oncology, Tohoku University Hospital, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Hospital, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan
| | - Koh Miura
- Department of Gastroenterological Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan
| | - Iwao Sasaki
- Department of Gastroenterological Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan
| | - Shunsuke Kato
- Department of Clinical Oncology, Institute of Development, Aging and Cancer Tohoku University, 4-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan.,Department of Clinical Oncology, Tohoku University Hospital, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan
| | - Chikashi Ishioka
- Department of Clinical Oncology, Institute of Development, Aging and Cancer Tohoku University, 4-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan. .,Department of Clinical Oncology, Tohoku University Hospital, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8575, Japan.
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Ogata Y, Tanaka T, Akagi Y, Ishibashi N, Tsuji Y, Matono K, Isobe M, Sueyoshi S, Kaibara A, Shirouzu K. Multicenter Phase II Study of a New Effective S-1 and Irinotecan Combination Schedule in Patients with Unresectable Metastatic or Recurrent Colorectal Cancer. Clin Med Insights Oncol 2013; 7:21-30. [PMID: 23439317 PMCID: PMC3572922 DOI: 10.4137/cmo.s10769] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION This multicenter phase II study determined the efficacy and safety of new daily oral S-1 and weekly irinotecan (CPT-11) combination schedule in patients with previously untreated advanced or recurrent colorectal cancer. PATIENTS AND METHODS Patients received first-line chemotherapy comprising S-1 80 mg/m(2)/day given on days 3 to 7, 10 to 14, and 17 to 21 and 60 mg/m(2) CPT-11 administered intravenously on days 1, 8, and 15 of a 28-day cycle. RESULTS A total of 45 eligible patients were enrolled in this study. The overall response rate was 48.9%. Median progression-free survival and median overall survival was 8.1 months and 20.9 months, respectively. The rates of grade 3 or 4 toxicity were as follows: neutropenia, 8.9%; anemia, 4.4%; anorexia, 6.7%; and diarrhea, 6.7%. CONCLUSIONS This new S-1 and irinotecan combination schedule appeared to be an effective, well-tolerated, and convenient regimen in patients with advanced colorectal cancer as compared with conventional regimens such as FOLFIRI and IRIS.
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Abstract
INTRODUCTION 5-Fluorouracil (5-FU)-based regimens are used worldwide as the standard treatment in chemotherapy for gastric cancer. S-1 , a fourth-generation oral fluoropyrimidine that combines tegafur and two biochemical modulators: gimeracil and oteracil potassium, is now attracting considerable interest. AREAS COVERED This review addresses the clinical evidence of S-1 in gastrointestinal malignancies, such as gastric, colorectal, pancreatic and biliary tract cancers. S-1 has demonstrated advantages over standard therapies, in both advanced and postoperative settings, in large Phase III studies. S-1 alone or S-1 plus cisplatin is recommended in the 2010 Gastric Cancer Treatment Guidelines, by the Japanese Gastric Cancer Association. Results from Phase III studies have demonstrated that S-1 in combination with chemotherapies, such as cisplatin in gastric cancer, and irinotecan and oxaliplatin in colorectal cancers, is non-inferior to conventional 5-FU-based standard regimens, with the benefit of convenience and reduced toxicity. EXPERT OPINION The excellent design of S-1 aimed to reduce toxicity by avoiding certain routes of degradation, and to enhance activity by reducing catabolism. This has provided not only a suitable alternative to 5-FU, but also higher efficacy.
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Affiliation(s)
- Taroh Satoh
- Osaka University Graduate School of Medicine, Department of Frontier Science for Cancer and Chemotherapy, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
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Choi YH, Kim TW, Kim KP, Lee SS, Hong YS, Ryu MH, Lee JL, Chang HM, Ryoo BY, Kim HS, Shin JG, Kang YK. A Phase II study of clinical outcomes of 3-week cycles of irinotecan and S-1 in patients with previously untreated metastatic colorectal cancer: influence of the UGT1A1 and CYP2A6 polymorphisms on clinical activity. Oncology 2012; 82:290-7. [PMID: 22555197 DOI: 10.1159/000337989] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 03/12/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We investigated the efficacy and safety of the combination of irinotecan (CPT-11) and S-1 (IRIS regimen) as a first-line treatment in patients with metastatic colorectal cancer. We also evaluated the association between UGT1A1 and CYP2A6 polymorphisms and clinical phenotypes. METHODS The patients received CPT-11 (225 mg/m(2)) on day 1 and S-1 (80 mg/m(2)) on days 1-14 every 3 weeks. The association of the UGT1A1 (*6 and *28) and CYP2A6(*4, *7, *9, and *10) polymorphisms with toxicities and efficacy were analyzed. RESULTS Thirty patients were treated. The overall response rate was 66.7% (95% CI 48.7-84.6). The median time to progression was 7.6 months (95% CI 5.8-9.5). The most common grade 3/4 hematologic and non-hematologic toxicity were neutropenia (53.4%) and diarrhea (16.7%), respectively. The allele frequencies of UGT1A1*6 and *28 were 15.5 and 10.3%, respectively. The frequencies of CYP2A6*4, *7, *9, and *10 were 15.5, 8.6, 29.3, and 3.5%, respectively. Stratification of patients according to the number of UGT1A1*28 and *6 alleles showed a significant correlation between the number of defective alleles and the incidence of grade 3/4 neutropenia. CONCLUSIONS Our results indicate that IRIS is a promising first-line regimen in patients with metastatic colorectal cancer. Severe neutropenia may be associated with interindividual variations in UGT1A1 polymorphisms.
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Affiliation(s)
- Yoon Hee Choi
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kato S, Andoh H, Gamoh M, Yamaguchi T, Murakawa Y, Shimodaira H, Takahashi S, Mori T, Ohori H, Maeda SI, Suzuki T, Kato S, Akiyama S, Sasaki Y, Yoshioka T, Ishioka C. Safety Verification Trials of mFOLFIRI and Sequential Irinotecan + Bevacizumab as First- or Second-Line Therapies for Metastatic Colorectal Cancer in Japanese Patients. Oncology 2012; 83:101-7. [DOI: 10.1159/000339541] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 05/04/2012] [Indexed: 11/19/2022]
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Yamada Y, Yamaguchi T, Matsumoto H, Ichikawa Y, Goto A, Kato K, Hamaguchi T, Shimada Y. Phase II study of oral S-1 with irinotecan and bevacizumab (SIRB) as first-line therapy for patients with metastatic colorectal cancer. Invest New Drugs 2011; 30:1690-6. [PMID: 21894500 DOI: 10.1007/s10637-011-9743-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 08/23/2011] [Indexed: 01/14/2023]
Abstract
Fluorouracil (5-FU) plus irinotecan combined with bevacizumab has significant activity in metastatic colorectal cancer (mCRC), but S-1 has become a substitute for continuous infusion of 5-FU and has a very low incidence of hand-foot syndrome. With the S-1 plus irinotecan regimen (SIR), the response rate was 62.5%, and the progression-free survival was 8.0 months. We report here on an update of efficacy and safety of the SIR plus bevacizumab (SIRB) regimen as first line treatment for mCRC patients. Fifty-one eligible patients with histologically confirmed advanced or recurrent colorectal cancer received this treatment. S-1 was administered orally on days 1-14 of a 21-day cycle. Patients were assigned on the basis of body surface area (BSA) to receive one of the following oral doses twice daily: 40 mg, 50 mg, or 60 mg. Irinotecan (150 mg/m(2)) plus bevacizumab (7.5 mg/kg) were administered by intravenous infusion on day 1. Safety analysis identified a grade 3/4 neutropenia rate of 26%. Other grade 3/4 toxicities were diarrhea (8%), nausea (6%), vomiting (2%), and hypertension (8%). The response rate was 67% and the median progression-free survival time was 373 days. The SIRB regimen appears to be highly active and well tolerated as first-line treatment for mCRC.
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Affiliation(s)
- Yasuhide Yamada
- Gastrointestinal Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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Komatsu Y, Yuki S, Sogabe S, Fukushima H, Iwanaga I, Kudo M, Tateyama M, Meguro T, Uebayashi M, Saga A, Sakata Y, Asaka M. Phase II study of combined treatment with irinotecan and S-1 (IRIS) in patients with inoperable or recurrent advanced colorectal cancer (HGCSG0302). Oncology 2011; 80:70-5. [PMID: 21659785 DOI: 10.1159/000328739] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 03/24/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This phase II study was designed to evaluate the efficacy and safety of oral fluoropyrimidine S-1 plus irinotecan (IRIS regimen) in patients with previously untreated metastatic colorectal cancer. METHODS The response rate was the primary endpoint. Safety, progression-free survival time, and median survival time were secondary endpoints. The subjects were untreated patients with inoperable advanced colorectal cancer. Irinotecan was administered at a dose of 100 mg/m² (on days 1 and 15). S-1 (40 mg/m²) was administered for 2 weeks (on days 1 to 14) and followed by a 2-week rest. RESULTS Forty patients were enrolled. Four patients had grade 4 neutropenia, and six patients had grade 3 diarrhea. No other serious hematologic or nonhematologic adverse reactions occurred, and all patients received IRIS safely on an outpatient basis. The response rate was 52.5% (95% confidence interval [CI], 36.1-68.5%). Median progression-free survival was 8.6 months (95% CI, 5.3-11.9), and median survival time was 23.4 months (95% CI, 15.9-30.8). CONCLUSIONS IRIS produced a high response rate and could be given safely. IRIS may become a first-line treatment for inoperable or recurrent advanced colorectal cancer.
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Affiliation(s)
- Yoshito Komatsu
- Department of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Japan.
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Choi YH, Kim TW, Lee SS, Hong YS, Ryu M, Lee J, Chang HM, Kang Y. A phase I study of combination therapy with S-1 and irinotecan in patients with previously untreated metastatic or recurrent colorectal cancer. Cancer Chemother Pharmacol 2011; 68:905-12. [DOI: 10.1007/s00280-011-1562-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 01/16/2011] [Indexed: 12/16/2022]
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Kusaba H, Esaki T, Futami K, Tanaka S, Fujishima H, Mitsugi K, Sakai K, Ariyama H, Tanaka R, Kinugawa N, Ueki T, Mibu R, Baba E, Nakano S, Akashi K. Phase I/II study of a 3-week cycle of irinotecan and S-1 in patients with advanced colorectal cancer. Cancer Sci 2010; 101:2591-5. [PMID: 21077997 DOI: 10.1111/j.1349-7006.2010.01728.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The combination of an oral fluoropyrimidine derivative, S-1, and irinotecan is expected to be a promising regimen for advanced colorectal cancer. This study was performed to determine the maximum tolerated dose (MTD) and recommended dose (RD) of irinotecan combined with S-1 in a 3-week cycle regimen and to observe the safety and efficacy for patients with previously untreated advanced colorectal cancer. Eighty milligrams per m(2) of S-1 was given orally for 14 consecutive days and escalated doses of irinotecan were administered on days 1 and 8 every 3 weeks in the phase I trial. Forty patients were treated at the RD during the phase II trial. Forty-three patients were enrolled between February 2005 and March 2007. The dose-limiting toxicity was diarrhea and abdominal pain. The MTD of irinotecan was 100 mg/m(2) and the RD was determined to be 80 mg/m(2) of irinotecan combined with 80 mg/m(2) of S-1. The phase II trial showed that 22 of 40 patients achieved a complete or partial response and eight had stable disease. The overall response rate was 55.0%. The median progression-free survival time and median survival time were 6.7 and 21 months, respectively. There were no treatment-related deaths. The main toxicities were leukopenia, neutropenia, anorexia and diarrhea. This study suggests the combination of irinotecan and S-1 repeated every 3 weeks is tolerable and effective for patients with previously untreated advanced colorectal cancer.
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Affiliation(s)
- Hitoshi Kusaba
- Department of Medicine and Biosystemic Science, Kyushu University, Fukuoka, Japan.
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Oh SY, Ju YT, Choi SK, Ha CY, Lee WS, Kim HG, Lee GW, Kwon HC, Kang JH. Phase II study of irinotecan/S-1 combination chemotherapy for patients with oxaliplatin-refractory colorectal cancer. Invest New Drugs 2010; 29:1050-6. [DOI: 10.1007/s10637-010-9409-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 02/17/2010] [Indexed: 01/22/2023]
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