A combination of S-1 and cisplatin chemotherapy may become the first-line therapy for patients with advanced gastric cancer. These findings were recently published in Lancet Oncology.
Gastric cancer forms in the tissues and lining of the stomach. The cause of gastric cancer is unknown. It is estimated that approximately 21,500 new cases of gastric cancer will occur in 2008, and the disease will be responsible for 10,800 deaths within the United States. Current treatment options include surgery, chemotherapy, and radiation. Research is ongoing to determine which therapy or combination of therapy can produce the best outcome while still being tolerable for the patient.
This recent study conducted in Japan enrolled 305 gastric cancer patients who had never received chemotherapy. The goal was to determine if chemotherapy with S-1 plus cisplatin was superior to treatment with S-1 alone. S-1 is a combination drug that is taken orally (see Related News). It is a combination of the agents tegafur, 5-chloro-2, 4-dihydroxypyridine, and oxonic acid. Cisplatin is a platinum-based drug that is given by infusion and is frequently used to treat a variety of different cancers.
Patients in the trial were randomly assigned to receive either S-1 alone or S-1 plus cisplatin. The researchers evaluated the following: overall survival rates between the two groups, the number of patients who responded to their therapy, and overall safety. Final analysis was based on 148 patients who received S-1 plus cisplatin and 150 patients who received S-1 alone.
- Overall survival for patients who received S-1 plus cisplatin was superior to the S-1 alone treatment group (13 months versus 11 months).
- Survival periods without disease progression were also two months longer among the S-1 and cisplatin treatment group.
- Response rates among the combination therapy patients were 54% compared with 31% for the patients treated with S-1 alone.
- Side effects were more severe among the patients treated with S-1 and cisplatin and included low blood counts, nausea, and anorexia.
- There were no treatment-related deaths reported for either group.
Researchers were encouraged by the significant benefits seen with the combination of S-1 and cisplatin. This combination has the potential to becoming the standard treatment for patients with advanced gastric cancer.
Reference: Koizumi, W., Akiya, T., Hara, T., et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a Phase III trial. Lancet Oncology. 2008; 9:215-221.