Skip to main content

Advertisement

Log in

A multicenter phase II study of gemcitabine and S-1 combination chemotherapy in patients with unresectable pancreatic cancer

  • Original Article
  • Published:
Cancer Chemotherapy and Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To confirm the efficacy and toxicity of gemcitabine and S-1 combination chemotherapy when used as a first-line therapy in patients with unresectable pancreatic cancer.

Methods

Patients with locally advanced or metastatic or recurrent pancreatic adenocarcinoma, which was histologically or cytologically proven, with at least one measurable lesion were eligible for the study. Gemcitabine at a dose of 1,000 mg/m2 was intravenously given over 30 min on days 1 and 8, while S-1 at a dose of 40 mg/m2 was orally given twice daily from day 1 to 14, and the cycle was repeated every 3 weeks. The objective response rate, which was assessed according to RECIST criteria, was the primary end point.

Results

A total of 38 patients were enrolled between June 2006 and June 2007. The median number of treatment courses was 5.5 (range 1–22). Thirty-four patients were evaluable for response. Although no complete response was seen, partial responses were achieved in 11 patients, resulting in an overall response rate of 32% [95% confidence interval (CI) 17–48%]. The median response duration was 6.0 months (95% CI 4.6–8.3 months), the median time-to-progression was 5.4 months (95% CI 2.9–8.0 months), and the median overall survival was 8.4 months (95% CI 5.7–11.1 months). The major grade 3/4 hematologic toxicities were neutropenia (39.5%), leukopenia (15.8%), thrombocytopenia (2.6%), and anemia (7.9%). The major grade 3/4 non-hematologic toxicities included anorexia (10.5%), stomatitis (2.6%), rash (7.9%), fatigue (7.9%) and hyperbilirubinemia (5.3%).

Conclusions

Gemcitabine and S-1 combination chemotherapy was effective and tolerable in patients with unresectable pancreatic cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Shin HR, Won YJ, Jung KW et al (2005) Nationwide cancer incidence in Korea, 1999–2001; first result using the National Cancer Incidence Database. Cancer Res Treat 37:325–331

    Article  PubMed  Google Scholar 

  2. Burris HA 3rd, Moore MJ, Andersen J et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15:2403–2413

    CAS  PubMed  Google Scholar 

  3. Berlin JD, Catalano P, Thomas JP, Kugler JW, Haller DG, Benson AB 3rd (2002) Phase III study of gemcitabine in combination with fluorouracil versus gemcitabine alone in patients with advanced pancreatic carcinoma: Eastern Cooperative Oncology Group Trial E2297. J Clin Oncol 20:3270–3275

    Article  CAS  PubMed  Google Scholar 

  4. Bramhall SR, Schulz J, Nemunaitis J, Brown PD, Baillet M, Buckels JA (2002) A double-blind placebo-controlled, randomised study comparing gemcitabine and marimastat with gemcitabine and placebo as first line therapy in patients with advanced pancreatic cancer. Br J Cancer 87:161–167

    Article  CAS  PubMed  Google Scholar 

  5. Colucci G, Giuliani F, Gebbia V et al (2002) Gemcitabine alone or with cisplatin for the treatment of patients with locally advanced and/or metastatic pancreatic carcinoma: a prospective, randomized phase III study of the Gruppo Oncologia dell’Italia Meridionale. Cancer 94:902–910

    Article  CAS  PubMed  Google Scholar 

  6. Oettle H, Richards D, Ramanathan RK et al (2005) A phase III trial of pemetrexed plus gemcitabine versus gemcitabine in patients with unresectable or metastatic pancreatic cancer. Ann Oncol 16:1639–1645

    Article  CAS  PubMed  Google Scholar 

  7. Rocha Lima CM, Green MR, Rotche R et al (2004) Irinotecan plus gemcitabine results in no survival advantage compared with gemcitabine monotherapy in patients with locally advanced or metastatic pancreatic cancer despite increased tumor response rate. J Clin Oncol 22:3776–3783

    Article  CAS  PubMed  Google Scholar 

  8. Heinemann V, Quietzsch D, Gieseler F et al (2006) Randomized phase III trial of gemcitabine plus cisplatin compared with gemcitabine alone in advanced pancreatic cancer. J Clin Oncol 24:3946–3952

    Article  CAS  PubMed  Google Scholar 

  9. Louvet C, Labianca R, Hammel P et al (2005) Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol 23:3509–3516

    Article  CAS  PubMed  Google Scholar 

  10. Moore MJ, Goldstein D, Hamm J et al (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 25:1960–1966

    Article  CAS  PubMed  Google Scholar 

  11. Miksad RA, Schnipper L, Goldstein M (2007) Does a statistically significant survival benefit of erlotinib plus gemcitabine for advanced pancreatic cancer translate into clinical significance and value? J Clin Oncol 25:4506–4507 (author reply 4508)

    Article  PubMed  Google Scholar 

  12. Herrmann R, Bodoky G, Ruhstaller T et al (2007) Gemcitabine plus capecitabine compared with gemcitabine alone in advanced pancreatic cancer: a randomized, multicenter, phase III trial of the Swiss Group for Clinical Cancer Research and the Central European Cooperative Oncology Group. J Clin Oncol 25:2212–2217

    Article  CAS  PubMed  Google Scholar 

  13. Bernhard J, Dietrich D, Scheithauer W et al (2008) Clinical benefit and quality of life in patients with advanced pancreatic cancer receiving gemcitabine plus capecitabine versus gemcitabine alone: a randomized multicenter phase III clinical trial—SAKK 44/00-CECOG/PAN.1.3.001. J Clin Oncol 26:3695–3701

    Article  CAS  PubMed  Google Scholar 

  14. Cunningham D, Chau I, Stocken D et al (2005) Phase III randomized comparison of gemcitabine versus gemcitabine plus capecitabine in patients with advanced pancreatic cancer. Eur J Cancer 4:Abstract PSII

  15. Shirasaka T, Shimamato Y, Ohshimo H et al (1996) Development of a novel form of an oral 5-fluorouracil derivative (S-1) directed to the potentiation of the tumor selective cytotoxicity of 5-fluorouracil by two biochemical modulators. Anticancer Drugs 7:548–557

    Article  CAS  PubMed  Google Scholar 

  16. Takechi T, Nakano K, Uchida J et al (1997) Antitumor activity and low intestinal toxicity of S-1, a new formulation of oral tegafur, in experimental tumor models in rats. Cancer Chemother Pharmacol 39:205–211

    Article  CAS  PubMed  Google Scholar 

  17. Ueno H, Okusaka T, Ikeda M, Takezako Y, Morizane C (2005) An early phase II study of S-1 in patients with metastatic pancreatic cancer. Oncology 68:171–178

    Article  CAS  PubMed  Google Scholar 

  18. Okusaka T, Funakoshi A, Furuse J et al (2008) A late phase II study of S-1 for metastatic pancreatic cancer. Cancer Chemother Pharmacol 61:615–621

    Article  CAS  PubMed  Google Scholar 

  19. Halloran CM, Ghaneh P, Shore S et al (2004) 5-Fluorouracil or gemcitabine combined with adenoviral-mediated reintroduction of p16INK4A greatly enhanced cytotoxicity in Panc-1 pancreatic adenocarcinoma cells. J Gene Med 6:514–525

    Article  CAS  PubMed  Google Scholar 

  20. Ueno H, Okusaka T, Ikeda M et al (2005) A phase I study of combination chemotherapy with gemcitabine and oral S-1 for advanced pancreatic cancer. Oncology 69:421–427

    Article  CAS  PubMed  Google Scholar 

  21. Longo DL, Duffey PL, DeVita VT Jr, Wesley MN, Hubbard SM, Young RC (1991) The calculation of actual or received dose intensity: a comparison of published methods. J Clin Oncol 9:2042–2051

    CAS  PubMed  Google Scholar 

  22. Ueno H, Okusaka T, Furuse J et al (2007) A multicenter phase II study of gemcitabine and S-1 combination therapy (GS therapy) in patients with metastatic pancreatic cancer. J Clin Oncol. 2007 ASCO Annual Meeting Proceedings Part I. 25:Abstract No. 4550

  23. Lee GW, Kim HJ, Ju JH et al (2009) Phase II trial of S-1 in combination with gemcitabine for chemo-naive patients with locally advanced or metastatic pancreatic cancer. Cancer Chemother Pharmacol (in press)

  24. Nakamura K, Yamaguchi T, Ishihara T et al (2005) Phase I trial of oral S-1 combined with gemcitabine in metastatic pancreatic cancer. Br J Cancer 92:2134–2139

    Article  CAS  PubMed  Google Scholar 

  25. Nakamura K, Yamaguchi T, Ishihara T, Sudo K, Kato H, Saisho H (2006) Phase II trial of oral S-1 combined with gemcitabine in metastatic pancreatic cancer. Br J Cancer 94:1575–1579

    CAS  PubMed  Google Scholar 

  26. Kim MK, Lee KH, Jang BI et al (2009) S-1 and gemcitabine as an outpatient-based regimen in patients with advanced or metastatic pancreatic cancer. Jpn J Clin Oncol 39:49–53

    Article  PubMed  Google Scholar 

  27. Wong D, Ko AH, Hwang J, Venook AP, Bergsland EK, Tempero MA (2008) Serum CA19-9 decline compared to radiographic response as a surrogate for clinical outcomes in patients with metastatic pancreatic cancer receiving chemotherapy. Pancreas 37:269–274

    Article  PubMed  Google Scholar 

  28. Murakami Y, Uemura K, Sudo T et al (2008) Adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic adenocarcinoma. Am J Surg 195:757–762

    Article  CAS  PubMed  Google Scholar 

  29. Murakami Y, Uemura K, Sudo T et al (2009) Impact of adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for adenocarcinoma of the body or tail of the pancreas. J Gastrointest Surg 13:85–92

    Google Scholar 

Download references

Acknowledgment

S-1 was kindly supplied by Jeil Pharm. Co., Ltd.

Conflict of interest statement

None declared.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yeul Hong Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oh, DY., Cha, Y., Choi, IS. et al. A multicenter phase II study of gemcitabine and S-1 combination chemotherapy in patients with unresectable pancreatic cancer. Cancer Chemother Pharmacol 65, 527–536 (2010). https://doi.org/10.1007/s00280-009-1059-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00280-009-1059-9

Keywords

Navigation