Conversion therapy for inoperable advanced gastric cancer patients by docetaxel, cisplatin, and S-1 (DCS) chemotherapy: a multi-institutional retrospective study

Abstract

Background Conversion therapy is an option for unresectable metastatic gastric cancer when distant metastases are controlled by chemotherapy; however, the feasibility and efficacy remain unclear. This study aimed to assess the feasibility and efficacy of conversion therapy in patients with initially unresectable gastric cancer treated with docetaxel, cisplatin, and S-1 (DCS) chemotherapy by evaluating clinical outcomes.Methods One hundred unresectable metastatic gastric cancer patients, enrolled in three DCS chemotherapy clinical trials, were retrospectively evaluated. The patients received oral S-1 (40 mg/m 2 b.i.d.) on days 1-14 and intravenous cisplatin (60 mg/m 2 ) and docetaxel (50-60 mg/m 2 ) on day 8 every 3 weeks. Conversion therapy was defined when the patients could undergo R0 resection post-DCS chemotherapy and were able to tolerate curative surgery. Results Conversion therapy was achieved in 33/100 patients, with no perioperative mortality. Twenty-eight of the 33 patients (84.8 %) achieved R0 resection, and 78.8 % were defined as histological chemotherapeutic responders. The median overall survival (OS) of patients who underwent conversion therapy was 47.8 months (95 % CI 28.0-88.5 months). Patients who underwent R0 resection had significantly longer OS than those who underwent R1 and R2 resections (P = 0.0002). Of the patients with primarily unresectable metastases, 10 % lived [5 years. Among patients who underwent conversion therapy, multivariate analysis showed that the pathological response was a significant independent predictor for OS. Conclusions DCS safely induced a high conversion rate, with very high R0 and pathological response rates, and was associated with a good prognosis; these findings warrant further prospective investigations.

Conversion surgery for stage IV gastric cancer

“…The reported incidence of postoperative complications after gastrectomy is 24% to 29% [30,32] , which is similar to that in patients undergoing conventional radical surgery for gastric cancer (20.9% in patients with D2 lymph node dissection and 28.1% in patients undergoing an extended operation with aortic lymph node dissection) (JCOG9501) [33] .…”

“…Yamaguchi et al [30] analyzed the treatment outcomes of 259 patients with stage IV gastric cancer and found that the MST of those who underwent R0 resection (41.3 months) was significantly better than that of patients who underwent R1 and R2 resection (21.2 months). Sato et al [32] evaluated the treatment outcomes of initially unresectable gastric cancer treated with docetaxel, cisplatin, and S-1 (DCS) chemotherapy in a clinical trial. Conversion therapy was achieved in 33 of 100 patients (33%), and R0 resection was performed in 28 (84.8%) patients.…”

Recent trends of gastric cancer treatment in Turkey

“…However, data from the eastern experience and the possibility of more extensive surgeries with low morbidity have led the physicians to be more aggressive in the treatment of metastatic disease. Curative outcomes have been reported with an R0 resection in potentially/marginally resectable cases, although they are initially metastatic diseases, referred to as conversion treatment (30)(31)(32). Although potentially resectable cases, such as single liver metastasis or 16a2-b1 paraaortic lymph node metastasis are technically suitable for surgical resection, we prefer preoperative chemotherapy followed by surgical resection.…”

Prognostic Indicators in Stage IV Surgically Treated Gastric Cancer Patients: A Retrospective Multi-Institutional Study

“…In this way, no patients would be excluded from chemotherapy, and surgery would be performed in selected patients with a measurable response to chemotherapy [20]. New chemotherapeutic schedules and improved response rates have led to the development of several conversion therapy protocols that are currently under investigation in Eastern countries [21,22].…”