Skip to main content
Top
Published in: Clinical and Translational Oncology 10/2013

01-10-2013 | Research Article

Randomized phase II study comparing paclitaxel with S-1 vs. S-1 as first-line treatment in patients with advanced gastric cancer

Authors: X. Wang, M. L. Wang, L. Y. Zhou, X. Y. Lu, J. F. Yang, H. G. Yu

Published in: Clinical and Translational Oncology | Issue 10/2013

Login to get access

Abstract

Purpose

This randomized phase II study was conducted to compare the efficacy and safety of paclitaxel with S-1 (PS) vs. S-1 in patients with advanced gastric cancer (AGC).

Methods

Eighty-two (82) patients were 1:1 randomly assigned to oral S-1 (daily for 2 weeks, every 4 weeks’ cycle) or S-1 (daily for 2 weeks, every 4 weeks’ cycle) plus paclitaxel (on day 1, 8 and 15 of a 4 weeks’ cycle). S-1 was orally administered with a fixed quantity according to body surface area (BSA), while paclitaxel was given 60 mg/m2 i.v. daily through an implanted catheter. The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), overall responsible rates and safety.

Results

The median OS with PS versus S-1 monotherapy was 14.0 versus 11.0 months (P = 0.02), survival at 12 months was 61.0 % in the PS group and 46.3 % in the S-1 group. Median PFS was also significantly longer in the PS group (6.0 months) than in the S-1 group (4.0 months). The overall response rate was determined in 82 evaluable patients, and was significantly higher (P = 0.04) with PS (19 patients, 46.3 %) than with S-1 monotherapy (10 patients, 24.4 %). PS was well tolerated with no treatment-related deaths, all were grade 3–4 gastrointestinal toxicities, including anorexia, nausea, and diarrhea developed in less than 10 % of the patients.

Conclusions

Combination chemotherapy of paclitaxel with S-1 is well tolerated and active in AGC patients. Further investigation with comparative trials is needed for confirmation.
Literature
1.
go back to reference Yang XJ, Huang CQ, Suo T, Mei LJ, Yang GL, Cheng FL, Zhou YF, Xiong B, Yonemura Y, Li Y (2011) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol 18:1575–1581PubMedCrossRef Yang XJ, Huang CQ, Suo T, Mei LJ, Yang GL, Cheng FL, Zhou YF, Xiong B, Yonemura Y, Li Y (2011) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol 18:1575–1581PubMedCrossRef
2.
go back to reference Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer. J Clin 55:74–108 Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer. J Clin 55:74–108
3.
go back to reference Pyrhonen S, Kuitunen T, Nyandoto P, Kouri M (1995) Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer 71:587–591PubMedCrossRef Pyrhonen S, Kuitunen T, Nyandoto P, Kouri M (1995) Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer 71:587–591PubMedCrossRef
4.
go back to reference Murad AM, Santiago FF, Petroianu A, Rocha PR, Rodrigues MA, Rausch M (1993) Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer 72:37–41PubMedCrossRef Murad AM, Santiago FF, Petroianu A, Rocha PR, Rodrigues MA, Rausch M (1993) Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer 72:37–41PubMedCrossRef
5.
go back to reference Sumpter K, Harper-Wynne C, Cunningham D, Rao S, Tebbutt N, Norman AR, Ward C, Iveson T, Nicolson M, Hickish T et al (2005) Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF. Br J Cancer 92:1976–1983PubMedCrossRef Sumpter K, Harper-Wynne C, Cunningham D, Rao S, Tebbutt N, Norman AR, Ward C, Iveson T, Nicolson M, Hickish T et al (2005) Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF. Br J Cancer 92:1976–1983PubMedCrossRef
6.
go back to reference Van Cutsem E, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, Rodrigues A, Fodor M, Chao Y, Voznyi E et al (2006) 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 24:4991–4997PubMedCrossRef Van Cutsem E, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, Rodrigues A, Fodor M, Chao Y, Voznyi E et al (2006) 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 24:4991–4997PubMedCrossRef
7.
8.
go back to reference Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, Miyashita K, Nishizaki T, Kobayashi O, Takiyama W et al (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9:215–221PubMedCrossRef Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, Miyashita K, Nishizaki T, Kobayashi O, Takiyama W et al (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9:215–221PubMedCrossRef
9.
go back to reference Sakata Y, Ohtsu A, Horikoshi N, Sugimachi K, Mitachi Y, Taguchi T (1998) Late phase II study of novel oral fluoropyrimidine anticancer drug S-1 (1 M tegafur-0.4 M gimestat-1 M otastat potassium) in advanced gastric cancer patients. Eur J Cancer 34:1715–1720PubMedCrossRef Sakata Y, Ohtsu A, Horikoshi N, Sugimachi K, Mitachi Y, Taguchi T (1998) Late phase II study of novel oral fluoropyrimidine anticancer drug S-1 (1 M tegafur-0.4 M gimestat-1 M otastat potassium) in advanced gastric cancer patients. Eur J Cancer 34:1715–1720PubMedCrossRef
10.
go back to reference Ajani JA, Faust J, Ikeda K, Yao JC, Anbe H, Carr KL, Houghton M, Urrea P (2005) Phase I pharmacokinetic study of S-1 plus cisplatin in patients with advanced gastric carcinoma. J Clin Oncol 23:6957–6965PubMedCrossRef Ajani JA, Faust J, Ikeda K, Yao JC, Anbe H, Carr KL, Houghton M, Urrea P (2005) Phase I pharmacokinetic study of S-1 plus cisplatin in patients with advanced gastric carcinoma. J Clin Oncol 23:6957–6965PubMedCrossRef
11.
go back to reference Narahara H, Iishi H, Imamura H, Tsuburaya A, Chin K, Imamoto H, Esaki T, Furukawa H, Hamada C, Sakata Y (2011) Randomized phase III study comparing the efficacy and safety of irinotecan plus S-1 with S-1 alone as first-line treatment for advanced gastric cancer (study GC0301/TOP-002). Gastric Cancer 14:72–80PubMedCrossRef Narahara H, Iishi H, Imamura H, Tsuburaya A, Chin K, Imamoto H, Esaki T, Furukawa H, Hamada C, Sakata Y (2011) Randomized phase III study comparing the efficacy and safety of irinotecan plus S-1 with S-1 alone as first-line treatment for advanced gastric cancer (study GC0301/TOP-002). Gastric Cancer 14:72–80PubMedCrossRef
12.
go back to reference Schiff PB, Fant J, Horwitz SB (1979) Promotion of microtubule assembly in vitro by taxol. Nature 277:665–667PubMedCrossRef Schiff PB, Fant J, Horwitz SB (1979) Promotion of microtubule assembly in vitro by taxol. Nature 277:665–667PubMedCrossRef
13.
go back to reference Ganansia-Leymarie V, Bischoff P, Bergerat JP, Holl V (2003) Signal transduction pathways of taxanes-induced apoptosis. Curr Med Chem Anticancer Agents 3:291–306PubMedCrossRef Ganansia-Leymarie V, Bischoff P, Bergerat JP, Holl V (2003) Signal transduction pathways of taxanes-induced apoptosis. Curr Med Chem Anticancer Agents 3:291–306PubMedCrossRef
14.
go back to reference Ohtsu A, Boku N, Tamura F, Muro K, Shimada Y, Saigenji K, Akazawa S, Kitajima M, Kanamaru R, Taguchi T (1998) An early phase II study of a 3-hour infusion of paclitaxel for advanced gastric cancer. Am J Clin Oncol 21:416–419PubMedCrossRef Ohtsu A, Boku N, Tamura F, Muro K, Shimada Y, Saigenji K, Akazawa S, Kitajima M, Kanamaru R, Taguchi T (1998) An early phase II study of a 3-hour infusion of paclitaxel for advanced gastric cancer. Am J Clin Oncol 21:416–419PubMedCrossRef
15.
go back to reference Yamada Y, Shirao K, Ohtsu A, Boku N, Hyodo I, Saitoh H, Miyata Y, Taguchi T (2001) Phase II trial of paclitaxel by three-hour infusion for advanced gastric cancer with short premedication for prophylaxis against paclitaxel-associated hypersensitivity reactions. Ann Oncol 12:1133–1137PubMedCrossRef Yamada Y, Shirao K, Ohtsu A, Boku N, Hyodo I, Saitoh H, Miyata Y, Taguchi T (2001) Phase II trial of paclitaxel by three-hour infusion for advanced gastric cancer with short premedication for prophylaxis against paclitaxel-associated hypersensitivity reactions. Ann Oncol 12:1133–1137PubMedCrossRef
16.
go back to reference Yonemura Y, Endou Y, Bando E, Kuno K, Kawamura T, Kimura M, Shimada T, Miyamoto K, Sasaki T, Sugarbaker PH (2004) Effect of intraperitoneal administration of docetaxel on peritoneal dissemination of gastric cancer. Cancer Lett 210:189–196PubMedCrossRef Yonemura Y, Endou Y, Bando E, Kuno K, Kawamura T, Kimura M, Shimada T, Miyamoto K, Sasaki T, Sugarbaker PH (2004) Effect of intraperitoneal administration of docetaxel on peritoneal dissemination of gastric cancer. Cancer Lett 210:189–196PubMedCrossRef
17.
go back to reference Chen L, Tian H, Chen J, He ZG, Tao SF, Lokesh G, Peng SY (2005) Surgical management of gastric stump cancer: a report of 37 cases. J Zhejiang Univ Sci B 6:38–42PubMedCrossRef Chen L, Tian H, Chen J, He ZG, Tao SF, Lokesh G, Peng SY (2005) Surgical management of gastric stump cancer: a report of 37 cases. J Zhejiang Univ Sci B 6:38–42PubMedCrossRef
18.
go back to reference Li XD, Shen H, Jiang JT, Zhang HZ, Zheng X, Shu YQ, Wu CP (2011) Paclitaxel based vs oxaliplatin based regimens for advanced gastric cancer. World J Gastroenterol 17:1082–1087PubMedCrossRef Li XD, Shen H, Jiang JT, Zhang HZ, Zheng X, Shu YQ, Wu CP (2011) Paclitaxel based vs oxaliplatin based regimens for advanced gastric cancer. World J Gastroenterol 17:1082–1087PubMedCrossRef
19.
go back to reference Masuzawa T, Fujiwara Y, Okada K, Nakamura A, Takiguchi S, Nakajima K, Miyata H, Yamasaki M, Kurokawa Y, Osawa R et al (2012). Phase I/II study of S-1 plus cisplatin combined with peptide vaccines for human vascular endothelial growth factor receptor 1 and 2 in patients with advanced gastric cancer. Int J Oncol (epub ahead of print) Masuzawa T, Fujiwara Y, Okada K, Nakamura A, Takiguchi S, Nakajima K, Miyata H, Yamasaki M, Kurokawa Y, Osawa R et al (2012). Phase I/II study of S-1 plus cisplatin combined with peptide vaccines for human vascular endothelial growth factor receptor 1 and 2 in patients with advanced gastric cancer. Int J Oncol (epub ahead of print)
20.
go back to reference Uedo N, Narahara H, Ishihara R, Takiuchi H, Goto M, Fujitani K, Hirao M, Tsujinaka T, Imano M, Furukawa H et al (2007) Phase II study of a combination of irinotecan and S-1 in patients with advanced gastric cancer (OGSG0002). Oncology 73:65–71. doi:10.3892/ijo.2012.1573 PubMedCrossRef Uedo N, Narahara H, Ishihara R, Takiuchi H, Goto M, Fujitani K, Hirao M, Tsujinaka T, Imano M, Furukawa H et al (2007) Phase II study of a combination of irinotecan and S-1 in patients with advanced gastric cancer (OGSG0002). Oncology 73:65–71. doi:10.​3892/​ijo.​2012.​1573 PubMedCrossRef
21.
go back to reference Fujitani K, Narahara H, Takiuchi H, Tsujinaka T, Satomi E, Gotoh M, Hirao M, Furukawa H, Taguchi T (2005) Phase I and pharmacokinetic study of S-1 combined with weekly paclitaxel in patients with advanced gastric cancer. Oncology 69:414–420PubMedCrossRef Fujitani K, Narahara H, Takiuchi H, Tsujinaka T, Satomi E, Gotoh M, Hirao M, Furukawa H, Taguchi T (2005) Phase I and pharmacokinetic study of S-1 combined with weekly paclitaxel in patients with advanced gastric cancer. Oncology 69:414–420PubMedCrossRef
22.
go back to reference Mochiki E, Ohno T, Kamiyama Y, Aihara R, Haga N, Ojima H, Nakamura J, Ohsawa H, Nakabayashi T, Takeuchi K et al (2006) Phase I/II study of S-1 combined with paclitaxel in patients with unresectable and/or recurrent advanced gastric cancer. Br J Cancer 95:1642–1647PubMedCrossRef Mochiki E, Ohno T, Kamiyama Y, Aihara R, Haga N, Ojima H, Nakamura J, Ohsawa H, Nakabayashi T, Takeuchi K et al (2006) Phase I/II study of S-1 combined with paclitaxel in patients with unresectable and/or recurrent advanced gastric cancer. Br J Cancer 95:1642–1647PubMedCrossRef
23.
go back to reference Kawabata R, Fujiwara Y, Doki Y, Fujita J, Tsukahara Y, Yamasaki M, Miyata H, Takiguchi S, Monden M (2007) Phase I/II study of a combination of S-1 and weekly paclitaxel in patients with advanced or recurrent gastric cancer. Oncology 72:219–225PubMedCrossRef Kawabata R, Fujiwara Y, Doki Y, Fujita J, Tsukahara Y, Yamasaki M, Miyata H, Takiguchi S, Monden M (2007) Phase I/II study of a combination of S-1 and weekly paclitaxel in patients with advanced or recurrent gastric cancer. Oncology 72:219–225PubMedCrossRef
Metadata
Title
Randomized phase II study comparing paclitaxel with S-1 vs. S-1 as first-line treatment in patients with advanced gastric cancer
Authors
X. Wang
M. L. Wang
L. Y. Zhou
X. Y. Lu
J. F. Yang
H. G. Yu
Publication date
01-10-2013
Publisher
Springer Milan
Published in
Clinical and Translational Oncology / Issue 10/2013
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-013-1012-6

Other articles of this Issue 10/2013

Clinical and Translational Oncology 10/2013 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine