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Poster Display

1287 - The gene expression levels of gamma-glutamyl hydrolase in tumor tissues may be a useful biomarker for proper use of S-1 and tegafur-uracil /leucovorin in preoperative chemoradiotherapy in patients with rectal cancer


08 Oct 2016


Poster Display


Sotaro Sadahiro


Annals of Oncology (2016) 27 (6): 149-206. 10.1093/annonc/mdw370


S. Sadahiro1, T. Suzuki1, A. Tanaka1, K. Okada1, G. Saito1, A. Kamijo1, H. Nagase2

Author affiliations

  • 1 Surgery, Tokai University School of Medicine Isehara Campus, 259-1193 - Isehara/JP
  • 2 Applied Pharmacology Labo, Taiho Pharmaceutical Co., Ltd., 771-0132 - Tokushima/JP


Abstract 1287


Preoperative chemoradiotherapy (CRT) with 5-FU-based chemotherapy is the standard of care for locally advanced rectal cancer. Both S-1 and tegafur-uracil (UFT) are 5-FU-based oral drugs. UFT is used in combination with leucovorin (LV) to enhance the effect of 5-FU. S-1 is used without LV and causes the stronger antitumor effect than UFT. We examined the association of the response to CRT with the expression levels of CRT-related genes in tumor tissues before CRT.


Data of 51 patients (pts) with locally advanced rectal cancer who received preoperative CRT at a total radiation dose of 45Gy with S-1 or UFT/LV for 5 weeks were analyzed. The pathological tumor response was assessed according to the tumor regression grade (TRG) criteria. A patient with TRG 1-2 was defined as a responder. The expression levels of CRT-related 18 genes in tumor tissues were determined using a RT-PCR assay. The relationships between tumor response and the gene expression levels were analyzed. The cutoff value for gene expression of gamma-glutamyl hydrolase (GGH) was determined by the ROC curve.


Pathological response (TRG 1-2) and pathological complete response (pCR) was observed in 23 pts (45.1%) and 8 pts (15.7%), respectively. The expression levels of methylenetetrahydrofolate dehydrogenase 1 (MTHFD1) and glycine amide phosphoribosyl synthetase (GART) were significantly higher in the pCR pts than in the non-pCR pts (p = 0.0091 and p = 0.0477). In UFT/LV group, the gene expression levels of methylenetetrahydrofolate reductase (MTHFR) and GGH were significantly lower in the responders than in non-responders (p = 0.0368 and p = 0.0379). The total pathological response rate of both high-GGH pts in S-1 group and low-GGH pts in UFT/LV group was 65.2%, and was higher than that (45.1%) in all pts.


The expression levels of genes related to folate metabolism in tumor tissue were associated with response to preoperative CRT including S-1 or UFT/LV. In particular, the gene expression level of GGH in tumor tissues may be a useful biomarker for determining which regimen, S-1 or UFT/LV, should be used in CRT.

Clinical trial identification

Legal entity responsible for the study



Tokai University


H. Nagase: Is an employee of Taiho Pharmaceutical Co. Ltd. All other authors have declared no conflicts of interest.

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