Randomized clinical trial of adjuvant chemotherapy with S-1 versus gemcitabine after pancreatic cancer resection

Abstract

Overall, S-1 did not improve DFS compared with gemcitabine after pancreatic cancer resection, but there seemed to be a DFS advantage in patients with low expression of DPD or high expression of TS. Reference number: UMIN000009118 (http://www.umin.ac.jp/ctr/).

Chemotherapy in Pancreatic Cancer: A Systematic Review

“…Four clinical trials, two phase 3, one phase 2, and one phase 1/2, assessed gemcitabine and S-1, alone or in combination [2,9,10,11]. Uesaka et al [11] assessed gemcitabine or S-1 in patients with invasive ductal pancreatic carcinoma, stage I–III, with no local residual or microscopic residual tumor, and those with resected pancreatic cancer with no history of chemotherapy or radiotherapy within the past three years.…”

“…Median OS was 25.5 months in the gemcitabine group and 46.5 months in the S-1 group. Shimoda et al [2] assessed gemcitabine or S-1 in patients following the surgical resection of pancreatic cancer. Median PFS was not assessed.…”

“…The five-year survival rate for pancreatic cancer in the United States was reported at 8%, which was the lowest among many other common types of cancer [1]. Only about 20% of pancreatic cancers are resectable, thus surgical resection is an essential component of any curative treatment modality for this cancer where it is possible [2]. A recent study investigated the usefulness of radiofrequency ablation in the resection of tumors, and found this technique aided separation and dissection of the tumor from blood vessels; although this study was very small ( n = 6), the results were promising [3].…”

“…Targeted and immune therapies have not been successful to date [5]. Adjuvant chemotherapy with radiation or alone have been used widely in an attempt to improve outcomes [2]. Cytotoxic chemotherapy has remained as the mainstream treatment for unresectable pancreatic cancer [5].…”

State of the art and future directions of pancreatic ductal adenocarcinoma therapy

“…Recently, oral S-1, a fluoropyrimidine derivative was shown to be non-inferior, and furthermore, even superior to gemcitabine in a randomized phase III trial in a Japanese population (JASPAC-01) (HR for DFS: 0.56, p < 0.0001; HR for OS: 0.56, p < 0.0001) (Fukutomi et al, 2013). Low mRNA levels of dihydropyrimidine dehydrogenase (DPD) and high mRNA levels of thymidylate synthase (TS) might be predictive of S-1 benefit (Shimoda, Kubota, Shimizu, & Katoh, 2015). S-1 is now considered as the new standard treatment for patients with resected PDAC in Japan.…”