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Phase II Study of S-1 Plus Docetaxel As First-line Treatment for Older Patients with Advanced Gastric Cancer (OGSG 0902)

Abstract

Background: Although there is insufficient evidence for the treatment of older patients with advanced gastric cancer, fluorouracil combined with platinum chemotherapy has been recognized as a standard first-line treatment for such populations in Japan despite the lack of efficacy and toxicity data.

Methods: Patients aged 75 years or older with advanced gastric cancer were enrolled. S-1 plus docetaxel (docetaxel: 40 mg/m, day 1; S-1: 80 mg/m, days 1-14; q21 days) was repeated every 3 weeks. The primary endpoint was overall response rate. Secondary endpoints were safety, progression-free survival, time to treatment failure, and overall survival. The sample size was calculated as 30 under the hypothesis of an expected response rate of 40% and a threshold response rate of 20%, at a power of 90% and a two-sided alpha value of 5%.

Results: From February 2010 to January 2015, 31 patients were enrolled and assessed for efficacy and toxicity. The response rate was 45.2% (95% CI 27.3%-64.0%; p = 0.001) and it exceeded the expected response rate set at 40%. Median progression-free survival was 5.8 months, the 1-year survival rate was 58.1%, and the median survival time was 16.1 months. The major grade 3/4 adverse events were neutropenia (58%), febrile neutropenia (13%), anemia (10%), anorexia (10%), and fatigue (6%).

Conclusions: These findings indicate that S-1 plus docetaxel as first-line treatment for older patients is feasible and that it has promising efficacy against advanced gastric cancer.

References
1.
Cunningham D, Starling N, Rao S, Iveson T, Nicolson M, Coxon F . Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 2008; 358(1):36-46. DOI: 10.1056/NEJMoa073149. View

2.
Van Cutsem E, Moiseyenko V, Tjulandin S, Majlis A, Constenla M, Boni C . Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol. 2006; 24(31):4991-7. DOI: 10.1200/JCO.2006.06.8429. View

3.
Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M . S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 2008; 9(3):215-21. DOI: 10.1016/S1470-2045(08)70035-4. View

4.
Makiyama A, Kunieda K, Noguchi M, Kajiwara T, Tamura T, Takeda K . First-line chemotherapy with S-1 alone or S-1 plus cisplatin for elderly patients with advanced gastric cancer: a multicenter propensity score matched study. Gastric Cancer. 2018; 21(5):792-801. DOI: 10.1007/s10120-018-0797-y. View

5.
Yamada Y, Higuchi K, Nishikawa K, Gotoh M, Fuse N, Sugimoto N . Phase III study comparing oxaliplatin plus S-1 with cisplatin plus S-1 in chemotherapy-naïve patients with advanced gastric cancer. Ann Oncol. 2014; 26(1):141-148. DOI: 10.1093/annonc/mdu472. View