Abstract
Aim
The aim of this study was to evaluate the efficacy and toxicity of low dose of docetaxel in combination with standard dose of S-1 for patients with advanced or recurrent gastric cancer and to investigate whether the protein expression level of dihydropyrimidine dehydrogenase is a predictive factor of toxicities or responses.
Methods
Between March 2010 and December 2011, 61 patients from the Department of Medical Oncology of Shanghai Zhong Shan Hospital, Fudan University, were enrolled in the study. Patients with advanced or recurrent gastric adenocarcinoma were treated with docetaxel of 40 mg/m2 intravenously on day 1 and S-1 of 80 mg/m2 orally on days 1–14 every 3 weeks as first-line chemotherapy. The chemotherapeutic effects were evaluated following every 3 cycles of chemotherapy using the Response Evaluation Criteria In Solid Tumors (RECIST). The serum of peripheral blood was obtained at the start of the study and at each evaluation point to analyze the protein expression level of DPD, which was estimated using an enzyme-linked immunosorbent assay. All the patients were followed-up until the time of progression, death, or the censor time, to calculate progression-free survival and overall survival (OS) time.
Results
In total, 61 patients [median age 60 years (range 28–76 years)] received a total of 318 treatment cycles [median 5 (range 2–9)], and 94 cycles of single S-1 maintenance treatment. One complete response (CR) and 25 partial responses (PR) were observed, with an overall response rate of 42.6 %. A total of 29 patients (47.5 %) had stable disease (SD) and 6 patients (9.8 %) had progressive disease (PD). The disease control rate (DCR, CR + PR + SD) was 90.2 %. Median overall survival was 13.0 months [95 % confidence interval (CI) 10.76–15.24 months], and median PFS was 6.0 months (95 % CI 4.61–7.39 months). Progression-free survival was far longer in peritoneal metastatic patients than that in patients with other metastases (7.3 ± 2. 6 vs. 5.4 ± 2.8 months; P < 0.05); however, this was not the case for OS. Grade 3–4 neutropenia was well controlled and grade 4 non-hematologic toxicities did not occur. Baseline expression level of DPD was not associated with efficacy. Lower expression level of DPD was correlated with high grade of toxicities (P < 0.05).
Conclusion
This combination of standard dose of S-1 and low dose of docetaxel is effective and well tolerated in patients with advanced or recurrent gastric cancer. Peritoneal metastasis is treated more effectively by this regimen than other forms of metastases. Baseline DPD expression level in the serum is associated with toxicity, but not tumor response.
Similar content being viewed by others
References
Kamangar F, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24(14):2137–2150
Chollet P, Schoffski P, Weigang-Kohler K et al (2003) Phase II trial with S-1 in chemotherapy-naive patients with gastric cancer. A trial performed by the EORTC early clinical studies group (ECSG). Eur J Cancer 39(9):1264–1270
Koizumi W, Kurihara M, Nakano S et al (2000) Phase II study of S-1, a novel oral derivative of 5-fluorouracil, in advanced gastric cancer. For the S-1 cooperative gastric cancer study group. Oncology 58(3):191–197
Koizumi W, Tanabe S, Saigenji K et al (2003) Phase I/II study of S-1 combined with cisplatin in patients with advanced gastric cancer. Br J Cancer 89(12):2207–2212
Ajani JA, Faust J, Ikeda K et al (2005) Phase I pharmacokinetic study of S-1 plus cisplatin in patients with advanced gastric carcinoma. J Clin Oncol 23(28):6957–6965
Schuette W, Nagel S, Blankenburg T et al (2005) Phase III study of second-line chemotherapy for advanced non-small-cell lung cancer with weekly compared with 3-weekly docetaxel. J Clin Oncol 23(33):8389–8395
Bria E, Cuppone F, Ciccarese M et al (2006) Weekly docetaxel as second line chemotherapy for advanced non-small-cell lung cancer: metaanalysis of randomized trials. Cancer Treat Rev 32(8):583–587
Camps C, Massuti B, Jimenez A et al (2006) Randomized phase III study of 3-weekly vs weekly docetaxel in pretreated advanced non-small-cell lung cancer: a Spanish lung cancer group trial. Ann Oncol 17(3):467–472
Kunisaki C, Takahashi M, Nagahori Y et al (2008) Phase I study of biweekly docetaxel and S-1 combination chemotherapy for advanced gastric cancer. Anticancer Res 28(4C):2473–2478
Park SR, Kim HK, Kim CG et al (2008) Phase I/II study of S-1 combined with weekly docetaxel in patients with metastatic gastric carcinoma. Br J Cancer 98(8):1305–1311
Sato Y, Takayama T, Sagawa T et al (2010) Phase II study of S-1, docetaxel and cisplatin combination chemotherapy in patients with unresectable metastatic gastric cancer. Cancer Chemother Pharmacol 66(4):721–728
Yamaguchi K, Shimamura T, Hyodo I et al (2006) Phase I/II study of docetaxel and S1 in patients with advanced gastric cancer. Br J Cancer 94(12):1803–1808
Yoshida K, Ninomiya M, Norihisa T et al (2006) Phase II study of docetaxel and S-1 combination therapy for advanced or recurrent gastric cancer. Clin Cancer Res 12(11 Pt 1):3402–3407
Nakayama N, Koizumi W, Sasaki T et al (2008) A multicenter, phase I dose-escalating study of docetaxel, cisplatin and S-1 for advanced gastric cancer (KDOG0601). Oncology 75(1–2):1–7
Lorenzen S, Hentrich M, Haberl C et al (2007) Split-dose docetaxel, cisplatin and leucovorin/fluorouracil as first-line therapy in advanced gastric cancer and adenocarcinoma of the gastroesophageal junction: results of a phase II trial. Ann Oncol 18(10):1673–1679
Goel G, Jauhri M, Negi A et al (2010) Feasibility study of docetaxel, oxaliplatin and capecitabine combination regimen in advanced gastric or gastroesophageal adenocarcinoma. Hematol Oncol Stem Cell Ther 3(2):55–59
Wada Y, Yoshida K, Suzuki T et al (2006) Synergistic effects of docetaxel and S-1 by modulating the expression of metabolic enzymes of 5-fluorouracil in human gastric cancer cell lines. Int J Cancer 119(4):783–791
Ajani JA, Fodor MB, Tjulandin SA et al (2005) Phase II multi-institutional randomized trial of docetaxel plus cisplatin with or without fluorouracil in patients with untreated, advanced gastric, or gastroesophageal adenocarcinoma. J Clin Oncol 23(24):5660–5667
De Vita F, Orditura M, Matano E et al (2005) A phase II study of biweekly oxaliplatin plus infusional 5-fluorouracil and folinic acid (FOLFOX-4) as first-line treatment of advanced gastric cancer patients. Br J Cancer 92(9):1644–1649
Sadeghi B, Arvieux C, Glehen O et al (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88(2):358–363
Tamura S, Miki H, Okada K et al (2010) Pilot study of a combination of S-1 and paclitaxel for patients with peritoneal metastasis from gastric cancer. Gastric Cancer 13(2):101–108
Fujiwara Y, Nishida T, Takiguchi S et al (2010) Feasibility study of S-1 and intraperitoneal docetaxel combination chemotherapy for gastric cancer with peritoneal dissemination. Anticancer Res 30(4):1335–1339
Sadahiro S, Suzuki T, Maeda Y et al (2010) Pharmacokinetic study of S-1 for the treatment of peritoneal metastasis from colon cancer–using a mouse peritoneal metastasis model. Gan To Kagaku Ryoho 37(9):1725–1728
Takeda M, Okamoto I, Hirabayashi N et al (2011) Thymidylate synthase and dihydropyrimidine dehydrogenase expression levels are associated with response to S-1 plus carboplatin in advanced non-small cell lung cancer. Lung Cancer 73(1):103–109
Kim SJ, Han SW, Oh DY et al (2010) Combination chemotherapy with S-1 and platinum in advanced hepatocellular carcinoma. Anticancer Res 30(12):5245–5250
Kondo N, Murakami Y, Uemura K et al (2011) Prognostic impact of dihydropyrimidine dehydrogenase expression on pancreatic adenocarcinoma patients treated with S-1-based adjuvant chemotherapy after surgical resection. J Surg Oncol 104(2):146–154
Zhang XP, Bai ZB, Chen BA et al (2012) Polymorphisms for dihydropyrimidine dehydrogenase gene and clinical outcomes of gastric cancer patients treated with fluorouracil-based adjuvant chemotherapy in Chinese population. Chin Med J Engl 125(5):741–746
Miyazaki I, Kawai T, Harada Y et al (2010) A predictive factor for the response to S-1 plus cisplatin in gastric cancer. World J Gastroenteral 16(36):4575–4582
Tao GH, Zhong CJ, Cao XJ et al (2008) Expression and clinical implication of mRNA levels of thymidylate synthase and dihydropyrimidine dehydrogenase in the peripheral blood of digestive tract cancer. Chin J Lab Diagn 12(12):1548–1551
Hoffmann AC, Brabender J, Metzger R et al (2009) Dihydropyrimidine dehydrogenase mRNA expression in peripheral blood of rectal cancer patients is significantly associated with residual tumor and distant metastases following resection. J Surg Oncol 99(5):296–301
Cordier PY, Nau A, Ciccolini J et al (2011) 5-FU-induced neurotoxicity in cancer patients with profound DPD deficiency syndrome: a report of two cases. Cancer Chemother Pharmacol 68(3):823–826
Kamoshida S, Shiogama K, Shimomura R et al (2005) Immunohistochemical demonstration of fluoropyrimidine-metabolizing enzymes in various types of cancer. Oncol Rep 14(5):1223–1230
Saif MW, Rosen LS, Saito K et al (2011) A phase I study evaluating the effect of CDHP as a component of S-1 on the pharmacokinetics of 5-fluorouracil. Anticancer Res 31(2):625–632
Acknowledgments
We would like to thank all the patients and colleagues in our department. We also express gratitude to teacher Hu Meiyu at Biomedical Research Center.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cui, Y., Li, Q., Yu, Y. et al. Combination of low-dose docetaxel and standard-dose S-1 for the treatment of advanced gastric cancer: efficacy, toxicity, and potential predictive factor. Cancer Chemother Pharmacol 71, 145–152 (2013). https://doi.org/10.1007/s00280-012-1991-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00280-012-1991-y