Yasushi Sato1, Hiroyuki Ohnuma2, Takayuki Nobuoka3, Masahiro Hirakawa2, Tamotsu Sagawa4, Koshi Fujikawa4, Yasuo Takahashi4, Minami Shinya5, Shinich Katsuki6, Minoru Takahashi7, Masahiro Maeda8, Yutaka Okagawa2, Uemura Naoki2, Syouhei Kikuch2, Koichi Okamoto9, Hiroshi Miyamoto9, Mitsuo Shimada10, Ichiro Takemasa3, Junji Kato2, Tetsuji Takayama9. 1. Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan. yasushis2008@gmail.com. 2. Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan. 3. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan. 4. Department of Gastroenterology, Hokkaido Cancer Center, Sapporo, Japan. 5. Department of Gastroenterology, Oji General Hospital, Tomakomai, Japan. 6. Department of Gastroenterology, Otaru Ekisaikai Hospital, Otaru, Japan. 7. Department of Gastroenterology, Sapporo Kyoritsu Gorinbashi Hospital, Sapporo, Japan. 8. Department of Gastroenterology, Steel Memorial Muroran Hospital, Muroran, Japan. 9. Department of Gastroenterology and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan. 10. Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
Abstract
BACKGROUND: Conversion therapy is an option for unresectable metastatic gastric cancer when distant metastases are controlled by chemotherapy; however, the feasibility and efficacy remain unclear. This study aimed to assess the feasibility and efficacy of conversion therapy in patients with initially unresectable gastric cancer treated with docetaxel, cisplatin, and S-1 (DCS) chemotherapy by evaluating clinical outcomes. METHODS: One hundred unresectable metastatic gastric cancer patients, enrolled in three DCS chemotherapy clinical trials, were retrospectively evaluated. The patients received oral S-1 (40 mg/m2 b.i.d.) on days 1-14 and intravenous cisplatin (60 mg/m2) and docetaxel (50-60 mg/m2) on day 8 every 3 weeks. Conversion therapy was defined when the patients could undergo R0 resection post-DCS chemotherapy and were able to tolerate curative surgery. RESULTS: Conversion therapy was achieved in 33/100 patients, with no perioperative mortality. Twenty-eight of the 33 patients (84.8 %) achieved R0 resection, and 78.8 % were defined as histological chemotherapeutic responders. The median overall survival (OS) of patients who underwent conversion therapy was 47.8 months (95 % CI 28.0-88.5 months). Patients who underwent R0 resection had significantly longer OS than those who underwent R1 and R2 resections (P = 0.0002). Of the patients with primarily unresectable metastases, 10 % lived >5 years. Among patients who underwent conversion therapy, multivariate analysis showed that the pathological response was a significant independent predictor for OS. CONCLUSIONS: DCS safely induced a high conversion rate, with very high R0 and pathological response rates, and was associated with a good prognosis; these findings warrant further prospective investigations.
BACKGROUND: Conversion therapy is an option for unresectable metastatic gastric cancer when distant metastases are controlled by chemotherapy; however, the feasibility and efficacy remain unclear. This study aimed to assess the feasibility and efficacy of conversion therapy in patients with initially unresectable gastric cancer treated with docetaxel, cisplatin, and S-1 (DCS) chemotherapy by evaluating clinical outcomes. METHODS: One hundred unresectable metastatic gastric cancerpatients, enrolled in three DCS chemotherapy clinical trials, were retrospectively evaluated. The patients received oral S-1 (40 mg/m2 b.i.d.) on days 1-14 and intravenous cisplatin (60 mg/m2) and docetaxel (50-60 mg/m2) on day 8 every 3 weeks. Conversion therapy was defined when the patients could undergo R0 resection post-DCS chemotherapy and were able to tolerate curative surgery. RESULTS: Conversion therapy was achieved in 33/100 patients, with no perioperative mortality. Twenty-eight of the 33 patients (84.8 %) achieved R0 resection, and 78.8 % were defined as histological chemotherapeutic responders. The median overall survival (OS) of patients who underwent conversion therapy was 47.8 months (95 % CI 28.0-88.5 months). Patients who underwent R0 resection had significantly longer OS than those who underwent R1 and R2 resections (P = 0.0002). Of the patients with primarily unresectable metastases, 10 % lived >5 years. Among patients who underwent conversion therapy, multivariate analysis showed that the pathological response was a significant independent predictor for OS. CONCLUSIONS:DCS safely induced a high conversion rate, with very high R0 and pathological response rates, and was associated with a good prognosis; these findings warrant further prospective investigations.
Authors: Eric Van Cutsem; Vladimir M Moiseyenko; Sergei Tjulandin; Alejandro Majlis; Manuel Constenla; Corrado Boni; Adriano Rodrigues; Miguel Fodor; Yee Chao; Edouard Voznyi; Marie-Laure Risse; Jaffer A Ajani Journal: J Clin Oncol Date: 2006-11-01 Impact factor: 44.544
Authors: David Cunningham; Naureen Starling; Sheela Rao; Timothy Iveson; Marianne Nicolson; Fareeda Coxon; Gary Middleton; Francis Daniel; Jacqueline Oates; Andrew Richard Norman Journal: N Engl J Med Date: 2008-01-03 Impact factor: 91.245
Authors: T Takayama; Y Sato; T Sagawa; T Okamoto; H Nagashima; Y Takahashi; H Ohnuma; G Kuroiwa; K Miyanishi; R Takimoto; T Matsunaga; J Kato; K Yamaguchi; K Hirata; Y Niitsu Journal: Br J Cancer Date: 2007-09-11 Impact factor: 7.640
Authors: Ho Seok Seo; Kyo Young Song; Yoon Ju Jung; Seung Man Park; Hae Myung Jeon; Wook Kim; Hyung Min Chin; Jin-Jo Kim; Sung Keun Kim; Kyung Hwa Chun; Jeong Goo Kim; Jun Hyun Lee; Han Hong Lee; Dong Jin Kim; Han Mo Yoo; Chang Hyun Kim; Eun Young Kim; Cho Hyun Park Journal: World J Surg Date: 2018-10 Impact factor: 3.352