Adjuvant Chemotherapy with S-1 Followed by Docetaxel for Gastric Cancer and CY1P0 Peritoneal Metastasis after Relatively Curative Surgery

• Published in: Journal of Nippon Medical School Vol. 80; no. 5; pp. 378 - 383
• Main Authors: Kanazawa, Yoshikazu, Kato, Shunji, Fujita, Itsuo, Onodera, Hiroyuki, Uchida, Eiji
• Format: Journal Article
• Language: English
• Published: Japan The Medical Association of Nippon Medical School 2013
• Subjects: adjuvant chemotherapy; Administration, Intravenous; Administration, Oral; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma - drug therapy; Carcinoma - mortality; Carcinoma - secondary; Carcinoma - surgery; Carcinoma - therapy; Chemotherapy, Adjuvant; CY1; Disease Progression; Disease-Free Survival; docetaxel; Doxorubicin - administration & dosage; Drug Administration Schedule; Drug Combinations; Feasibility Studies; Female; Gastrectomy; gastric cancer; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Oxonic Acid - administration & dosage; peritoneal metastasis; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - secondary; S-1; Stomach Neoplasms - drug therapy; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Stomach Neoplasms - therapy; Survival Rate; Tegafur - administration & dosage; Time Factors; Treatment Outcome
• ISSN: 1345-4676; 1347-3409
• DOI: 10.1272/jnms.80.378

Objective: The aim of this study was to assess the feasibility and safety of adjuvant chemotherapy with S-1 followed by docetaxel. Patients and Method: Twenty-eight patients with advanced gastric cancer underwent gastrectomy without preoperative chemotherapy. These patients were divided into 3 groups on the basis of cytologic results of peritoneal lavage (CY) and the presence of local peritoneal metastatic nodules (P): CY1-P0, CY0-P1, and CY1-P1. Oral S-1 (80 mg/m2/day) was administered for 3 consecutive weeks, followed by intravenous docetaxel (35 mg/m2) on days 29 and 43 (1 cycle). This cycle was repeated every 8 weeks. The primary endpoint was the ability to complete 6 cycles of S-1 followed by docetaxel. The secondary endpoints were safety, progression-free survival, mean survival time (MST), and overall survival (OS). Results: The subjects were 18 men and 10 women (39 to 78 years old, median age, 64 years). The extent of peritoneal metastasis was CY1-P0 in 8 patients, CY0-P1 in 14 patients, and CY1-P1 in 6 patients. Both hematologic and nonhematologic toxicities were generally mild. The completion rate of the planned 6 cycles of the protocol was 71.4% (20 of 28 patients). Median progression-free survival was 22.9 months, and the 2-year survival rate was 78.6%. The overall MST was 34.3 months, and the MST by group was 34.5 for CY1-P0, 34.3 for CY0-P1, and 19.3 months for CY1-P1. The OS in the CY1-P0 and CY0-P1 groups was significantly longer than that in the CY1-P1 group (P<0.05). Conclusion: Adjuvant chemotherapy with S-1 followed by docetaxel is safe and well tolerated and has the potential to improve OS in patients with a status of CY1P0 following relatively curative resection.