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Takeda T, Sasaki T, Mie T, Furukawa T, Yamada Y, Kasuga A, Matsuyama M, Ozaka M, Sasahira N. The impact of body composition on short-term outcomes of neoadjuvant chemotherapy with gemcitabine plus S-1 in patients with resectable pancreatic cancer. Jpn J Clin Oncol 2021; 51:604-611. [PMID: 33479765 DOI: 10.1093/jjco/hyaa247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/29/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although the efficacy of neoadjuvant chemotherapy with gemcitabine plus S-1 (NAC GS) has recently been reported in resectable pancreatic cancer, severe adverse events were frequently observed. Sarcopenia has been reported to be associated with reduced antitumor response and chemotherapy toxicity in several malignancies. The aim of this study is to evaluate the impact of body composition on short-term outcomes of NAC GS in resectable pancreatic cancer patients. METHODS Clinicopathological data of consecutive patients treated with NAC GS at our institution from February 2019 to April 2020 were retrospectively reviewed. Anthropometric variables were calculated at the third lumbar vertebra using pretreatment computed tomography images. We investigated the association between body composition variables, and antitumor response and chemotherapy toxicity. RESULTS Among 62 patients included in this study, 25 patients (40%) were sarcopenic at diagnosis. Sixty-one patients received surgery at our institution and 57 patients received pancreatic resection (R0/R1 resection 56/1). Fifty-six patients completed two cycles of NAC GS and severe adverse events (≥grade 3) occurred in 42 patients (hematologic toxicity 41 patients [66%]; non-hematologic toxicity 3 patients). Body mass index and total adipose tissue index were significantly lower in sarcopenic patients compared to non-sarcopenic patients. Completion rate of NAC, rate of treatment delay/interruption, relative dose intensity of gemcitabine and S-1, radiological and pathological tumor response after NAC were not different between sarcopenic and non-sarcopenic patients. Furthermore, there was no significant association between body composition, and severe adverse events and intolerance. CONCLUSIONS In our experience, NAC GS was similarly tolerable and effective in resectable pancreatic cancer patients regardless of the presence of sarcopenia.
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Affiliation(s)
- Tsuyoshi Takeda
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Sasaki
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takafumi Mie
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takaaki Furukawa
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuto Yamada
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiyoshi Kasuga
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masato Matsuyama
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masato Ozaka
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Sasahira
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Morizane C, Okusaka T, Mizusawa J, Katayama H, Ueno M, Ikeda M, Ozaka M, Okano N, Sugimori K, Fukutomi A, Hara H, Mizuno N, Yanagimoto H, Wada K, Tobimatsu K, Yane K, Nakamori S, Yamaguchi H, Asagi A, Yukisawa S, Kojima Y, Kawabe K, Kawamoto Y, Sugimoto R, Iwai T, Nakamura K, Miyakawa H, Yamashita T, Hosokawa A, Ioka T, Kato N, Shioji K, Shimizu K, Nakagohri T, Kamata K, Ishii H, Furuse J. Combination gemcitabine plus S-1 versus gemcitabine plus cisplatin for advanced/recurrent biliary tract cancer: the FUGA-BT (JCOG1113) randomized phase III clinical trial. Ann Oncol 2019; 30:1950-1958. [PMID: 31566666 DOI: 10.1093/annonc/mdz402] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gemcitabine plus cisplatin (GC) is the standard treatment of advanced biliary tract cancer (BTC); however, it causes nausea, vomiting, and anorexia, and requires hydration. Gemcitabine plus S-1 (GS) reportedly has equal to, or better, efficacy and an acceptable toxicity profile. We aimed to confirm the non-inferiority of GS to GC for patients with advanced/recurrent BTC in terms of overall survival (OS). PATIENTS AND METHODS We undertook a phase III randomized trial in 33 institutions in Japan. Eligibility criteria included chemotherapy-naïve patients with recurrent or unresectable BTC, an Eastern Cooperative Oncology Group Performance Status of 0 - 1, and adequate organ function. The calculated sample size was 350 with a one-sided α of 5%, a power of 80%, and non-inferiority margin hazard ratio (HR) of 1.155. The primary end point was OS, while the secondary end points included progression-free survival (PFS), response rate (RR), adverse events (AEs), and clinically significant AEs defined as grade ≥2 fatigue, anorexia, nausea, vomiting, oral mucositis, or diarrhea. RESULTS Between May 2013 and March 2016, 354 patients were enrolled. GS was found to be non-inferior to GC [median OS: 13.4 months with GC and 15.1 months with GS, HR, 0.945; 90% confidence interval (CI), 0.78-1.15; P = 0.046 for non-inferiority]. The median PFS was 5.8 months with GC and 6.8 months with GS (HR 0.86; 95% CI 0.70-1.07). The RR was 32.4% with GC and 29.8% with GS. Both treatments were generally well-tolerated. Clinically significant AEs were observed in 35.1% of patients in the GC arm and 29.9% in the GS arm. CONCLUSIONS GS, which does not require hydration, should be considered a new, convenient standard of care option for patients with advanced/recurrent BTC. CLINICAL TRIAL NUMBER This trial has been registered with the UMIN Clinical Trials Registry (http://www.umin.ac.jp/ctr/index.htm), number UMIN000010667.
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Affiliation(s)
- C Morizane
- Department of Hepatobiliary and Pancreatic Oncology, Tokyo.
| | - T Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, Tokyo
| | - J Mizusawa
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo
| | - H Katayama
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo
| | - M Ueno
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama
| | - M Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa
| | - M Ozaka
- Hepato-Biliary-Pancreatic Medicine Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo
| | - N Okano
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo
| | - K Sugimori
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama
| | - A Fukutomi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka
| | - H Hara
- Department of Gastroenterology, Saitama Cancer Center, Saitama
| | - N Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya
| | - H Yanagimoto
- Department of Surgery, Kansai Medical University Hospital, Hirakata
| | - K Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo
| | - K Tobimatsu
- Division of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine, Kobe
| | - K Yane
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo
| | - S Nakamori
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka
| | - H Yamaguchi
- Department of Clinical Oncology, Jichi Medical University, Shimotsuke
| | - A Asagi
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama
| | - S Yukisawa
- Department of Medical Oncology, Tochigi Cancer Center, Utsunomiya
| | - Y Kojima
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo
| | - K Kawabe
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Y Kawamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo
| | - R Sugimoto
- Department of Hepato-Biliary-Pancreatology, National Hospital Organization Kyushu Cancer Center, Fukuoka
| | - T Iwai
- Department of Gastroenterology, Kitasato University Hospital, Sagamihara
| | - K Nakamura
- Division of Gastroenterology, Chiba Cancer Center, Chiba
| | - H Miyakawa
- Department of Bilio-Pancreatology, Sapporo Kousei General Hospital, Sapporo
| | - T Yamashita
- Department of Gastroenterology, Kanazawa University, Kanazawa
| | - A Hosokawa
- Department of Gastroenterology and Hematology, University of Toyama, Faculty of Medicine, Toyama
| | - T Ioka
- Department of Cancer Survey and Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka
| | - N Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba
| | - K Shioji
- Department of Internal medicine, Niigata Cancer Center Hospital, Niigata
| | - K Shimizu
- Department of Gastroenterology, Tokyo Women's Medical University, Tokyo
| | - T Nakagohri
- Gastroenterological Surgery, Tokai University School of Medicine, Isehara
| | - K Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka
| | - H Ishii
- Clinical Research Center, Chiba Cancer Center, Chiba, Japan
| | - J Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo
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