Randomized Clinical Trial of Adjuvant Mitomycin Plus Tegafur in Patients With Resected Stage III Gastric Cancer

Cirera, Lluís; Balil, A.; Batiste-Alentorn, E.; Tusquets, Ignasi; Cardona, T.; Arcusa, Àngels; Jolis, L.; Saigí, Eugeni; Guasch, Imma; Badia, Anna; Boleda, M.

doi:10.1200/jco.1999.17.12.3810

Cited by 106 publications

(48 citation statements)

References 37 publications

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“…A survival benefit has been shown for one regimen vs another (Cirera et al, 1999;Roth et al, 1999;Waters et al, 1999;Chao et al, 2000) and in a small number of studies with small numbers of patients comparing chemotherapy with best supportive care (Murad et al, 1993;Pyrhonen et al, 1995;Glimelius et al, 1997). The absence of a large randomised study of chemotherapy vs best supportive care has allowed the debate on its merits to continue.…”

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confidence: 99%

Marimastat as maintenance therapy for patients with advanced gastric cancer: a randomised trial

et al. 2002

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This randomised, double-blind, placebo-controlled study was designed to evaluate the ability of the orally administered matrix metalloproteinase inhibitor, marimastat, to prolong survival in patients with non-resectable gastric and gastro-oesophageal adenocarcinoma. Three hundred and sixty-nine patients with histological proof of adenocarcinoma, who had received no more than a single regimen of 5-fluorouracil-based chemotherapy, were randomised to receive either marimastat (10 mg b.d.) or placebo. Patients were treated for as long as was tolerable. The primary endpoint was overall survival with secondary endpoints of time to disease progression and quality of life. At the point of protocol-defined study completion (85% mortality in the placebo arm) there was a modest difference in survival in the intention-to-treat population in favour of marimastat (P=0.07 log-rank test, hazard ratio=1.23 (95% confidence interval 0.98 -1.55)). This survival benefit was maintained over a further 2 years of follow-up (P=0.024, hazard ratio=1.27 (1.03 -1.57)). The median survival was 138 days for placebo and 160 days for marimastat, with 2-year survival of 3% and 9% respectively. A significant survival benefit was identified at study completion in the pre-defined sub-group of 123 patients who had received prior chemotherapy (P=0.045, hazard ratio=1.53 (1.00 -2.34)). This benefit increased with 2 years additional follow-up (P=0.006, hazard ratio=1.68 (1.16 -2.44)), with 2-year survival of 5% and 18% respectively. Progression-free survival was also significantly longer for patients receiving marimastat compared to placebo (P=0.009, hazard ratio=1.32 (1.07 -1.63)). Marimastat treatment was associated with the development of musculoskeletal pain and inflammation. Events of anaemia, abdominal pain, jaundice and weight loss were more common in the placebo arm. This is one of the first demonstrations of a therapeutic benefit for a matrix metalloproteinase inhibitor in cancer patients. The greatest benefit was observed in patients who had previously received chemotherapy. A further randomised study of marimastat in these patients is warranted.

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Marimastat as maintenance therapy for patients with advanced gastric cancer: a randomised trial

et al. 2002

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“…However, the prognosis of patients with locally advanced gastric cancer is generally poor even with curative resection (Noguchi et al, 1989;Shiu et al, 1989;Fuchs and Mayer, 1995). Adjuvant chemotherapy has failed to demonstrate a significant survival benefit for such patients in most randomized trials and meta-analyses, except in a few studies with positive results (Shiu et al, 1989;Krook et al, 1991;Kim et al, 1992;Hermans et al, 1993;Nakazato et al, 1994;Fuchs and Mayer, 1995;Lise et al, 1995;Macdonald et al, 1995;Kelsen, 1996;Kim et al, 1998;Cirera et al, 1999;Earle and Maroun, 1999).…”

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Expression of thymidylate synthase in gastric cancer patients treated with 5-fluorouracil and doxorubicin-based adjuvant chemotherapy after curative resection

Lim

Nam

et al. 2001

Br J Cancer

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SummaryWe evaluated the expression of thymidylate synthase (TS) in locally advanced gastric cancer patients treated with adjuvant chemotherapy after curative resection and investigated the association between TS expression and clinicopathologic characteristics including prognosis of the patients. TS expression was evaluated by immunohistochemical staining using TS106 monoclonal antibody in 103 locally advanced gastric cancer patients (stage IB-IV) who underwent 5-fluorouracil (5-FU) and doxorubicin-based adjuvant chemotherapy after curative resection. 65 patients (63%) had primary tumours with high TS expression (≥ 25% of tumour cells positive), and 38 patients (37%) demonstrated low TS expression (< 25% of tumour cells positive or no staining). High TS expression was associated with male gender (P = 0.002), poorly differentiated histology (P = 0.015), and mixed type in Lauren's classification (P = 0.027). There were no statistically significant differences in 4-year disease-free survival (60.0% vs 57.2%, P = 0.548) and overall survival (59.6% vs 59.3%, P = 0.792) between high-TS group and low-TS group. In conclusion, although high TS expression was associated with poorly differentiated histology and mixed type in Lauren's classification, it did not predict poor disease-free and overall survival in gastric cancer patients treated with 5-FU and doxorubicin-based adjuvant chemotherapy after curative resection. Further prospective studies including the evaluation of other biological markers associated with the resistance to 5-FU and doxorubicin are necessary. 186-192 © 2001 Cancer Research Campaign doi: 10.1054/ bjoc.2000.1553, available online at http://www.idealibrary.com on http://www.bjcancer.com based adjuvant chemotherapy after curative surgical resection at Ajou University Medical Center in Suwon, Korea, between July 1994 and October 1996. All patients had a postsurgical pathologic stage ranging from IB to IV without evidence of distant metastasis according to the American Joint Committee on Cancer TNM classification (American Joint Committee on Cancer, 1997). Curative resection was defined by the General Rules for the Gastric Cancer Study in Surgery and Pathology of the Japanese Research Society for Gastric Cancer as: no involvement of surgical stumps; sufficient lymphatic dissection (R number ≥ N number); no distant metastasis; removal of involved adjacent organs and structures by combined en-bloc resection; and no gross residual disease (Japanese Research Society for Gastric Cancer, 1981). None of these patients received chemotherapy prior to surgery.Although all patients received 5-FU and doxorubicin-based adjuvant chemotherapy, the regimens were not uniform. The most commonly administered regimen was FA (5-FU, doxorubicin) with OK-432 (51 patients), followed by FAM (5-FU, doxorubicin, mitomycin-C) (33 patients), FA (11 patients), and FA with lentinan (eight patients). Chemotherapy was usually started 2-3 weeks after surgery. In the FA regimen with or without immunotherapy (OK-432 or lentinan), 5-FU (...

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“…The prognosis of patients with locally advanced gastric cancer is generally poor even with curative resection, which is an essential treatment for the long-term survival of patients (Noguchi et al, 1989;Fuchs and Mayer, 1995). Adjuvant chemotherapy has failed to demonstrate a significant survival benefit for such patients in most randomized trials and meta-analyses although a recent study showed improved survival with postoperative chemoradiotherapy compared to surgery alone (Krook et al, 1991;Hermans et al, 1993;Fuchs and Mayer, 1995;Lise et al, 1995;Macdonald et al, 1995;Kelsen, 1996;Kim et al, 1998;Cirera et al, 1999;Earle and Maroun, 1999;Macdonald et al, 2001).…”

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Expression of multidrug resistance-associated protein1,P-glycoprotein, and thymidylate synthase in gastric cancer patients treated with 5-fluorouracil and doxorubicin-based adjuvant chemotherapy after curative resection

Lim

Joo

et al. 2002

Br J Cancer

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Both 5-fluorouracil and doxorubicin are commonly used agents in chemotherapy of gastric cancer in adjuvant setting as well as metastatic disease. In a variety of malignancies, high expression of multidrug resistance-associated protein1 and P-glycoprotein has been associated with resistance to doxorubicin, whereas 5-fluorouracil resistance has correlated with the level of thymidylate synthase expression. We evaluated the expression of multidrug resistance-associated protein1, P-glycoprotein, and thymidylate synthase using immunohistochemistry in 103 locally advanced gastric cancer patients (stage IB-IV) who underwent 5-fluorouracil and doxorubicin-based adjuvant chemotherapy after curative resection and investigated the association between their expression and clinicopathologic characteristics including prognosis of the patients. While high expression (55% of tumour cells positive) of multidrug resistance-associated protein1 and P-glycoprotein was observed in 70 patients (68%) and 42 patients (41%), respectively, 65 patients (63%) had primary tumours with high expression (525% of tumour cells positive) of thymidylate synthase. There was a significant association between multidrug resistance-associated protein1 and Pglycoprotein expression (P50.0001) as well as P-glycoprotein and thymidylate synthase expression (P50.0001). High multidrug resistance-associated protein1 and P-glycoprotein expressions were associated with well and moderately differentiated histology (P50.0001 and P=0.03, respectively) and intestinal type (P50.0001 and P=0.009, respectively). High multidrug resistance-associated protein1 expression correlated with lymph node metastasis (P=0.037), advanced stage (P=0.015), and older age (P=0.021). Five-year disease-free survival and overall survival of total patients were 55.2% and 56.2%, respectively, with a median follow-up of 68 months. There were no significant differences in disease-free survival and overall survival according to the expression of multidrug resistance-associated protein1 (P=0.902 and P=0.975, respectively), Pglycoprotein (P=0.987 and P=0.955, respectively), and thymidylate synthase (P=0.604 and P=0.802, respectively). Concurrent high expression of these proteins (high multidrug resistance-associated protein1/P-glycoprotein, high multidrug resistanceassociated protein1/thymidylate synthase, high P-glycoprotein/thymidylate synthase) did not correlate with disease-free survival or overall survival. Even high expression of all three proteins was not associated with poor disease-free survival (P=0.919) and overall survival (P=0.852). In conclusion, high expression of multidrug resistance-associated protein1, P-glycoprotein, and thymidylate synthase did not predict poor prognosis of gastric cancer patients treated with 5-fluorouracil and doxorubicinbased adjuvant chemotherapy. A larger study including patients treated with surgical resection alone would be necessary.

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Randomized Clinical Trial of Adjuvant Mitomycin Plus Tegafur in Patients With Resected Stage III Gastric Cancer

Abstract: Our positive results are consistent with the results of recent studies; which conclude that there is a potential benefit from adjuvant chemotherapy in resected gastric cancer.

Cited by 106 publications

References 37 publications

Marimastat as maintenance therapy for patients with advanced gastric cancer: a randomised trial

Marimastat as maintenance therapy for patients with advanced gastric cancer: a randomised trial

Expression of thymidylate synthase in gastric cancer patients treated with 5-fluorouracil and doxorubicin-based adjuvant chemotherapy after curative resection

Expression of multidrug resistance-associated protein1,P-glycoprotein, and thymidylate synthase in gastric cancer patients treated with 5-fluorouracil and doxorubicin-based adjuvant chemotherapy after curative resection

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