S-1 and Gemcitabine as an Outpatient-based Regimen in Patients with Advanced or Metastatic Pancreatic Cancer

• Published in: Japanese journal of clinical oncology Vol. 39; no. 1; pp. 49 - 53
• Main Authors: Kim, Min Kyoung, Lee, Kyung Hee, Jang, Byung Ik, Kim, Tae Nyeun, Eun, Jong Ryul, Bae, Sung Hwa, Ryoo, Hun Mo, Lee, Sun Ah, Hyun, Myung Soo
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-01-2009; Oxford Publishing Limited (England)
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - secondary; Administration, Oral; Aged; Ambulatory Care; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; combination; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Drug Combinations; drug therapy; Female; Follow-Up Studies; gemcitabine; Humans; Male; Maximum Tolerated Dose; Middle Aged; Neoplasm Staging; Oxonic Acid - administration & dosage; Pancreatic cancer; pancreatic neoplasms; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - pathology; Prognosis; Retrospective Studies; S-1; Tegafur - administration & dosage; gemcitabine; drug therapy, combination; pancreatic neoplasms; S-1
• ISSN: 0368-2811; 1465-3621
• DOI: 10.1093/jjco/hyn126

Objective The standard beneficial chemotherapy proved for patients with pancreatic cancer is a regimen containing gemcitabine. Novel oral fluoropyrimidine, S-1, can be added to gemcitabine to improve the efficacy of chemotherapy and to provide better convenience for patients. We aimed to evaluate the efficacy and safety of S-1 plus gemcitabine combination chemotherapy as a first-line treatment in patients with locally advanced or metastatic pancreatic cancer. Methods Patients with histologically confirmed, bidimensionally measurable advanced/metastatic pancreatic cancer were eligible for the study. Chemotherapy consisted of S-1 (30 mg/m2 p.o. bid from Day 1 to 14) and gemcitabine (1000 mg/m2 on Days 8 and 15) every 3 weeks based on the results of a previously reported Phase I trial. Treatment was repeated until disease progression or unacceptable toxicity occurred. Results From January 2005 to August 2007, 22 patients were enrolled. Median age was 62 years (range, 50–73). Nineteen patients (86.3%) had metastases and of these, 11 patients (57.9%) had multiple liver metastases. The overall response rate was 27.3% (95% CI, 8.7–45.9), with a partial response in six patients, stable disease in nine (40.9%) and progressive disease in seven (31.8%). With a median follow-up of 25.4 months, the median time to progression and overall survival were 4.6 (95% CI, 2–7.2 months) and 8.5 months (95% CI, 6.8–10.1 months), respectively, and 1-year survival rate was 27.3%. S-1 plus gemcitabine was well tolerated. Grade 3/4 hematological adverse events were neutropenia (9.1/9.1%) and anemia (4.5/0%). Non-hematological adverse events were mainly gastrointestinal events. Twenty patients (91%) received chemotherapy on an outpatient basis. Conclusions Combination chemotherapy of S-1 plus gemcitabine appears to be active and well tolerated as first-line treatment in patients with advanced/metastatic pancreatic cancer.