626PD - A randomized phase III trial comparing 4 courses and 8 courses of S-1 adjuvant chemotherapy for p-stage II gastric cancer: JCOG1104 (OPAS-1)

Date 11 September 2017
Event ESMO 2017 Congress
Session Gastrointestinal tumours, non-colorectal
Topics Anti-Cancer Agents & Biologic Therapy
Gastric Cancer
Gastrointestinal Cancers
Presenter Takaki Yoshikawa
Citation Annals of Oncology (2017) 28 (suppl_5): v209-v268. 10.1093/annonc/mdx369
Authors T. Yoshikawa1, M. Terashima2, J. Mizusawa3, S. Nunobe4, Y. Nishida5, M. Kaji6, N. Fukushima7, S. Hato8, Y. Choda9, H. Yabusaki10, K. Yoshida11, S. Ito12, A. Takeno13, T. Yasuda14, Y. Kawachi15, H. Katayama3, H. Fukuda3, N. Boku16, T. Sano4, M. Sasako17
  • 1Department Of Gastrointestinal Surgery, Kanagawa Cancer Center, 2418515 - Yokohama/JP
  • 2Division Of Gastric Surgery, Shizuoka Cancer Center, 411-8777 - Shizuoka/JP
  • 3Jcog Data Center/operations Office, National Cancer Center Hospital, 104-0045 - Tokyo/JP
  • 4Gastroenterological Surgery, Cancer Institute Ariake Hospital, 1358550 - Tokyo/JP
  • 5Department Of Surgery, Keiyukai Sapporo Hospital, 0030027 - Sapporo/JP
  • 6Department Of Surgery, Toyama Prefectural Central Hospital, 9308550 - Toyama/JP
  • 7Department Of Surgery, Yamagata Prefectural Central Hospital, 990-2292 - Yamagata/JP
  • 8Department Of Surgery, Shikoku Cancer Center, 7910280 - Matsuyama/JP
  • 9Department Of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7308518 - Hiroshima/JP
  • 10Department Of Gastroenterological Surgery, Niigata Cancer Center Hospital, 951-8566 - Niigata/JP
  • 11Department Of Surgical Oncology, Gifu University, Graduate School of Medicine, 5011194 - Gifu/JP
  • 12Department Of Gastroenterological Surgery, Aichi Cancer Center Hospital, 4648681 - Nagoya/JP
  • 13Department Of Surgery, Kansai Rosai Hospital, 660-8511 - Amagasaki/JP
  • 14Department Of Gastroenterological Surgery, Hyogo Cancer Center, 673-8558 - Akashi/JP
  • 15Department Of Surgery, Nagaoka Chuo General Hospital, 9408653 - Nagaoka/JP
  • 16Division Of Gastrointestinal Medical Oncology, National Cancer Center Hospital, 104-0045 - Tokyo/JP
  • 17Department Of Multidisciplinary Surgical Oncology, Hyogo College of Medicine, 663-8501 - Nishinomiya/JP

Abstract

Background

Postoperative S-1 for 1 year (corresponding to 8 courses) is a standard adjuvant chemotherapy for p-stage II gastric cancer based on ACTS-GC phase III study comparing surgery alone and S-1. Duration of adjuvant chemotherapy for 1 year selected in ACTS-GC was not based on solid evidence while 6 months are established for colon cancer based on several phase III studies to compare duration. It remains unclear whether S-1 for 1 year could be shortened to 6 months (corresponding to 4 courses) without worsening the survival.

Methods

We conducted a multi-center phase III trial to confirm non-inferiority in relapse-free survival (RFS) of 4 courses S-1 to 8 courses S-1 in p-stage II gastric cancer. Key eligibility criteria were p-stage II except T1 and T3N0 (7th edition of TNM), performance status 0-1, R0 resection with D2 lymph node dissection for ≥c-stage II or D1+ lymph node dissection for c-stage I, within 7 weeks after surgery, and age between 20 and 80 years. Primary endpoint was RFS and secondary endpoints included overall survival (OS), time to treatment failure (TTF), and adverse events. Patients were randomized into 4 course S-1 or 8 courses S-1. 80 mg/m2 of S-1 was administered for 4 weeks with a rest for 2 weeks as one course. Total sample size was determined to be 1,000 with 3-year RFS of 85% in both arms and non-inferiority margin of hazard ratio (HR) of 1.37, one-sided alpha of 5% and 80% power.

Results

Between Feb 2012 and Mar 2017, 590 patients were enrolled in this study. Among them, 528 patients were analyzed at the first planned interim analysis at Mar 2017. JCOG Data and Safety Monitoring Committee recommended early termination of the trial because the point estimate of HR was greater than non-inferiority margin of HR, which met the prespecified criteria for early stopping. The study was closed on the basis of futility. RFS at 3 years was 88.9% for 4-courses arm and 95.3% for 8-courses arm (HR 2.52, 95% CI 1.11-5.77). OS at 3 years was 91.7% for 4-courses arm and 97.7% for the 8-courses arm (HR 5.18, 95% CI 1.50-17.89).

Conclusions

Postoperative S-1 adjuvant chemotherapy for p-stage II gastric cancer should be continued until 1 year so far as feasible.

Clinical trial identification

UMIN000007306, released on 16th Feb 2016

Legal entity responsible for the study

Japan Clinical Oncology Group (JCOG)

Funding

Japan Agency for Medical Research and Development and the National Cancer Center Research and Development Fund

Disclosure

T. Yoshikawa, N. Boku, M. Sasako: Lecture fee from Taiho, Eli Lilly, and Chugai Pharmaceutical. M. Terashima, H. Yabusaki, S. Ito, T. Sano: Lecture fee from Taiho. H. Fukuda: Lecture fee from Taiho Pharma, Chugai Pharmaceutical. All other authors have declared no conflicts of interest.