P-071 - Single-center experience with first-line S-1 plus cisplatin chemotherapy for locally advanced unresectable and metastatic gastric and gastroesophage...

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Oesophageal Cancer
Gastric Cancer
Presenter Á. Petrányi
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors Á. Petrányi1, M. Farkas1, É. Végh1, G. Lakatos1, G. Demeter1, G. Bodoky2
  • 1St. Istvan and St. Laszlo Hospital of Budapest, Budapest/HU
  • 2St László Teaching Hospital, Budapest/HU

Abstract

Introduction

S-1 is an oral fluoropyrimidine that contains the active substances tegafur, gimeracil, and oteracil. This combination was optimized to reduce the toxicity of 5-fluorouracil (5-FU) therapy. Tegafur is a prodrug of 5-FU, gimeracil decreases the metabolism of 5-FU in the body, and oteracil inhibits phosphorylation of intestinal 5-FU which= is thought to be responsible for treatment-related diarrhea. Phase III studies among advanced and metastatic gastric and gastroesophageal cancer patients demonstrated equivalence between infusional 5-FU, capecitabine, and S-1. A Phase III global study demonstrated non-significant differences in efficacy between S-1/cisplatin and 5-FU/cisplatin, with lower toxicity in the S-1/cisplatin group.

The objective of this retrospective review was to compare the tolerability and toxicity of S-1/cisplatin therapy to capecitabine/cisplatin (CX) when administered as first-line therapy to patients with locally advanced, unresectable, metastatic gastric and gastroesophageal junction adenocarcinoma.

Methods

In March 2011, S-1 was approved for use in advanced gastric cancer in combination with cisplatin and became available in September 2011 in Hungary for reimbursed chemotherapy. From September 2013 through September 2014, 41 patients (19 female, mean age, 69.2 years; 22 male, mean age, 67.1 years) were treated with S-1 plus cisplatin at our oncology center. Data for these patients were reviewed and compared to those from a similar patient group treated with CX during a previous one-year period at our center.

Results

S-1 plus cisplatin treatment was well tolerated. Nausea/vomiting was observed in 30 patients (73%, Gr 3/4: 12%), fatigue in 25 (61%), abdominal discomfort in 15 (37%), loss of appetite in 16 (39%), abdominal pain in 15 (37%), and diarrhea in 2 (5%) patients. Dry skin developed in 8 patients (19.5%), stomatitis/mucositis in 3 (7%), and hyperpigmentation in 2 (5%) patients. Grade 3/4 neutropenia, thrombocytopenia, or febrile neutropenia were not observed in any patients. We did not detect hand-foot syndrome in any patients. Dose reduction was needed in 4 cases (10%). Treatment was terminated due to side effects in 5 patients (12%).

Prior to initiating S-1/cisplatin treatment regimens in our department, patients with advanced or metastatic gastric carcinoma received CX as first-line treatment. Analysis of previous data for 51 patients treated with the CX regimen showed that dose modification had been necessary in 13 patients (25%) and treatment was terminated as a result of toxicity in 50%. Hand-foot syndrome occurred in 20 patients (39%), 72% complained of fatigue, and 36% reported abdominal discomfort or spasm. There were no significant differences between the two groups for other side effects.

Conclusion

S-1/cisplatin treatment was better tolerated than capecitabine/cisplatin in a similar patient group. S-1 treatment resulted in fewer side effects and there were fewer dose reductions and toxicity-related treatment terminations. Due to this satisfactory outcome, we recommend S-1/cisplatin as first-line treatment for HER2-negative, locally advanced, unresectable, metastatic gastric and gastroesophageal junction adenocarcinoma.