Sequential methotrexate and 5-fluorouracil therapy for gastric cancer patients with peritoneal dissemination: a retrospective study

Tahara, Makoto; Ohtsu, Atsushi; Boku, Narikazu; Nagashima, Fumio; Muto, Manabu; Sano, Yasushi; Yoshida, Midori; Mera, Kiyomi; Hironaka, Shuichi; Tajiri, Hisao; Yoshida, Shigeaki

doi:10.1007/s10120-001-8012-x

Cited by 24 publications

(24 citation statements)

References 13 publications

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“…The median survival time of patients with ascites was also 211 days (95% CI, 114-308 days). This result was compatible with the results in studies by Yamao et al [36] and Tahara et al [37], who reported the median survival times of patients with ascites as 155 days and 244 days after MF tharapy, respectively.…”

Section: Discussionsupporting

confidence: 83%

“…Yamao et al [36] reported that sequential methotrexate and 5-fluorouracil distinctly decreased ascites in 13 of 37 patients (35.1%, including 3 with complete disappearance of ascites) who had inoperable or recurrent gastric cancer with malignant ascites. Tahara et al [37] demonstrated a clearcut decrease in ascites in 13 of 26 patients with gastric cancer (50.0%; 5 with complete disappearance of ascites) who received sequential methotrexate and 5-fluorouracil. Pleural effusion distinctly decreased in 6 of 8 patients (75.0%), including 4 with complete resolution.…”

Section: Discussionmentioning

confidence: 99%

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A phase II study of combined chemotherapy with methotrexate, 5-fluorouracil, and low-dose cisplatin (MFP) for histologically diffuse-type advanced and recurrent gastric cancer (KDOG9501)

et al. 2006

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

A phase II study of combined chemotherapy with methotrexate, 5-fluorouracil, and low-dose cisplatin (MFP) for histologically diffuse-type advanced and recurrent gastric cancer (KDOG9501)

et al. 2006

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“…The response rate of patients with peritoneal dissemination in their study was 23% (6/26) and ascites was eliminated in 8 of 16 patients (50%). Tahara et al [29] reported that sequential MTX/5-FU therapy for patients with confi rmed peritoneal dissemination was effective, and an objective attenuation of ascites was seen in 13 of 26 patients, including 5 who showed complete disappearance of ascites; the MST and median time to treatment failure were 259 days and 167 days, respectively.…”

Section: Discussionmentioning

confidence: 99%

Pilot study of a combination of S-1 and paclitaxel for patients with peritoneal metastasis from gastric cancer

et al. 2010

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dissemination still have a poor prognosis [1]; most of these patients die within 6 months of diagnosis, while the 5-year survival rate is nil [2,3].The recent introduction of an oral drug, S-1, has increased the overall response rates (ORRs) to 44% and 49% and median survival time (MST) to 8 months in phase II studies [4,5].Several reports have demonstrated that S-1 was effective for undifferentiated histological types, such as poorly differentiated adenocarcinoma and signet-ring cell carcinoma, which are relevant to peritoneal dissemination [6]. S-1 has been reported to be effective in prolonging the survival of gastric cancer patients with peritoneal dissemination [4][5][6][7].Moreover, S-1 in combination with other anticancer drugs such as cisplatin (CDDP), taxanes, and irinotecan (CPT-11) increased ORRs and prolonged MST [8][9][10][11].Paclitaxel is a cytotoxic antineoplastic agent that causes excessive polymerization of tubulin and microtubule dysfunction, resulting in tumor cell death [12]. Kobayashi et al. [13] have demonstrated that paclitaxel is a promising drug for the treatment of malignant ascites in patients with gastric cancer: the concentration of paclitaxel in ascites was maintained within the optimal level for the treatment of cancer cells for up to 72 h after intravenous administration.Recent phase II studies of systemic chemotherapy with S-1 plus taxanes have demonstrated strong anticancer effects and a good MST in the treatment of advanced gastric cancer [9,10,14]. However, the effi cacy of systemic chemotherapy for peritoneal dissemination from gastric cancer has been unclear, because peritoneal metastases have not been defi ned as measurable lesions in conventional phase II studies. Therefore, few reports describing the effi cacy of chemotherapy for these lesions are available.In this pilot study, we planned therapeutic strategies to observe the effect of chemotherapy on peritoneal metastasis by second-look laparoscopy for patients Abstract Background. This pilot study was carried out to evaluate the effi cacy of chemotherapy for patients with peritoneal dissemination from gastric cancer or positive lavage cytology diagnosed by staging laparoscopy. Methods. Sixteen patients were enrolled. Paclitaxel was administered at 120 mg/m 2 on day 1 and S-1 was administered orally at 80 mg/m 2 for 14 consecutive days, followed by a 1-week rest, as one course. After fi ve courses of this therapy, the primary gastric tumors were evaluated and second-look laparoscopy was performed for patients showing partial response or stable disease with clinical benefi t. Results. Partial response or stable disease with clinical benefi t was confi rmed in seven and fi ve patients, respectively, and these patients underwent second-look laparoscopy. No viable cancer cells were detected on cytopathological investigation during second-look laparoscopy in 9 patients who underwent surgical treatment. The intent-to-treat response rate for gastric tumor was 44% and the rate of disappearance of peritoneal metastasis was 38% ...

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“…The response rate of patients with peritoneal dissemination in their study was 23% (6/26) and ascites was eliminated in 8 of 16 patients (50%). Tahara et al [13] reported that sequential MTX/5FU therapy was effective for patients with confi rmed peritoneal dissemination, and objective improvement of ascites was seen in 13 of 26 patients, including 5 who showed complete disappearance of the ascites. Although the median survival time and median time to treatment failure were 259 days and 167 days, respectively, the results of this therapy have been unsatisfactory.…”

Section: Discussionmentioning

confidence: 99%

Intraperitoneal administration of paclitaxel and oral S-1 for a patient with peritoneal dissemination and hydronephrosis due to advanced gastric cancer

et al. 2007

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S-1 has been developed in Japan as an oral anticancer drug, composed of tegafur, 5-chloro-2, 4-dihydroxypyridine (gimeracil), and monopotassium 1, 2, 3, 4-tetrahydro-2, 4-dioxo-1, 3, 5-triazine-6-carboxylate (oteracil), based on the biological modulation of 5-fl uorouracil (FU) [5]. Japanese late phase II trials of S-1 in gastric cancer have shown overall response rates of up to 49% and a median survival period of 8 months [6,7]. We have demonstrated that S-1 has a larger area under the curve 5-FU for peritoneal dissemination and ascites than for plasma [8], and thus S-1 might be effective for prolonging the survival of gastric cancer patients with peritoneal metastasis.Paclitaxel is a cytotoxic antineoplastic agent that results in tumor cell death by causing the excessive polymerization of tubulin and microtubule dysfunction [9]. The large molecular weight and bulky chemical structure of paclitaxel delay its peritoneal clearance [10] and increase exposure in the peritoneal cavity, and thus it can be exploited in the treatment of gastric cancer with peritoneal dissemination.We report a gastric cancer patient with peritoneal dissemination and hydronephrosis who was successfully treated with intraperitoneal infusion of paclitaxel and oral administration of S-1. Case reportA 34-year-old man was treated with an H2-blocker antagonist for about 6 months for a chief complaint of upper abdominal discomfort, suggesting the possibility of duodenal ulcer. Because his condition did not improve, he underwent endoscopic examination at another clinic. He was diagnosed as having type 3 advanced gastric cancer on the greater curvature of the gastric body by upper gastrointestinal (UGI) and endoscopic examination. He was referred to a hospital for surgical resection. An abdominal computed tomogra- AbstractWe report a patient with type 3 gastric cancer with peritoneal dissemination and hydronephrosis who was successfully treated with intraperitoneal infusion of paclitaxel and oral administration of S-1. He was diagnosed with unresectable gastric cancer with severe peritoneal dissemination by staging laparoscopy. We selected combined chemotherapy with both paclitaxel and S-1. Paclitaxel at 60 mg/m 2 was administered intraperitoneally on days 1 and 8, and S-1 at 100 mg/body was administered orally for 14 days, followed by 7 days' rest, as one course. After fi ve courses, primary tumor reduction was confi rmed and no cancer cells were detected on pathocytological investigation at second-look laparoscopy. The patient underwent total gastrectomy with lymph node dissection. He died from liver metastasis 29 months after the initial treatment, but he had not suffered from peritoneal metastases and had kept a good quality of life (QOL) since that treatment. This chemotherapy can be applied as one of the promising candidates for the treatment of patients with peritoneal metastasis of gastric cancer.

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Sequential methotrexate and 5-fluorouracil therapy for gastric cancer patients with peritoneal dissemination: a retrospective study

Abstract: Conclusions. This regimen may be of clinical benefit for patients with peritoneal dissemination of gastric cancer.

Cited by 24 publications

References 13 publications

A phase II study of combined chemotherapy with methotrexate, 5-fluorouracil, and low-dose cisplatin (MFP) for histologically diffuse-type advanced and recurrent gastric cancer (KDOG9501)

A phase II study of combined chemotherapy with methotrexate, 5-fluorouracil, and low-dose cisplatin (MFP) for histologically diffuse-type advanced and recurrent gastric cancer (KDOG9501)

Pilot study of a combination of S-1 and paclitaxel for patients with peritoneal metastasis from gastric cancer

Intraperitoneal administration of paclitaxel and oral S-1 for a patient with peritoneal dissemination and hydronephrosis due to advanced gastric cancer

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