-Report on Experiments and Clinical Cases-

Adjuvant Chemotherapy with S-1 Followed by Docetaxel for Gastric Cancer and CY1P0 Peritoneal Metastasis after Relatively Curative Surgery

Yoshikazu Kanazawa, Shunji Kato, Itsuo Fujita, Hiroyuki Onodera and Eiji Uchida

Department of Surgery, Nippon Medical School

Objective: The aim of this study was to assess the feasibility and safety of adjuvant chemotherapy with S-1 followed by docetaxel.
Patients and Method: Twenty-eight patients with advanced gastric cancer underwent gastrectomy without preoperative chemotherapy. These patients were divided into 3 groups on the basis of cytologic results of peritoneal lavage (CY) and the presence of local peritoneal metastatic nodules (P): CY1-P0, CY0-P1, and CY1-P1. Oral S-1 (80 mg/m²/day) was administered for 3 consecutive weeks, followed by intravenous docetaxel (35 mg/m²) on days 29 and 43 (1 cycle). This cycle was repeated every 8 weeks. The primary endpoint was the ability to complete 6 cycles of S-1 followed by docetaxel. The secondary endpoints were safety, progression-free survival, mean survival time (MST), and overall survival (OS).
Results: The subjects were 18 men and 10 women (39 to 78 years old, median age, 64 years). The extent of peritoneal metastasis was CY1-P0 in 8 patients, CY0-P1 in 14 patients, and CY1-P1 in 6 patients. Both hematologic and nonhematologic toxicities were generally mild. The completion rate of the planned 6 cycles of the protocol was 71.4% (20 of 28 patients). Median progression-free survival was 22.9 months, and the 2-year survival rate was 78.6%. The overall MST was 34.3 months, and the MST by group was 34.5 for CY1-P0, 34.3 for CY0-P1, and 19.3 months for CY1-P1. The OS in the CY1-P0 and CY0-P1 groups was significantly longer than that in the CY1-P1 group (P<0.05).
Conclusion: Adjuvant chemotherapy with S-1 followed by docetaxel is safe and well tolerated and has the potential to improve OS in patients with a status of CY1P0 following relatively curative resection.

J Nippon Med Sch 2013; 80: 378-383

Keywords
S-1, docetaxel, gastric cancer, peritoneal metastasis, CY1, adjuvant chemotherapy

Correspondence to
Yoshikazu Kanazawa, MD, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
kanazawa-y@nms.ac.jp

Received, May 1, 2013
Accepted, May 17, 2013