S-1 Versus S-1 Plus Cisplatin as First-line Treatment for Metastatic Gastric Cancer
KS Lau, KO Lam, WL Chan, VHF Lee, DLW Kwong, TW Leung
Hong Kong J Radiol 2017;20:318-22
DOI: 10.12809/hkjr1716810
Objective: To compare S-1 with S-1 plus cisplatin (SP) as first-line treatment for metastatic gastric cancer.
Methods: Records of patients with metastatic gastric cancer who received either the S-1 or SP regimen as first-line treatment for metastatic gastric cancer between January 2013 and December 2014 in Queen Mary Hospital were retrospectively reviewed. Baseline characteristics, overall response rate, median progression-free survival (PFS), overall survival (OS), and toxicity of the two groups were compared.
Results: During the study period, 17 patients received S-1 and 13 patients received SP. The median patient ages were 69 and 57 years, respectively. In the S-1 group, more patients were aged ≥70 years (47.1% vs. 7.7%, p = 0.02), fewer patients underwent surgical resection of primary tumours (23.5% vs. 53.8%, p = 0.09), more patients required initial dose reduction (70.6% vs. 15.4%, p = 0.001), and fewer patients received subsequent chemotherapy (5.9% vs. 30.8%, p = 0.07) compared with the SP group. The S-1 group had a lower response rate (11.8% vs. 46.2%, p = 0.049). Nonetheless, S-1 and SP groups were comparable for clinical benefit rate (47.1% vs. 77.0%, p = 0.14), median PFS (34.5 weeks vs. 28.8 weeks, p = 0.72), median OS (46.4 weeks vs. 52.7 weeks, p = 0.18), and 30-day mortality (11.8% vs. 7.7%, p = 1.00). There was a trend of improved OS in the SP group (hazard ratio = 1.84, 95% confidence interval = 0.74-4.55, p = 0.185). The two groups were also comparable for the rate of grade 3/4 neutropaenia (17.7% vs. 38.5%, p = 0.24) and grade 3/4 diarrhoea (5.9% vs. 30.8%, p = 0.14). There was no treatment-related death.
Conclusion: Both S-1 and SP regimens are effective and safe as first-line treatment for metastatic gastric cancer. A dose-adjusted S-1 regimen is a viable option for patients with advanced age and marginal performance status.
Authors' affiliation:
KS Lau, KO Lam, WL Chan, VHF Lee, DLW Kwong, TW Leung
Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
中文摘要
比較S-1與S-1加順鉑作為轉移性胃癌的一線治療
劉健生、林嘉安、陳穎樂、李浩勳、鄺麗雲、梁道偉
目的：比較S-1與S-1加順鉑（SP）作為轉移性胃癌的一線治療。
方法：回顧分析2013年1月至2014年12月間在瑪麗醫院接受S-1或SP方案作為轉移性胃癌的一線治療的患者紀錄。比較兩組的基線特徵、總體反應率、中位無進展生存期（PFS）、總生存期（OS）和毒性。
結果：17例患者接受S-1，13例患者接受SP。患者年齡中位數分別為69歲和57歲。在S-1組中，與SP組比較較多患者年齡≥70歲（47.1%對7.7%，p = 0.02），較少患者接受原發腫瘤切除（23.5%對53.8%，p = 0.09），較多患者需要減少初始劑量（70.6%對15.4%，p = 0.001），和較少患者接受後續化療（5.9%對30.8%，p = 0.07）。S-1組的反應率較低（11.8%對46.2%，p = 0.049）。儘管如此，S-1和SP兩組有相當的臨床獲益率（47.1%對77.0%，p = 0.14），中位PFS（34.5週對28.8週，p = 0.72），中位OS（46.4週對52.7週，p = 0.18），30天死亡率（11.8%對7.7%，p = 1.00）。SP組有改善OS的趨勢（風險比 = 1.84，95%置信區間 = 0.74-4.55，p = 0.185）。兩組有相當的3 / 4級中性粒細胞減少率（17.7%對38.5%，p = 0.24）和3 / 4級腹瀉率（5.9%對30.8%，p = 0.14）。沒有患者出現治療相關的死亡。
結論：S-1和SP方案作為轉移性胃癌的一線治療是有效和安全的。經過劑量調整的S-1方案對於高齡和邊緣狀態的患者是可行的選擇。