Combination chemotherapy with S-1 plus cisplatin for gastric cancer that recurs after adjuvant chemotherapy with S-1: multi-institutional retrospective analysis

Abstract

BackgroundIt is unclear whether S-1 plus cisplatin is effective for patients with recurrent gastric cancer after adjuvant S-1 chemotherapy.MethodsWe retrospectively evaluated the efficacy of S-1 plus cisplatin in patients whose gastric cancer recurred after adjuvant S-1 chemotherapy.ResultsIn the 52 patients evaluated, the median duration of adjuvant S-1 chemotherapy was 8.1 months, and the median recurrence-free interval (RFI) since the last administration of adjuvant S-1 was 6.4 months. Among the 36 patients with measurable lesions, 7 achieved a complete or partial response, and 13 were evaluated as having stable disease, for an overall response rate of 19.4% and a disease control rate of 55.6%. For all patients, the median progression-free survival (PFS) was 4.8 months, and the median overall survival (OS) was 12.2 months. Compared with patients with an RFI of <6 months (n = 25), patients with an RFI of ≥6 months (n = 27) had a significantly higher response rate (5.0 vs. 37.5%, respectively), longer PFS (2.3 vs. 6.2 months, respectively), and longer overall survival (7.3 vs. 16.6 months, respectively). According to a multivariate Cox model including performance status (PS) and reason for discontinuation of adjuvant S-1, an RFI of 6 months was still significantly associated with PFS and OS.ConclusionsS-1 plus cisplatin is effective for patients with gastric cancer that recurs after adjuvant S-1 chemotherapy, especially for those with an RFI of ≥6 months.

A phase II trial of capecitabine plus cisplatin (XP) for patients with advanced gastric cancer with early relapse after S-1 adjuvant therapy: XParTS-I trial

“…Because the PFS was 2.3 months in recurrent gastric cancer with RFI of less than 6 months after adjuvant S-1 chemotherapy in the previous retrospective analysis [6], the threshold PFS was set at 2 months. The addition of XP was expected to increase PFS by 1 month.…”

“…After the results were reported from the JCOG9912 and SPIRITS trials, S-1 plus cisplatin (SP) became accepted as the standard treatment for patients with advanced gastric cancer (AGC) in Japan [4,5]. In a retrospective analysis of those patients by Shitara et al, SP was not shown to be effective in patients with recurrent gastric cancer, especially with a relapse-free interval (RFI) of less than 6 months after adjuvant S-1 chemotherapy [6]. In their report, compared with patients with RFI of ≥ 6 months, patients with RFI of < 6 months had a significantly lower objective overall response rate (ORR) (5.0 vs. 37.5%), shorter progression-free survival (PFS) (2.3 vs. 6.2 months), and shorter overall survival (OS) (7.3 vs. 16.6 months).…”

Japanese gastric cancer treatment guidelines 2014 (ver. 4)

“…The response rate of treatment by S-1 + cisplatin is reportedly low (5 %) for patients who had recurrence within 6 months from completion of the S-1 adjuvant therapy when compared with the response rate for recurrences after 6 months from the completion (37.5 %) [50]. This result, found in a multi-institutional retrospective analysis, suggests that cancers that recur during or early after completion of an adjuvant chemotherapy are resistant to the drug used in that chemotherapy.…”

Efficacy of capecitabine in patients with locally advanced or metastatic breast cancer with or without prior treatment with fluoropyrimidine: a retrospective study

“…We used RFI to compare patients with prior FP use and those without prior FP use. The previous studies that assessed re-challenge with a chemotherapeutic agent in other cancers reported that drug-free interval (time since last administration of the drug until relapse) is predictive of the efficacy of re-challenge [10–12]. However, drug-free interval may be dependent upon the nature of the tumor (aggressive or indolent).…”

“…As such, some patients with ABC receiving capecitabine have a previous history of treatment with other FPs. Re-challenge of chemotherapeutic agents has been assessed in other cancers [10–12]. However, aside from a few studies providing limited results, separately assessing patients either with or without prior use of FPs [4, 13], the efficacy of capecitabine in patients with ABC who have received FPs for the early breast cancer has not been studied sufficiently.…”