Salvage chemotherapy of biweekly irinotecan plus S-1 (biweekly IRIS) in previously treated patients with advanced gastric cancer

Abstract

PurposeThis phase II trial first describes the combination chemotherapy of biweekly irinotecan plus S-1 (biweekly IRIS) for pretreated advanced gastric cancer (AGC) patients.MethodsPatients who had previously been treated with greater than or equal to one regimen were enrolled. They received S-1 35 mg/m2 twice daily on days 1–14 and irinotecan 150 mg/m2 on days 1 and 15, every 4 weeks. The primary endpoint was overall survival (OS).ResultsAmong the 38 patients enrolled, 18 patients were treated as second line, and the remaining 20 patients were enrolled as third- or fourth line. A total of 208 cycles were administered with the median being four cycles (range 1–16). The median OS was 8.7 months [95% confidence interval (CI) 7.5–10.3], and the median progression-free survival was 6.3 months (95% CI 5.3–7.3). Low serum albumin (<3.5 mg/dL) was an independent adverse prognosticator for survival. Overall response rate was 17% (95% CI 4–30%). The major grade 3/4 toxicities were neutropenia (26%) and diarrhea (18%).ConclusionsBiweekly IRIS showed the moderate activity as salvage treatment in AGC. Considering high neutropenia and gastrointestinal toxicity, patient selection should be warranted; serum albumin may be a predictive factor for treatment decision.

Irinotecan combined with 5-fluorouracil and leucovorin third-line chemotherapy after failure of fluoropyrimidine, platinum, and taxane in gastric cancer: treatment outcomes and a prognostic model to predict survival

“…At the present time, although there have been some studies on salvage chemotherapy for MRGC in which chemotherapy regimens were used as second-or third-line treatments [9,[12][13][14], studies specifically focused on third-line chemotherapy have been scarce [15,16]. To our knowledge, this report is one of the largest studies about third-line palliative chemotherapy and the first study on third-line FOLFIRI therapy in MRGC patients.…”

“…Most of them reported the combined results of second-line and third-line chemotherapy together and contained a small number of patients in the third-line setting [12][13][14]. The reported median PFS was 2.1-5.6 months and the median OS was 6.1-7.6 months in those studies.…”

Pemetrexed for previously treated patients with metastatic gastric cancer: a prospective phase II study

“…For instance, for patients with ascites, oedema, intestinal obstruction or poor bone marrow function, taxanes or iritecan, which was associated with higher incidence of grade 3–4 neutropenia or diarrhoea, might not be a good choice because of the toxicity. Recently, multiple new drugs including S-1, oxaliplatin and pemetrexed have proved to be effective and tolerated in gastric cancer ( Suh et al , 2005 ; Barone et al , 2007 ; Ishigami et al , 2008 ; Chon et al , 2011 ). Therefore, more treatment choices of effective salvage regimens with acceptable toxicity for previously treated metastatic gastric cancer are deserved exploring.…”