Facilitated completion of 1-year adjuvant S-1 monotherapy for pathological stage II or III gastric cancer by medical onc
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ORIGINAL ARTICLE
Facilitated completion of 1‑year adjuvant S‑1 monotherapy for pathological stage II or III gastric cancer by medical oncologists Yosuke Kano1 · Manabu Ohashi1 · Naoki Hiki2 · Daisuke Takahari3 · Keisho Chin3 · Kensei Yamaguchi3 · Satoshi Ida1 · Koshi Kumagai1 · Takeshi Sano1 · Souya Nunobe1 Received: 5 January 2020 / Accepted: 6 March 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Several factors are known to be significantly associated with a low completion rate of 1-year adjuvant S-1 monotherapy for gastric cancer. The present study investigated whether or not the specialties of physicians conducting adjuvant S-1 monotherapy affect the completion rate. Methods A total of 437 patients who underwent curative gastrectomy followed by adjuvant S-1 monotherapy for pathological stage II or III gastric cancer between 2008 and 2013 were retrospectively analyzed. Factors affecting completion of adjuvant S-1 monotherapy, including the physicians (medical oncologists or surgeons) administering S-1, were evaluated by a multivariate analysis. The relationship between patient factors and physicians was analyzed regarding the cumulative incidence of discontinuation. The number of times the dose was reduced, the schedule changed, or administration was suspended or delayed in patients completing adjuvant S-1 monotherapy was also counted. Results The multivariate analysis showed that old age (≥ 65 years old), excess body weight loss (≥ 15%), and surgeons were independently associated with discontinuation. In older patients, the cumulative incidence of discontinuation by medical oncologists was significantly lower than that by surgeons. Medical oncologists ensured that older patients continued S-1 by frequent suspension or a delay in each course. Conclusions Medical oncologists may facilitate completion of adjuvant S-1 monotherapy. Keywords Gastric cancer · S-1 · Adjuvant chemotherapy
Introduction In Japan, the main treatment for locally advanced gastric cancer is gastrectomy with D2 lymph node dissection, and consequent treatment is determined according to the pathologically confirmed stage. The primarily recommended postoperative treatment for pathological stage (pStage) II * Manabu Ohashi [email protected] 1
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3‑8‑31 Ariake, Koto‑ku, Tokyo 135‑8550, Japan
2
Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
3
Department of Gastroenterological Medicine, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
or III gastric cancer was S-1 monotherapy for 1 year [1] or capecitabine–oxaliplatin for 6 months [2], although that for pStage III has now changed to S-1 plus docetaxel [3]. A nationwide phase III trial called the adjuvant chemotherapy trial of S-1 for gastric cancer (ACTS-GC) demonstrated the additional effect of adjuvant S-1
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