Comparison of 2- and 4-week S-1 administration as adjuvant chemotherapy for advanced gastric cancer
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ORIGINAL ARTICLE
Comparison of 2‑ and 4‑week S‑1 administration as adjuvant chemotherapy for advanced gastric cancer Koichi Ogawa1 · Michitaka Honda2 · Yoshimasa Akashi1 · Satoshi Inagawa3 · Akinao Kaneda4 · Soshi Hori4 · Yohei Owada1 · Yusuke Ohara1 · Katsuji Hisakura1 · Tsuyoshi Enomoto1 · Osamu Shimomura1 · Kazuhiro Takahashi1 · Tatsuya Oda1 Received: 28 February 2020 / Accepted: 1 June 2020 © Japan Society of Clinical Oncology 2020
Abstract Background A 4-week administration of tegafur/gimeracil/oteracil (S-1) followed by a 2-week rest is the standard adjuvant chemotherapy for surgically resected advanced gastric cancer. This study aimed to evaluate the oncological feasibility of a 2-week S-1 administration followed by a 1-week rest, which is frequently applied in clinical practice to reduce toxicity and improve drug adherence. Methods We retrospectively enrolled patients with stage II/III gastric cancer who received S-1 adjuvant chemotherapy following radical gastrectomy from 2006 to 2016 in three institutions. Two-week and 4-week regimen cohorts were compared for relative dose intensity (RDI) as a primary outcome, and treatment completion rate, adverse event incidence, overall survival (OS), and relapse-free survival (RFS) as secondary outcomes. Confounders were adjusted for using propensity score matching (PSM). Results One hundred and thirty-four patients received the 2-week regimen and 121 patients received the 4-week regimen. Ninety-five patients were extracted from each group after PSM. The RDIs of S-1 in the 2-week and 4-week cohorts were 73.5 and 69.9%, respectively (p = 0.35), which were not significantly different. The treatment completion rate (54.7 vs. 53.7%, p = 1.0), incidence of grade ≥3 adverse events (7.4 vs. 12.6%, p = 0.33), 3-year OS (76.4 vs. 82.7%, p = 0.78), and 3-year RFS (71.3 vs. 73.4%, p = 0.70) did not significantly differ between both cohorts. Conclusions The 2-week S-1 adjuvant chemotherapy could not improve drug adherence in terms of RDI, but its relapse rates were not significantly different compared with those of the 4-week regimen. The 2-week regimen might be considered as an option depending on the patient’s status. Keywords Gastric cancer · S-1 · Adjuvant chemotherapy · 2-week administration · Propensity score-matched analysis
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10147-020-01719-5) contains supplementary material, which is available to authorized users. * Koichi Ogawa k‑[email protected] 1
Department of Gastrointestinal and Hepato‑Biliary‑Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki 305‑8575, Japan
2
Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
3
Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
4
Department of Surgery, Southern-Tohoku General Hospital, Fukushima, Japan
Introduction Adjuvant chemotherapy with tegafur/
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