Efficacy of adjuvant chemotherapy using tegafur-based regimen for curatively resected gastric cancer: update of a meta-analysis

Abstract

A consensus regarding standard adjuvant chemotherapy for curatively resected gastric cancer has not been obtained between Japan and the Western world. In order to evaluate the effect of a tegafur-based regimen (the most frequently used regimen in Japan) compared with a surgery-alone control, a meta-analysis was performed, investigating four clinical trials. After meticulous examination of each trial, trials with improper noncentralized randomization were excluded from the analysis. A total of 1197 patients were enrolled in the four relevant trials determined to be eligible for the meta-analysis (Nakajima 1984; Japan Clinical Oncology Group [JCOG] 8801, JCOG 9206-2, and National Surgical Adjuvant Study of Gastric Cancer [NSASGC], in which a tegafur-based regimen was used for chemotherapy and central randomization was performed. The endpoint was overall survival, and a common hazard ratio was estimated. The 5-year overall survival rates differed among the trials because of differences in the background disease status. But there was no heterogeneity (P = 0.235) of treatment effect. The estimated common hazard ratio was 0.75, with a 95% confidence interval of 0.58-0.98. The treatment effect of the tegafur-based agent was shown to be statistically significant (P = 0.037) compared with surgery-alone therapy (n = 1179). From the results of the above meta-analysis, it is suggested that chemotherapy with a tegafur-based agent after surgery can improve the survival of patients with curatively resected gastric cancer. The Global Advanced/Adjuvant Stomach Tumor Research through International Collaboration (GASTRIC) group is conducting two individual patient data meta-analyses, testing post-operative adjuvant chemotherapy for resect-able gastric cancer and chemotherapy for advanced gastric cancer. It is expected to determine and quantify the role of adjuvant chemotherapy in detail from the GASTRIC.

Impact of Adjuvant Chemotherapy Cycles on Prognosis of Resectable Stomach Cancer: A Retrospective Analysis

“…Meta-analyses indicated that patients with resectable gastric cancer could actually benefit from adjuvant chemotherapy (Oba, 2009;Paoletti et al, 2010). To date, there is no single, global standard for adjuvant chemotherapy regimens for stomach cancer after radical resection (Oh, 2012).…”

“…Although surgery is the first-line treatment for stomach cancer, the recurrence rate is high and the survival rates remain low, even after extended surgery (Degiuli et al, 2006;Oba, 2009). In order to prevent relapse and improve overall response rates, adjuvant therapies have been administered to patients with stomach cancer after radical resection, including adjuvant chemotherapy and chemoradiotherapy (Macdonald et al, 2001;Lim et al, 2005).…”

Alternating Treatment with S-1 Plus Low-Dose Cisplatin and S-1 Alone for Advanced Gastric Cancer

“…In 2005, a study performed in Japan by the National Surgical Adjuvant Study Group for Gastric Cancer (N-SAS-GC) reported that adjuvant therapy with uracil-tegafur (UFT) after D2 surgery was effective. 23 Moreover, the Adjuvant Chemotherapy Trial of TS-1 for Gastric Cancer (ACTS-GC) study has shown that S-1 alone is effective as adjuvant therapy in patients who undergo curative resection. 13 The most common adverse events of grade 3 or 4 as compared with surgery alone were anorexia (6.0%), nausea (3.7%), and diarrhea (3.1%).…”

Prognostic effects of oral anti-cancer drugs as adjuvant chemotherapy for 2 years after gastric cancer surgery

“…These findings suggest the efficacy of adjuvant chemotherapy using a tegafur-based regimen for curatively resected gastric cancer with extensive lymph node dissection [10,11]. However, the optimal length of time for which these drugs should be administered has not been established.…”