Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine - PubMed (original) (raw)

Randomized Controlled Trial

. 2007 Nov 1;357(18):1810-20.

doi: 10.1056/NEJMoa072252.

Mitsuru Sasako, Toshiharu Yamaguchi, Taira Kinoshita, Masashi Fujii, Atsushi Nashimoto, Hiroshi Furukawa, Toshifusa Nakajima, Yasuo Ohashi, Hiroshi Imamura, Masayuki Higashino, Yoshitaka Yamamura, Akira Kurita, Kuniyoshi Arai; ACTS-GC Group

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Randomized Controlled Trial

Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine

Shinichi Sakuramoto et al. N Engl J Med. 2007.

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Abstract

Background: Advanced gastric cancer can respond to S-1, an oral fluoropyrimidine. We tested S-1 as adjuvant chemotherapy in patients with curatively resected gastric cancer.

Methods: Patients in Japan with stage II or III gastric cancer who underwent gastrectomy with extended (D2) lymph-node dissection were randomly assigned to undergo surgery followed by adjuvant therapy with S-1 or to undergo surgery only. In the S-1 group, administration of S-1 was started within 6 weeks after surgery and continued for 1 year. The treatment regimen consisted of 6-week cycles in which, in principle, 80 mg of oral S-1 per square meter of body-surface area per day was given for 4 weeks and no chemotherapy was given for the following 2 weeks. The primary end point was overall survival.

Results: We randomly assigned 529 patients to the S-1 group and 530 patients to the surgery-only group between October 2001 and December 2004. The trial was stopped on the recommendation of the independent data and safety monitoring committee, because the first interim analysis, performed 1 year after enrollment was completed, showed that the S-1 group had a higher rate of overall survival than the surgery-only group (P=0.002). Analysis of follow-up data showed that the 3-year overall survival rate was 80.1% in the S-1 group and 70.1% in the surgery-only group. The hazard ratio for death in the S-1 group, as compared with the surgery-only group, was 0.68 (95% confidence interval, 0.52 to 0.87; P=0.003). Adverse events of grade 3 or grade 4 (defined according to the Common Toxicity Criteria of the National Cancer Institute) that were relatively common in the S-1 group were anorexia (6.0%), nausea (3.7%), and diarrhea (3.1%).

Conclusions: S-1 is an effective adjuvant treatment for East Asian patients who have undergone a D2 dissection for locally advanced gastric cancer. (ClinicalTrials.gov number, NCT00152217 [ClinicalTrials.gov].).

Copyright 2007 Massachusetts Medical Society.

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