A phase I study of docetaxel/oxaliplatin/S-1 (DOS) combination neoadjuvant chemotherapy for patients with locally advanc
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ORIGINAL ARTICLE
A phase I study of docetaxel/oxaliplatin/S‑1 (DOS) combination neoadjuvant chemotherapy for patients with locally advanced adenocarcinoma of the esophagogastric junction Kei Hosoda1 · Mizutomo Azuma2 · Chikatoshi Katada2 · Kenji Ishido2 · Masahiro Niihara1 · Hideki Ushiku1 · Mikiko Sakuraya1 · Marie Washio1 · Takuya Wada2 · Akinori Watanabe2 · Hiroki Harada1 · Satoshi Tanabe2 · Wasaburo Koizumi2 · Keishi Yamashita1 · Naoki Hiki1 Received: 15 August 2019 / Accepted: 20 February 2020 © Japan Society of Clinical Oncology 2020
Abstract Background The optimal dose of each drug used in the docetaxel, oxaliplatin, and S-1 (DOS) chemotherapy remains to be clarified for the Japanese population. The purpose of this study was to determine a recommended dose for a combination neoadjuvant DOS chemotherapy for Japanese patients with locally advanced adenocarcinoma of the esophagogastric junction (AEG). Methods Patients with cT3 or more advanced AEG without distant metastasis were eligible for this study. The planned dosages of docetaxel (mg/m2, day 1), oxaliplatin (mg/m2, day 1), and S-1 (mg/day, days 1–14) were: 50/100/80–120 at level 1, and 60/100/80–120 at level 2, respectively. The treatment cycle was repeated every 3 weeks, and patients were assessed for response to the treatment after 2 and 3 cycles. This study was registered in the UMIN Clinical Trial Registry (UMIN 000022210). Results We enrolled 12 patients with locally advanced AEG in this study. At dose level 1, one of the six patients experienced dose-limiting toxicity (DLT) of grade 3 diarrhea and grade 3 febrile neutropenia. Two of the next six patients also experienced DLT of need for more than 2-week delay of the start of the second cycle due to adverse events at dose level 2. Based on these results, level 2 was considered the recommended dose for this regimen. Conclusion Recommended doses of docetaxel (mg/m2), oxaliplatin (mg/m2), and S-1 (mg/day) were 60/100/80–120. This chemotherapy scheme showed good preliminary efficacy with acceptable toxicity warranting a further phase II trial to investigate the efficacy of this regimen. Keywords Locally advanced esophagogastric junction cancer · Docetaxel · Oxaliplatin · S-1 · Neoadjuvant chemotherapy
Introduction An increasing number of patients with adenocarcinoma of the esophagogastric junction (AEG) have been recently reported in the Western countries [1, 2]. In Japan, Helicobacter pylori infection rate is decreasing, and obesity is * Kei Hosoda k.hosoda@kitasato‑u.ac.jp 1
Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1‑15‑1, Minami‑ku, Sagamihara, Kanagawa 252‑0374, Japan
Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
2
increasing in the population. This could lead to an increase in the incidence of gastroesophageal reflux disease, including Barret esophagus, which could in turn induce AEG [3]. In the Western countries, MAGIC trial showed that perioperative chemotherapy using ECF (epirubic
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