Abstract. Background: It has not been elucidated whether the clinical efficacy of oral fluoropyrimidines for adjuvant chemotherapy of colorectal cancer varies with tumor biological characteristics. Patients and MethodsThe postoperative survival of patients with primary colorectal cancer has been improving; a recent Japanese study reported 5-year disease-free survival (DFS) and overall survival (OS) rates for stage III colon/upper rectal cancer of 74.3% and 82.6%, respectively, after adjuvant chemotherapy with 5-fluorouracil (5-FU) and leucovorin (LV) over a 6-month period (1). Historically, oral fluoropyrimidines have been widely used postoperatively for 6-12 months as an adjuvant therapy for stage III colorectal cancer in Japan. A metaanalysis has shown the benefit of postoperative adjuvant therapy using oral fluoropyrimidines over surgery alone (2), as has a randomized controlled study (3). In many oral fluoropyrimidines, the mechanism of action is theoretically influenced by the content of modulators in the cancer tissue; such as thymidine phosphorylase (TP) in capecitabine (4), thymidine synthase (TS) or dihydropyrimidine dehydrogenase (DPD) in tegafur-uracil (UFT) or tegafur/gimeracil/oteracil (S-1). However, there have not been many clinical trials focusing on the efficacy of oral pyrimidines based on the content of modulators in cancer tissue. In the current study, we conducted a randomized clinical trial (UMIN000001560) comparing UFT/LV for 6 months with S-1 for 12 months for stage III colorectal cancers with a particular focus on mRNA expression of 5-FU metabolism-related enzymes in cancer tissue. Our aim was to determine whether the concentrations of these enzymes in cancer tissue can assist optimal selection of an oral anti-cancer fluoropyrimidine.
Patients and MethodsPatients and treatment protocol. Eligibility criteria were as follows: (i) histopathologically confirmed stage III adenocarcinoma, 5325