Akitaka Makiyama1, Kenji Kunieda2, Masaaki Noguchi3, Takeshi Kajiwara4, Takao Tamura5, Koji Takeda6, Junko Sugiyama7, Keiko Minashi8, Toshikazu Moriwaki9, Naotoshi Sugimoto10, Michitaka Nagase11, Yuji Negoro12, Takashi Tsuda13, Hideki Shimodaira14, Naohiro Okano15, Akihito Tsuji16, Daisuke Sakai17, Kazuhiro Yanagihara18, Shinya Ueda19, Shingo Tamura20, Satoshi Otsu21, Takuya Honda22, Yuzo Matsushita23, Tatsuya Okuno24, Tomomi Kashiwada25, Akira Nozaki26, Masahide Ebi27, Hiroyuki Okuda28, Mototsugu Shimokawa29, Shuichi Hironaka8, Ichinosuke Hyodo9, Eishi Baba30, Narikazu Boku31, Kei Muro32, Taito Esaki33. 1. Department of Hematology/Oncology, Japan Community Healthcare Organization, Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, 806-8501, Japan. makiyama20@hotmail.com. 2. Department of GI Oncology, Shizuoka Cancer Center, Shizuoka, Japan. 3. Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan. 4. Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan. 5. Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan. 6. Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan. 7. Department of Medical Oncology, Tonan Hospital, Sapporo, Japan. 8. Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan. 9. Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 10. Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan. 11. Department of Clinical Oncology, Nagoya Red-Cross Daiichi Hospital, Nagoya, Japan. 12. Division of Gastroenterological Medicine, Kochi Health Sciences Center, Kochi, Japan. 13. Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan. 14. Department of Clinical Oncology, Tohoku University Hospital, Sendai, Japan. 15. Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan. 16. Department of Medical Oncology, Kagawa University Hospital, Kagawa, Japan. 17. Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Osaka, Japan. 18. Department of Medical Oncology, Kansai Electric Power Hospital, Osaka, Japan. 19. Department of Medical Oncology, Nara Hospital Kindai University School of Medicine, Ikoma, Japan. 20. Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Japan. 21. Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, Yufu, Japan. 22. Department of Clinical Oncology Center, Nagasaki University Hospital, Nagasaki, Japan. 23. Department of Medical Oncology, Hamanomachi Hospital, Fukuoka, Japan. 24. Division of Gastroenterology, Department of Internal Medicine Graduate School of Medicine, Kobe University, Kobe, Japan. 25. Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan. 26. Department of Clinical Oncology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 27. Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan. 28. Department of Medical Oncology, Keiyukai Sapporo Hospital, Sapporo, Japan. 29. Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan. 30. Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan. 31. Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. 32. Department of Clinical Oncology and Outpatient Treatment Center, Aichi Cancer Center Hospital, Nagoya, Japan. 33. Department of Gastrointestinal and Medical Oncology, National Kyushu Cancer Center, Fukuoka, Japan.
Abstract
BACKGROUND: Fluoropyrimidine and platinum combination is the standard treatment for advanced or recurrent gastric cancer (AGC). However, fluoropyrimidine monotherapy is commonly used for elderly patients with AGC because of its good tolerability. METHODS: In this multicenter retrospective study, we collected clinical data of AGC patients aged 70 years or older, treated with S-1 alone or S-1 plus cisplatin (SP) as the first-line treatment between January 2009 and December 2011. Propensity score matched cohorts (PSMC) were used for reducing the confounding effects to compare efficacy and safety between the two treatment groups. Cox regression analysis was performed to clarify the prognostic factors. RESULTS: PSMC (n = 109 in each group) were selected from among 444 eligible patients (S-1 group, 210; SP group, 234); the S-1 group included more patients deemed unfit for intensive chemotherapy than the SP group (e.g., higher age, poorer PS, poor renal function). In the PSMC, patients' characteristics were comparable between groups, except the male ratio (S-1 group, 64.2%; SP group, 77.1%; p = 0.04). No significant differences were observed in either overall survival [hazard ratio (HR) 0.93, p = 0.63] or progression-free survival (HR 1.09, p = 0.61). Severe adverse events (AEs) and hospitalization due to AEs were more frequent in the SP group than in the S-1 group (p < 0.001 each). CONCLUSION: Our findings do not support the survival benefit of SP over S-1 in elderly patients with AGC. We are now conducting a prospective comparative study to optimize treatment strategy and explore applicability of the geriatric assessment for these patients.
BACKGROUND:Fluoropyrimidine and platinum combination is the standard treatment for advanced or recurrent gastric cancer (AGC). However, fluoropyrimidine monotherapy is commonly used for elderly patients with AGC because of its good tolerability. METHODS: In this multicenter retrospective study, we collected clinical data of AGC patients aged 70 years or older, treated with S-1 alone or S-1 plus cisplatin (SP) as the first-line treatment between January 2009 and December 2011. Propensity score matched cohorts (PSMC) were used for reducing the confounding effects to compare efficacy and safety between the two treatment groups. Cox regression analysis was performed to clarify the prognostic factors. RESULTS:PSMC (n = 109 in each group) were selected from among 444 eligible patients (S-1 group, 210; SP group, 234); the S-1 group included more patients deemed unfit for intensive chemotherapy than the SP group (e.g., higher age, poorer PS, poor renal function). In the PSMC, patients' characteristics were comparable between groups, except the male ratio (S-1 group, 64.2%; SP group, 77.1%; p = 0.04). No significant differences were observed in either overall survival [hazard ratio (HR) 0.93, p = 0.63] or progression-free survival (HR 1.09, p = 0.61). Severe adverse events (AEs) and hospitalization due to AEs were more frequent in the SP group than in the S-1 group (p < 0.001 each). CONCLUSION: Our findings do not support the survival benefit of SP over S-1 in elderly patients with AGC. We are now conducting a prospective comparative study to optimize treatment strategy and explore applicability of the geriatric assessment for these patients.
Authors: Jeremy Walston; Mary Ann McBurnie; Anne Newman; Russell P Tracy; Willem J Kop; Calvin H Hirsch; John Gottdiener; Linda P Fried Journal: Arch Intern Med Date: 2002-11-11
Authors: E A Eisenhauer; P Therasse; J Bogaerts; L H Schwartz; D Sargent; R Ford; J Dancey; S Arbuck; S Gwyther; M Mooney; L Rubinstein; L Shankar; L Dodd; R Kaplan; D Lacombe; J Verweij Journal: Eur J Cancer Date: 2009-01 Impact factor: 9.162