First-line chemotherapy with S-1 alone or S-1 plus cisplatin for elderly patients with advanced gastric cancer: a multicenter propensity score matched study
- 576 Downloads
Fluoropyrimidine and platinum combination is the standard treatment for advanced or recurrent gastric cancer (AGC). However, fluoropyrimidine monotherapy is commonly used for elderly patients with AGC because of its good tolerability.
In this multicenter retrospective study, we collected clinical data of AGC patients aged 70 years or older, treated with S-1 alone or S-1 plus cisplatin (SP) as the first-line treatment between January 2009 and December 2011. Propensity score matched cohorts (PSMC) were used for reducing the confounding effects to compare efficacy and safety between the two treatment groups. Cox regression analysis was performed to clarify the prognostic factors.
PSMC (n = 109 in each group) were selected from among 444 eligible patients (S-1 group, 210; SP group, 234); the S-1 group included more patients deemed unfit for intensive chemotherapy than the SP group (e.g., higher age, poorer PS, poor renal function). In the PSMC, patients’ characteristics were comparable between groups, except the male ratio (S-1 group, 64.2%; SP group, 77.1%; p = 0.04). No significant differences were observed in either overall survival [hazard ratio (HR) 0.93, p = 0.63] or progression-free survival (HR 1.09, p = 0.61). Severe adverse events (AEs) and hospitalization due to AEs were more frequent in the SP group than in the S-1 group (p < 0.001 each).
Our findings do not support the survival benefit of SP over S-1 in elderly patients with AGC. We are now conducting a prospective comparative study to optimize treatment strategy and explore applicability of the geriatric assessment for these patients.
KeywordsElderly patients Gastric cancer S-1 Cisplatin Propensity score matching method (3-5 words)
We thank all patients included in this study, the medical staff who contributed to the treatment of patients from each institution, and all the investigators in the West Japan Oncology Group (WJOG).
Compliance with ethical standards
Conflicts of interest
No potential conflicts of interest to disclose.
Research involving human participants
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.
- 1.Ferlay J, Bray F, Parkin DM, Pisani P, editors. Globocan 2000: cancer incidence and mortality worldwide (IARC Cancer Bases No. 5). Lyon: IARC Press; 2001.Google Scholar
- 2.Cancer Statistics in Japan. Foundation for promotion of cancer research. 2010. http://ganjoho.ncc.go.jp/public/statistics/backnumber/2010_en.html. Accessed 1 Oct 2015.
- 3.National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Older Adult Oncology (version 2. 2017).Google Scholar
- 4.National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Gastric Cancer (version 5.2017).Google Scholar
- 10.Abe T, Takeda K, Ohe Y, Kudoh S, Ichinose Y, Okamoto H, et al. Randomized phase III trial comparing weekly docetaxel plus cisplatin versus docetaxel monotherapy every 3 weeks in elderly patients with advanced non-small-cell lung cancer: the intergroup trial JCOG0803/WJOG4307L. J Clin Oncol. 2015;33:575–81.CrossRefPubMedGoogle Scholar
- 11.Takashima A, Boku N, Kato K, Nakamura K, Mizusawa J, Fukuda H, et al. Survival prolongation after treatment failure of first-line chemotherapy in patients with advanced gastric cancer: combined analysis of the Japan Clinical Oncology group trials JCOG9205 and JCOG9912. Gastric Cancer. 2014;17:522–8.CrossRefPubMedGoogle Scholar
- 12.Takahari D, Boku N, Mizusawa J, Takashima A, Yamada Y, Yoshino T, et al. Determination of prognostic factors in Japanese patients with advanced gastric cancer using the data from a randomized controlled trial, Japan clinical oncology group 9912. Oncologist. 2014;19:358–66.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Takahari D, Mizusawa J, Koizumi W, Hyodo I, Boku N. Validation of the JCOG prognostic index in advanced gastric cancer of the SPIRITS and G-SOX trials, using individual patient data. Gastric Cancer. 2017;20:757–63.Google Scholar
- 18.Senden C, Vandecasteele T, Vandenberghe E, Versluys K, Piers R, Grypdonck M, et al. The interaction between lived experiences of older patients and their family caregivers confronted with a cancer diagnosis and treatment: a qualitative study. Int J Nurs Stud. 2015;52:197–206.CrossRefPubMedGoogle Scholar