First-line chemotherapy with S-1 alone or S-1 plus cisplatin for elderly patients with advanced gastric cancer: a multicenter propensity score matched study

Makiyama, Akitaka; Kono, Kenji; Noguchi, Masaaki; Kajiwara, Takeshi; Tamura, Takao; Takeda, Koji; Sugiyama, Junko; Minashi, Keiko; Moriwaki, Toshikazu; Sugimoto, Naotoshi; Nagase, Michitaka; Negoro, Yuji; Tsuda, Takashi; Shimodaira, Hideki; Okano, Naohiro; Tsuji, Akihito; Sakai, Daisuke; Yanagihara, Kazuhiro; Ueda, Shinya; Tamura, Shingo; Otsu, Satoshi; Honda, Takeshi; Matsushita, Yuzo; Okuno, Tatsuya; Kashiwada, Tomomi; Nozaki, Akira; Ebi, Masahide; Okuda, Hiroyuki; Shimokawa, Mototsugu; Hironaka, Shuichi; Hyodo, Ichinosuke; Baba, Eishi; Boku, Narikazu; Muro, Kei; Esaki, Taito

doi:10.1007/s10120-018-0797-y

Cited by 13 publications

(18 citation statements)

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“…Two large retrospective studies demonstrated that CC was superior to SC in terms of OS [20, [20,21]. Moreover, because most randomized trials have included relatively young patients and patients with good PS, it is difficult to define the best chemotherapy strategy for elderly patients or those with poor PS [3][4][5][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Limited data are available regarding chemotherapy regimens for elderly patients with RPMGC, because such patients are underrepresented in clinical trials [3][4][5][8][9][10][11]. Two small retrospective studies comparing S-1 with S-1 and cisplatin (SP) for RPMGC patients older than 70 gave conflicting results, with both studies showing more severe toxicities in the SP group [11,22].…”

Section: Discussionmentioning

confidence: 99%

“…For patients with recurrent or primary metastatic GC (RPMGC), palliative chemotherapy is the standard of care. In terms of chemotherapy regimen, combination chemotherapy (CC) is generally recommended in clinical practice [3][4][5][6][7]. Two meta-analyses demonstrated a small but statistically significant survival benefit of CC compared to single-agent chemotherapy (SC) [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…However, individual randomized trials comparing CC and SC gave conflicting results [4,[6][7][8][9][10]. Moreover, most randomized trials excluded patients who were elderly or who had poor performance status (PS) [3][4][5][8][9][10][11]. Therefore, it is an important clinical issue to determine clearly whether CC is more beneficial than SC and to identify patient subgroups who may benefit from SC rather than CC.…”

Section: Introductionmentioning

confidence: 99%

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Combination versus single-agent as palliative chemotherapy for gastric cancer

Choi

Kang

et al. 2020

BMC Cancer

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Background: Although combination chemotherapy (CC) is generally recommended in recurrent or primary metastatic gastric cancer (RPMGC), the results of randomized trials are conflicting. Methods: A retrospective review was conducted on 687 RPMGC patients who received palliative chemotherapy. We compared the overall survival (OS) between CC and single-agent chemotherapy (SC) among these patients, and we analyzed the clinicopathological characteristics affecting outcome including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Results: Although 521 patients (75.8%) underwent CC, SC was more frequently performed in elderly patients (57.6%) and ECOG performance status (PS) 2 or 3 (65.8%) patients (p < 0.0001, in each case). The median OS of patients who received CC was significantly longer than that of patients who received SC (11 vs. 8 months, p < 0.0001). No difference in OS between CC and SC was observed in elderly patients (p = 0.583), poor PS (p = 0.810), signet ring cell (p = 0.347), palliative surgical resection (p = 0.307), and high PLR (p = 0.120), with a significant interaction between age and type of regimen (p = 0.012). Moreover, there was no difference in OS between CC and SC after propensity score matching (p = 0.322). Multivariate analysis revealed that palliative resection and ≥ second-line chemotherapy were independently associated with favorable OS (p < 0.0001, in each case), whereas poor PS (p = 0.004), signet ring cell (p < 0.0001), peritoneal metastasis (p = 0.04), high NLR (p = 0.001), and high PLR (p = 0.033) were independent prognostic factors of poor OS. Conclusions: Although CC is the standard of care in RPMGC, SC can be considered a reasonable option in certain subgroups, such as elderly patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combination versus single-agent as palliative chemotherapy for gastric cancer

Choi

Kang

et al. 2020

BMC Cancer

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“…Clinical trial data that are available regarding the treatment of elderly patients with AGC is limited and is mostly derived from phase II studies conducted in elderly patients, age subgroup analyses of phase III studies, and retrospective analyses of elderly patient populations. Overall, evidence from these clinical trials suggests that chemotherapy is feasible in elderly patients with AGC [14,[24][25][26][27][28], but elderly patients with AGC are less likely to receive multiple lines of chemotherapy than younger patients [14,15]. For example, studies of first-line chemotherapy in elderly vs younger patients have reported rates of second-line chemotherapy of 38.7% vs 62.7% [14] and 24% vs 68% [15].…”

Section: Clinical Trial Datamentioning

confidence: 99%

Achieving sequential therapy in advanced gastric cancer: the importance of appropriate patient management for the elderly and/or those with ascites

2020

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Treatment options for patients with advanced gastric cancer (AGC) are limited. One approach to improving survival in patients with AGC is to optimize the available agents via sequential therapy. However, clinical trial reports of first-line chemotherapy indicate that elderly patients and patients with massive ascites are less likely to receive subsequent lines of therapy. In addition, clinical trials of second-and third-line chemotherapy generally exclude these two patient populations because they are likely to have poor performance status and additional issues that are difficult to manage. Good patient management is likely to be key to the successful use of sequential therapy in these two patient populations by minimizing adverse effects to allow patients to derive benefit from the additional treatment. This narrative review summarizes the available information on AGC treatment and patient management in elderly patients and patients with massive ascites. The available data suggest that elderly patients benefit from chemotherapy; however, monitoring toxicity is essential to avoid chemotherapy-related toxicities. Important aspects of patient management for elderly patients include symptom monitoring, nutritional support, and fall prevention. The available data for patients with massive ascites show limited success for a range of treatment approaches, including systemic chemotherapy. The management of ascites is also challenging, with no clear guidance on the preferred strategies. To address these gaps in knowledge, future clinical trials should incorporate more inclusive eligibility criteria to enroll populations of patients with AGC that are more reflective of the real-world population with respect to age, complications, and overall health status.

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Phase II study of S-1 plus docetaxel as first-line treatment for older patients with advanced gastric cancer (OGSG 0902)

Kawase,

Imamura,

Kawabata

et al. 2024

Int J Clin Oncol

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BackgroundAlthough there is insu cient evidence for the treatment of older patients with advanced gastric cancer, uorouracil combined with platinum chemotherapy has been recognized as a standard rst-line treatment for such populations in Japan despite the lack of e cacy and toxicity data. MethodsPatients aged 75 years or older with advanced gastric cancer were enrolled. S-1 plus docetaxel (docetaxel: 40 mg/m 2 , day 1; S-1: 80 mg/m 2 , days 1-14; q21 days) was repeated every 3 weeks. The primary endpoint was overall response rate. Secondary endpoints were safety, progression-free survival, time to treatment failure, and overall survival. The sample size was calculated as 30 under the hypothesis of an expected response rate of 40% and a threshold response rate of 20%, at a power of 90% and a twosided alpha value of 5%. ResultsFrom February 2010 to January 2015, 31 patients were enrolled and assessed for e cacy and toxicity.The response rate was 45.2% (95% CI: 27.3-64.0%; p = 0.001) and it exceeded the expected response rate set at 40%. Median progression-free survival was 5.8 months, the 1-year survival rate was 58.1%, and the median survival time was 16.1 months. The major grade 3/4 adverse events were neutropenia (58%), febrile neutropenia (13%), anemia (10%), anorexia (10%), and fatigue (6%). ConclusionsThese ndings indicate that S-1 plus docetaxel as rst-line treatment for older patients is feasible and that it has promising e cacy against advanced gastric cancer.

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First-line chemotherapy with S-1 alone or S-1 plus cisplatin for elderly patients with advanced gastric cancer: a multicenter propensity score matched study

Abstract: Our findings do not support the survival benefit of SP over S-1 in elderly patients with AGC. We are now conducting a prospective comparative study to optimize treatment strategy and explore applicability of the geriatric assessment for these patients.

Cited by 13 publications

References 14 publications

Combination versus single-agent as palliative chemotherapy for gastric cancer

Combination versus single-agent as palliative chemotherapy for gastric cancer

Achieving sequential therapy in advanced gastric cancer: the importance of appropriate patient management for the elderly and/or those with ascites

Phase II study of S-1 plus docetaxel as first-line treatment for older patients with advanced gastric cancer (OGSG 0902)

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