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Okumura N, Soh J, Suzuki H, Nakata M, Fujiwara T, Nakamura H, Sonobe M, Fujinaga T, Kataoka K, Gemba K, Kataoka M, Hotta K, Yoshioka H, Matsuo K, Sakamoto J, Date H, Toyooka S. Randomized phase II study of daily and alternate-day administration of S-1 for adjuvant chemotherapy in completely-resected stage I non-small cell lung cancer: results of the Setouchi Lung Cancer Group Study 1301. BMC Cancer 2021; 21:506. [PMID: 33957881 PMCID: PMC8101150 DOI: 10.1186/s12885-021-08232-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this multicenter, randomized phase II study was to analyze the feasibility and safety of alternate-day S-1, an oral fluoropyrimidine, for adjuvant chemotherapy in patients with completely resected pathological stage I (tumor diameter > 2 cm) non-small cell lung cancer (NSCLC). METHODS Patients were randomly assigned to receive adjuvant chemotherapy for 1 year comprising either alternate-day oral administration of S-1 (80 mg/m2/day) for 4 days a week (Group A) or a 2-week oral administration of S-1 (80 mg/m2/day) followed by 1 week of rest (Group B). The primary endpoint was feasibility, which was defined as the proportion of patients who completed the allocated intervention for 6 months with a relative dose intensity (RDI) of 70% or more. RESULTS Ninety-three patients were enrolled of whom 90 patients received S-1 treatment. Median follow-up was 66.9 months. The treatment completion rate based on an RDI of 70% or more for 6 months was 84.4% (95%CI; 70.5-93.5%) in group A and 64.4% (95%CI; 48.8-78.1%) in group B. There were no grade 4 adverse events in either group. Moderate or severe adverse events (grade 2 or grade 3) were significantly more frequent in group B (67%) compared with group A (29%, P = 0.001). The 5-year relapse-free survival rate was 87.0 and 80.9% for group A and B, respectively (P = 0.451). The 5-year overall survival rate for all patients (n = 93) was 100 and 89.4% for group A and B, respectively (P = 0.136). CONCLUSION Alternate-day oral administration of S-1 for 1 year as adjuvant chemotherapy was demonstrated to be feasible with low toxicity in completely resected stage I (tumor diameter > 2 cm) NSCLC. TRIAL REGISTRATION Trial registration number: UMIN000011994 . Date of registration: 10/8/2013.
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Affiliation(s)
- Norihito Okumura
- Department of Thoracic Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan.
| | - Junichi Soh
- Department of Surgery, Division of Thoracic Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-, Sayama, Japan
| | - Hiroyuki Suzuki
- Department of Chest Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Masao Nakata
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Japan
| | - Toshiya Fujiwara
- Depatment of Thoracic Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-machi, Naka-ku, Hiroshima, Japan
| | - Hiroshige Nakamura
- Division of General Thoracic Surgery, Tottori University Hospital, 36-1, Nishi-cho, Yonago, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Kyoto University, 54 Shogoinkawara-cho, Sakyo-ku, Kyoto, Japan
| | - Takuji Fujinaga
- Department of General Thoracic Surgery, National Hospital Organization Nagara Medical Center, 1300-7 Nagara, Gifu, Japan
| | - Kazuhiko Kataoka
- Department of Thoracic Surgery, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atagomachi, Iwakuni, Japan
| | - Kenichi Gemba
- Department of Respiratory Medicine, Chugoku Central Hospital, 148-13 Kamiiwanari, Miyuki-cho, Fukuyama, Japan
| | - Masafumi Kataoka
- Department of Surgery, Okayama Saiseikai General Hospital, 1-17-18 Ifuku-cho, Kita-ku, Okayama, Japan
| | - Katsuyuki Hotta
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
- Department of Preventive Medicine, Kyushu University Faculty of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Junichi Sakamoto
- Tokai Central Hospital, 4-6-2 Sohara Higashijima-cho, Kakamigahara, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, 54 Shogoinkawara-cho, Sakyo-ku, Kyoto, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan
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2
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Uematsu S, Sano A, Isobe K, Usui K, Matsumoto J, Kiribayashi T, Obara K, Kitami A, Murakami Y, Iyoda A. Acceptability and feasibility of S-1 plus cisplatin adjuvant chemotherapy for completely resected non-small cell lung cancer: an open-label, single arm, multicenter, phase 2 trial. J Thorac Dis 2021; 13:2224-2232. [PMID: 34012573 PMCID: PMC8107543 DOI: 10.21037/jtd-20-3293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Although platinum-based chemotherapy is accepted as adjuvant chemotherapy for resectable advanced non-small cell lung cancer (NSCLC), its completion rate is low due to severe adverse events. S-1 plus cisplatin is associated with relatively low toxicity and an unimpaired quality of life, and has been used for unresectable advanced lung cancer. We investigated the acceptability and feasibility of combination therapy with S-1 plus cisplatin as postoperative adjuvant chemotherapy following complete resection of pathological stage II-IIIA NSCLC. Methods Enrolled patients received oral S-1 at a dose depending on their body weight twice daily for 21 days with intravenous cisplatin 60 mg/m2 on day 8, with 1 cycle comprising 5 weeks and 4 cycles. Patients received standard precautions against adverse events and received standard treatment when adverse events occurred. The primary endpoint was completion rate; secondary endpoints included safety, status of drug administration, disease-free survival (DFS), and overall survival (OS). Results A total of 19 patients [14 men, 5 women; mean age, 59.1 years; mean body surface area, 1.688 m2; 17 with an Eastern Cooperative Oncology Group performance status (PS) of 0 and 2 with a PS of 1; 7 (36.8%) with stage II disease and 12 (63.2%) with stage IIIA disease] were enrolled. The rate of completion of 4 cycles was 68.4%. Grade 3 adverse events that occurred in ≥10% of patients included neutropenia (21.1%), nausea (21.1%), and anorexia (15.8%). No grade 4 adverse events, febrile neutropenia, or treatment-related deaths occurred. The mean relative dose intensity (RDI) was 79% for S-1 and 80% for cisplatin. The 2-year DFS rate was 42.1%, and 2-year OS rate was 83.3%. Conclusions This study demonstrated the acceptability and feasibility of using S-1 plus cisplatin as adjuvant chemotherapy. Trial registration This study was registered on the UMIN clinical study registration site (protocol ID: UMIN000016191) on December 1, 2015.
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Affiliation(s)
- Shugo Uematsu
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Kazutoshi Isobe
- Department of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Kazuhiro Usui
- Division of Respirology, NTT Medical Center, Tokyo, Japan
| | - Jun Matsumoto
- Department of General Thoracic Surgery, NTT Medical Center, Tokyo, Japan
| | - Takaharu Kiribayashi
- Department of Surgery, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
| | - Kiyohaya Obara
- Division of General Thoracic Surgery, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Akihiko Kitami
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yoshitaka Murakami
- Department of Medical Statistics, Toho University School of Medicine, Tokyo, Japan
| | - Akira Iyoda
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan
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3
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Hasegawa T, Suzuki H, Abe J, Sakurada A, Endo C, Sato N, Hasumi T, Deguchi H, Oura H, Takahashi S, Saito H, Uramoto H, Sagawa M, Okada Y. A phase 2 study of adjuvant carboplatin plus S-1 followed by maintenance S-1 therapy for patients with completely resected stage II/IIIA non-small cell lung cancer-Japanese Northern East Area Thoracic Surgery Study Group JNETS1302 study. J Thorac Dis 2020; 12:3591-3601. [PMID: 32802438 PMCID: PMC7399402 DOI: 10.21037/jtd-20-715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The standard adjuvant chemotherapy regimen for completely resected pathological stage II/IIIA non-small cell lung cancer (NSCLC) is four courses of cisplatin plus vinorelbine. However, the continuity and toxicity of cisplatin-based regimens remain problematic. Conversely, carboplatin-based chemotherapy is a less toxic and more tolerable regimen for various stages of NSCLC. In particular, the efficacy and tolerability of carboplatin plus S-1 in advanced NSCLC were confirmed by previous pivotal studies such as the LETS trail. Therefore, this phase II study assessed the feasibility, safety, and usefulness of carboplatin plus S-1 followed by maintenance S-1 as an adjuvant treatment. Methods In this single-arm, multicenter phase II study, 40 patients who previously underwent complete resection of NSCLC were enrolled from November 2013 to January 2015. The chemotherapy protocol was four cycles of carboplatin (AUC 5 on day 1) and oral S-1 (80 mg/m2 every other day from days 1 to 21) followed by oral S-1 (80 mg/m2 every other day for 48 weeks). The primary endpoint was the treatment completion rate, and the secondary endpoints were adverse events and 2-year recurrence-free survival. Results The treatment completion rate of the planned schedule was as low as 30.0% (90% confidence interval: 40.3–63.0%). The reasons for adjuvant chemotherapy discontinuation were adverse events, refusal, tumor recurrence, and other reasons in 13, 6, 10, and 2 patients, respectively. The 2-year progression-free survival rate was 66.7% among patients who completed maintenance chemotherapy. There were no treatment-related deaths, and most adverse events were less than grade 3. Conclusions Carboplatin plus S-1 followed by S-1 maintenance for 1 year in the adjuvant treatment of NSCLC was not tolerable, although most adverse events were not severe. However, patients who can fully complete the regimen might experience clinical benefit.
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Affiliation(s)
- Takeo Hasegawa
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Department of Chest Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Hiroyuki Suzuki
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Department of Chest Surgery, Fukushima Medical University, Hikarigaoka, Fukushima, Japan
| | - Jiro Abe
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Division of Thoracic Surgery, Miyagi Prefectural Cancer Center, Medeshimashiote Nodayama, Natori, Japan
| | - Akira Sakurada
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Department of Thoracic Surgery, Tohoku University, Seiryomachi, Sendai Aoba-ku, Japan
| | - Chiaki Endo
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Department of Thoracic Surgery, Tohoku University, Seiryomachi, Sendai Aoba-ku, Japan
| | - Nobuyuki Sato
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Division of Thoracic Surgery, Aomori Prefectural Central Hospital, Higashitsukurimichi, Aomori, Japan
| | - Tohru Hasumi
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Division of Thoracic Surgery, Sendai Medical Center, Miyagino, Sendai Miyagino-ku, Japan
| | - Hiroyuki Deguchi
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Department of Thoracic Surgery, Iwate Medical University, Uchimaru, Morioka, Japan
| | - Hiroyuki Oura
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Division of Thoracic Surgery, Iwate Prefectural Central Hospital, Ueda, Morioka, Japan
| | - Satomi Takahashi
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Division of Thoracic Surgery, Miyagi Prefectural Cancer Center, Medeshimashiote Nodayama, Natori, Japan
| | - Hajime Saito
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Department of Thoracic Surgery, Iwate Medical University, Uchimaru, Morioka, Japan
| | - Hidetaka Uramoto
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Department of Thoracic Surgery, Kanazawa Medical University, Daigaku, Kahokugun Uchinadamachi, Japan
| | - Motoyasu Sagawa
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Division of Endoscopy, Tohoku Medical and Pharmaceutical University, Komatsushima, Sendai Aoba-ku, Japan
| | - Yoshinori Okada
- Japanese Northern East Area Thoracic Surgery Study Group, Seiryomachi, Sendai Aoba-ku, Japan.,Department of Thoracic Surgery, Tohoku University, Seiryomachi, Sendai Aoba-ku, Japan
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4
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Yang X, Xiang M, Geng L, Wen Y, Du X. Anlotinib Combined with S-1 in the Third-Line Treatment of Stage IV Non-Small Cell Lung Cancer: Study Protocol for Phase II Clinical Trial. Asian Pac J Cancer Prev 2019; 20:3849-3853. [PMID: 31870132 PMCID: PMC7173357 DOI: 10.31557/apjcp.2019.20.12.3849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Indexed: 01/25/2023] Open
Abstract
Background: A proportion of patients with stage IV non-small-cell lung cancer (NSCLC) is predicted to receive third-line treatment. However, currently no standard third-line treatment for NSCLC is available. Anlotinib is an oral, multi-targeted tyrosine kinase (TK) receptor inhibitor, which was approved as a third-line treatment for stage IV NSCLC in China on May 9, 2018. Nevertheless, The objective response rate of patients treated with anlotinib was merely 9.2% and the overall survival was only 3 months compared with the patients treated with placebo. Previous studies have shown that cancer treatment with a combination of chemotherapy with TK receptor inhibitors is effective and safe well tolerated. Therefore, the combination of anlotinib with other chemotherapeutic agents may be an effective treatment strategy for patients with stage IV NSCLC. Oral S-1 is a third-generation fluorouracil derivative; it showed good efficacy and caused relatively low toxicity in patients with NSCLC. Methods: The purpose of this trial is to evaluate the efficacy and safety of anlotinib combined with S-1 as the third-line treatment for patients with stage IV NSCLC. This is a prospective, phase II clinical trial. We will enroll29 patients with stage IV NSCLC treated with anlotinib plus S-1. Tumors will be assessed using computed tomography prior to treatment, after two, four, and six cycles of treatment, and during follow-up every 3 months until disease progression or death. The primary endpoint is the objective response rate (ORR). The secondary endpoints are progression-free survival, duration of response, proportion of disease control, and safety. Discussion: The expected outcome of this study is that anlotinib combined with S-1 has tolerable toxicity and better ORR than anlotinibmonotherapy. The results may indicate additional treatment options for patients with stage IV NSCLC.
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Affiliation(s)
- Xiyue Yang
- Department of Oncology, Mianyang Central Hospital, Mian Yang, China.,Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nan Chong, China
| | - Miao Xiang
- Department of Oncology, Mianyang Central Hospital, Mian Yang, China
| | - Lidan Geng
- Department of Oncology, Mianyang Central Hospital, Mian Yang, China.,Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nan Chong, China
| | - Yixue Wen
- Department of Oncology, Mianyang Central Hospital, Mian Yang, China.,Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nan Chong, China
| | - Xiaobo Du
- Department of Oncology, Mianyang Central Hospital, Mian Yang, China
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5
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Urushiyama H, Jo T, Yasunaga H, Michihata N, Matsui H, Hasegawa W, Takeshima H, Sakamoto Y, Hiraishi Y, Mitani A, Fushimi K, Nagase T, Yamauchi Y. Oral fluorouracil vs vinorelbine plus cisplatin as adjuvant chemotherapy for stage II-IIIA non-small cell lung cancer: Propensity score-matched and instrumental variable analyses. Cancer Med 2018; 7:4863-4869. [PMID: 30151905 PMCID: PMC6198210 DOI: 10.1002/cam4.1725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/12/2018] [Accepted: 07/18/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adjuvant chemotherapy with vinorelbine plus cisplatin (VNR/CDDP) is a standard regimen for treatment of postoperative stage II-IIIA non-small cell lung cancer (NSCLC). However, oral fluorouracil offers a feasible alternative adjuvant chemotherapeutic regimen. We compared the prognoses of patients with NSCLC treated with adjuvant chemotherapy with either VNR/CDDP or oral fluorouracil. METHODS We identified patients with stage II-IIIA NSCLC who underwent lung surgery followed by adjuvant chemotherapy with VNR/CDDP (n = 384) or oral fluorouracil (n = 268) between July 2010 and March 2015, using the national Japanese inpatient and outpatient Diagnosis Procedure Combination database. We compared recurrence-free survival between the groups by multivariable Cox regression analysis for one-to-one propensity score-matched patients and by instrumental variable analysis. RESULTS Younger patients and patients with positive N2 nodes were more likely to receive VNR/CDDP, while older patients and those with T3N0 classification were more likely to receive oral fluorouracil. Among 172 pairs of propensity-matched patients, time to adjuvant chemotherapy was shorter for oral fluorouracil compared with VNR/CDDP. Oral fluorouracil was also significantly associated with improved recurrence-free survival compared with VNR/CDDP, according to multivariable Cox regression analysis (hazard ratio, 0.41; 95% confidence interval, 0.26-0.64). Instrumental variable analysis showed a similar relationship (hazard ratio, 0.19; 95% confidence interval, 0.038-0.92). CONCLUSIONS On a large nationwide cohort, adjuvant chemotherapy with oral fluorouracil prolonged recurrence-free survival in patients with postoperative stage II-IIIA NSCLC, compared with VNR/CDDP. Oral fluorouracil may thus be a useful alternative to VNR/CDDP for the adjuvant treatment of these patients.
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Affiliation(s)
- Hirokazu Urushiyama
- Department of Respiratory MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Taisuke Jo
- Department of Respiratory MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
- Department of Health Services ResearchGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthThe University of TokyoTokyoJapan
| | - Nobuaki Michihata
- Department of Health Services ResearchGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthThe University of TokyoTokyoJapan
| | - Wakae Hasegawa
- Department of Respiratory MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hideyuki Takeshima
- Department of Respiratory MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yukiyo Sakamoto
- Department of Respiratory MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yoshihisa Hiraishi
- Department of Respiratory MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Akihisa Mitani
- Department of Respiratory MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Kiyohide Fushimi
- Department of Health Policy and InformaticsTokyo Medical and Dental University Graduate School of MedicineTokyoJapan
| | - Takahide Nagase
- Department of Respiratory MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yasuhiro Yamauchi
- Department of Respiratory MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
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Tsuboi M, Kondo K, Takizawa H, Kawakita N, Sawada T, Toba H, Kawakami Y, Yoshida M, Ishikura H, Kimura S, Tangoku A. A feasibility study of postoperative adjuvant chemotherapy with fluoropyrimidine S-1 in patients with stage II-IIIA non-small cell lung cancer. THE JOURNAL OF MEDICAL INVESTIGATION 2018; 65:90-95. [PMID: 29593202 DOI: 10.2152/jmi.65.90] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Adjuvant chemotherapy with uracil tegafur (UFT) improved survival among patients with completely resected stage I lung adenocarcinoma. S-1, an oral dihydropyrimidine dehydrogenase (DPD)-inhibitory 5-fluorouracil, is a more potent DPD inhibitor than UFT;therefore, we hypothesized that postoperative adjuvant chemotherapy with S-1 would be effective for advanced non-small cell lung cancer (NSCLC). We conducted a feasibility study of S-1 as postoperative adjuvant chemotherapy in patients with curatively resected pathological stage bold I back 10 bold I and bold I back 10 bold I back 20 bold I A NSCLC. METHODS Adjuvant chemotherapy consisted of 9 courses (4-week administration, 2-week withdrawal) of S-1 at 80-120 mg/body per day. Twenty-four patients with completely resected NSCLC were enrolled in this study from November 2007 through December 2010. The primary endpoint was the rate of completion of the scheduled adjuvant chemotherapy. The secondary endpoints were safety, overall survival, and relapse-free survival. RESULTS Five patients were censored because of disease recurrence. The planned 9 courses of S-1 were administered to completion in 8 patients. Twelve patients completed more than 70% of the planned courses. Grade 3 adverse reactions, such as elevated total bilirubin (4.2%) and pneumonitis (4.2%), were observed, but there were no Grade 4 adverse reactions. Patients who completed more than 70% of the 9 courses demonstrated better overall survival than those who completed less than 70%. CONCLUSION Postoperative administration of S-1 may be possible with few severe adverse events as adjuvant chemotherapy for patients with curatively resected pathological stage bold I back 10 bold I -bold I back 10 bold I back 20 bold I A NSCLC. J. Med. Invest. 65:90-95, February, 2018.
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Affiliation(s)
- Mitsuhiro Tsuboi
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Kazuya Kondo
- Department of Oncological Medical Services, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Naoya Kawakita
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Toru Sawada
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Hiroaki Toba
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Yukikiyo Kawakami
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Mitsuteru Yoshida
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Hisashi Ishikura
- Department of general thoracic surgery, Tokushima Red Cross Hospital
| | - Suguru Kimura
- Department of surgery, East Tokushima Medical Center
| | - Akira Tangoku
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School
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Okamoto T, Yano T, Shimokawa M, Takeo S, Yamazaki K, Sugio K, Takenoyama M, Nagashima A, Tsukamoto S, Hamatake M, Yokoyama H, Ueda H, Motohiro A, Tagawa T, Shoji F, Kometani T, Saito G, Fukuyama Y, Toyokawa G, Osoegawa A, Emi Y, Maehara Y. A phase II randomized trial of adjuvant chemotherapy with S-1 versus S-1 plus cisplatin for completely resected pathological stage II/IIIA non-small cell lung cancer. Lung Cancer 2018; 124:255-259. [PMID: 30268470 DOI: 10.1016/j.lungcan.2018.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 07/03/2018] [Accepted: 08/17/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Platinum-based combination chemotherapy is the standard postoperative adjuvant treatment for pathological stage II/III non-small cell lung cancer (NSCLC). Oral S-1 therapy has good efficacy and relatively low toxicity for the treatment of advanced NSCLC. We investigated whether long-term S-1 monotherapy is also useful as an adjuvant therapy after surgery in patients with NSCLC. PATIENTS AND METHODS We conducted a phase II randomized open-label multi-institutional study in patients with pathological stage II/IIIA NSCLC (7th TNM classification) who underwent complete resection from 2009 to 2013. The primary endpoint, the 2-year disease-free survival (DFS) rate, was evaluated using the Bayesian method. Eligible patients were randomly assigned to two arms: oral S-1 monotherapy (S-1 arm) and S-1 plus cisplatin combination therapy followed by S-1 (S-1 plus cisplatin arm) both for a total of 1 year. RESULTS A total of 70 and 71 patients were enrolled in S-1 arm and S-1 plus cisplatin arm, respectively. The 2-year DFS rates were 52% (95% confidence interval [CI], 0.40-0.63) and 61% (95% CI, 0.48-0.70) for S-1 arm and S-1 plus cisplatin arm, respectively. Both arms met the primary endpoint. Neither DFS nor OS was significantly different between the arms (log-rank test: P = 0.1695 and P = 0.8684, respectively). The main G3/4 adverse events were loss of appetite and anemia (S-1 vs. S-1 plus cisplatin: 4.3% vs. 11.6% and 0% vs. 5.8%, respectively). The treatment completion rate did not differ between the two arms (S-1 vs. S-1 plus cisplatin: 45.7%, 95% CI, 41.9-66.3% vs. 43.5% 95% CI, 44.0-68.4%). CONCLUSIONS Long-term adjuvant chemotherapy with S-1 was a feasible and promising treatment for patients with completely resected NSCLC, regardless of cisplatin addition. S-1 monotherapy should be investigated further, based on its low toxicity and practical convenience.
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Affiliation(s)
- Tatsuro Okamoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan.
| | - Tokujiro Yano
- Department of General Thoracic Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan
| | | | - Sadanori Takeo
- Department of Thoracic Surgery and Clinical Research Institute, National Hospital Organization Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Koji Yamazaki
- Department of Thoracic Surgery and Clinical Research Institute, National Hospital Organization Kyushu Medical Center Hospital, Fukuoka, Japan; Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Kenji Sugio
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan; Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | | | - Akira Nagashima
- Department of Thoracic Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Shuichi Tsukamoto
- Department of Thoracic Surgery, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Motoharu Hamatake
- Department of Thoracic Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan; Department of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Hideki Yokoyama
- Department of Thoracic Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Hitoshi Ueda
- Department of Surgery, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - Akira Motohiro
- Department of Thoracic Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Tetsuzo Tagawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Thoracic Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Fumihiro Shoji
- Department of Thoracic Surgery, Oita Red Cross Hospital, Oita, Japan; Department of Thoracic Surgery, Kyushu Center Hospital, Fukuoka, Japan
| | - Takuro Kometani
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan; Department of Thoracic Surgery, National Hospital Organization Oita Medical Center, Oita, Japan
| | - Genkichi Saito
- Department of Thoracic Surgery, Kyushu Center Hospital, Fukuoka, Japan
| | - Yasuro Fukuyama
- Department of Thoracic Surgery, Nakatsu Municipal Hospital, Nakatsu, Japan
| | - Gouji Toyokawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Osoegawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yasunori Emi
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Okuda K, Tatematsu T, Yano M, Nakamae K, Yamada T, Kasugai T, Nishida T, Sano M, Moriyama S, Haneda H, Kawano O, Sakane T, Oda R, Watanabe T, Nakanishi R. The relationship between the expression of thymidylate synthase, dihydropyrimidine dehydrogenase, orotate phosphoribosyltransferase, excision repair cross-complementation group 1 and class III β-tubulin, and the therapeutic effect of S-1 or carboplatin plus paclitaxel in non-small-cell lung cancer. Mol Clin Oncol 2018; 9:21-29. [PMID: 29977535 PMCID: PMC6031014 DOI: 10.3892/mco.2018.1619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/02/2018] [Indexed: 11/26/2022] Open
Abstract
Previous studies have reported that the expressions of specific proteins may predict the efficacy of chemotherapy agents for non-small cell lung cancer (NSCLC) patients. The present study evaluated the expression of proteins hypothesized to be associated with the effect of chemotherapeutic agents in 38 NSCLC patients with pathological stage II and IIIA. The subjects received carboplatin plus paclitaxel (CP) or S-1 as adjuvant chemotherapy following complete resection. The protein expressions evaluated were those of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD) and orotate phsphoribosyltransferase (OPRT), which were suspected to be associated with the effect of S-1 agents, excision repair cross-complementation group 1 (ERCC1), which was suspected to be associated with the effect of platinum-based agents, and class III β-tubulin (TUBB3), which was suspected to be associated with the effect of taxane-based agents. The positive rate of TS was 55.3% (n=21/38), DPD was 57.9% (n=22/38), OPRT was 42.1% (n=16/38), ERCC1 was 47.4% (n=18/38) and TUBB3 was 44.7% (n=17/38). Among the patients who received S-1 adjuvant chemotherapy, TS-negative cases demonstrated a significantly better disease-free survival than positive cases. Thus, TS protein expression may have been a factor that predicted the effect of S-1 agent as adjuvant chemotherapy.
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Affiliation(s)
- Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Tsutomu Tatematsu
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Motoki Yano
- Department of Surgery, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
| | - Katsumi Nakamae
- Department of Surgery, Nagoya City West Medical Center, Nagoya, Aichi 462-8508, Japan
| | - Takeshi Yamada
- Department of Surgery, Kariya Toyota General Hospital, Kariya, Aichi 448-8505, Japan
| | - Toshio Kasugai
- Department of Surgery, Matsunami General Hospital, Hashima, Gifu 501-6062, Japan
| | - Tsutomu Nishida
- Department of Surgery, Toyokawa City Hospital, Toyokawa, Aichi 442-8561, Japan
| | - Masaaki Sano
- Department of Surgery, Nagoya Memorial Hospital, Nagoya, Aichi 468-8520, Japan
| | - Satoru Moriyama
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Hiroshi Haneda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Osamu Kawano
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Tadashi Sakane
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Risa Oda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Takuya Watanabe
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
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Okuda K, Yano M, Tatematsu T, Nakamae K, Yamada T, Kasugai T, Nishida T, Sano M, Moriyama S, Haneda H, Kawano O, Nakanishi R. S-1 vs. paclitaxel plus carboplatin as adjuvant chemotherapy for completely resected stage II/IIIA non-small-cell lung cancer. Mol Clin Oncol 2018; 8:73-79. [PMID: 29387399 DOI: 10.3892/mco.2017.1481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/24/2017] [Indexed: 01/16/2023] Open
Abstract
The majority of patients with completely resected stage II or IIIA non-small-cell lung cancer (NSCLC) require adjuvant chemotherapy to improve survival following surgery. In the present trial, the 2-year disease-free survival (DFS), and the feasibility and safety of S-1 as an adjuvant chemotherapy for advanced lung cancer were evaluated. A total of 40 patients with completely resected stage II or IIIA NSCLC were enrolled and randomized to receive postoperative chemotherapy with either up to 4 cycles of paclitaxel plus carboplatin (arm A) or with up to 1 year of S-1 (arm B). The primary endpoint was 2-year DFS. The secondary endpoints were feasibility and toxicity. A total of 40 patients were enrolled, but 3 were excluded in accordance with the exclusion criteria. The remaining 37 patients were analyzed. The 2-year DFS rate was 54.2% in arm A and 84.2% in arm B. Overall, 15/18 (83.3%) patients completed 4 cycles of paclitaxel plus carboplatin and 13/19 (68.4%) completed 1-year of S-1adjuvant chemotherapy. Of the 18 (16.7%) patients in arm A, 3 experienced grade 3 or 4 adverse events, while none in arm B experienced such events. Therefore, S-1 chemotherapy for patients with completely resected stage II or IIIA NSCLC was a feasible and safe regimen, and it may therefore be considered as a potential adjuvant chemotherapy option for advanced NSCLC.
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Affiliation(s)
- Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Motoki Yano
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Tsutomu Tatematsu
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Katsumi Nakamae
- Department of Surgery, Nagoya West Medical Center, Nagoya, Aichi 462-8508, Japan
| | - Takeshi Yamada
- Department of Surgery, Kariya Toyota General Hospital, Kariya, Aichi 448-8505, Japan
| | - Toshio Kasugai
- Department of Surgery, Matsunami General Hospital, Hashima, Gifu 501-6062, Japan
| | - Tsutomu Nishida
- Department of Surgery, Toyokawa Hospital, Toyokawa, Aichi 442-8561, Japan
| | - Masaaki Sano
- Department of Surgery, Nagoya Memorial Hospital, Nagoya, Aichi 468-8520, Japan
| | - Satoru Moriyama
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Hiroshi Haneda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Osamu Kawano
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
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Hata Y, Kiribayashi T, Kishi K, Nagashima M, Nakayama T, Ikeda S, Kadokura M, Ozeki Y, Otsuka H, Murakami Y, Takagi K, Iyoda A. Adherence and feasibility of 2 treatment schedules of S-1 as adjuvant chemotherapy for patients with completely resected advanced lung cancer: a multicenter randomized controlled trial. BMC Cancer 2017; 17:581. [PMID: 28851314 PMCID: PMC5575891 DOI: 10.1186/s12885-017-3584-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 08/22/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We conducted a multicenter randomized study of adjuvant S-1 administration schedules for surgically treated pathological stage IB-IIIA non-small cell lung cancer patients. METHODS Patients receiving curative surgical resection were centrally randomized to arm A (4 weeks of oral S-1 and a 2-week rest over 12 months) or arm B (2 weeks of S-1 and a 1-week rest over 12 months). The primary endpoints were completion of the scheduled adjuvant chemotherapy over 12 months, and the secondary endpoints were relative total administration dose, toxicity, and 3-year disease-free survival. RESULTS From April 2005 to January 2012, 80 patients were enrolled, of whom 78 patients were eligible and assessable. The planned S-1 administration over 12 months was accomplished to 28 patients in 38 arm A patients (73.7%) and to 18 patients in 40 arm B patients (45.0%, p = 0.01). The average relative dose intensity was 77.2% for arm A and 58.4% for arm B (p = 0.01). Drug-related grade 3 adverse events were recorded for 11% of arm A and 5% of arm B (p = 0.43). Grade 1-3 elevation of bilirubin, alkaline phosphatase, aspartate aminotransferase, and alanine transaminase were more frequently recorded in arm A than in arm B. The 3-year disease-free survival rate was 79.0% for arm A and 79.3% for arm B (p = 0.94). CONCLUSIONS The superiority of feasibility of the shorter schedule was not recognized in the present study. The conventional schedule showed higher completion rates over 12 months (p = 0.01) and relative dose intensity of S-1 (p = 0.01). Toxicity showed no significant difference among the shorter schedule and the conventional schedule, except for grade 1-3 elevation of bilirubin. TRIAL REGISTRATION This randomized multicenter study was retrospectively registered with the UMIN-CTR (UMIN000016086, registration date December 30, 2014).
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Affiliation(s)
- Yoshinobu Hata
- Division of Chest Surgery (Omori), Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takaharu Kiribayashi
- Division of Chest Surgery (Ohashi), Toho University School of Medicine, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Kazuma Kishi
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Makoto Nagashima
- Division of Chest Surgery (Sakura), Toho University School of Medicine, 564-1 Shimosizu, Sakura, Chiba, 285-8741, Japan
| | - Takefumi Nakayama
- Department of Thoracic and Cardiovascular Surgery, Japan Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan
| | - Shingo Ikeda
- Department of Thoracic Surgery, Mitsui Memorial Hospital, 1 Kandaizumicho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Mitsutaka Kadokura
- Division of Chest Surgery, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Yuichi Ozeki
- Department of Thoracic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Hajime Otsuka
- Division of Chest Surgery (Omori), Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Yoshitaka Murakami
- Department of Medical Statistics, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Keigo Takagi
- Division of Chest Surgery (Omori), Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Akira Iyoda
- Division of Chest Surgery (Omori), Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
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Yamanashi K, Okumura N, Yamamoto Y, Takahashi A, Nakashima T, Matsuoka T, Kameyama K. Adjuvant chemotherapy for elderly patients with non-small-cell lung cancer. Asian Cardiovasc Thorac Ann 2017; 25:371-377. [DOI: 10.1177/0218492317714669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Adjuvant chemotherapy after complete surgical resection is currently the standard of care for patients with stage IB, II, or IIIA non-small-cell lung cancer. However, the generalizability of this treatment to elderly patients is controversial. We investigated the effects of adjuvant chemotherapy in patients aged over 75 years with stage IB-IIIA non-small-cell lung cancer. Methods We retrospectively analyzed 246 consecutive patients aged over 75 years with stage IB-IIIA non-small-cell lung cancer who underwent standard lung cancer surgery between January 2001 and December 2015. They were divided into 102 who had adjuvant chemotherapy and 144 who had none (control group). The outcomes were compared between the two groups, and prognostic factors were evaluated. Results Relapse-free survival and overall survival were significantly shorter in the control group than the chemotherapy group ( p = 0.006 and p = 0.008, respectively). In multivariable analyses, adjuvant chemotherapy was found to be an independent prognostic factor for relapse-free survival and overall survival (hazard ratio = 0.594, 95% confidence interval: 0.396–0.893, p = 0.012; and hazard ratio = 0.616, 95% confidence interval: 0.397–0.957, p = 0.031, respectively). After inverse-probability-of-treatment weighting adjustment using the propensity score for baseline characteristics, chemotherapy almost improved relapse-free survival and overall survival (hazard ratio = 0.652, 95% confidence interval: 0.433–0.981, p = 0.040; and hazard ratio = 0.657, 95% confidence interval: 0.429–1.004, p = 0.052, respectively). Conclusions Adjuvant chemotherapy improved the prognosis after standard lung cancer surgery in patients aged over 75 years with stage IB-IIIA non-small-cell lung cancer.
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Affiliation(s)
- Keiji Yamanashi
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Norihito Okumura
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Yoshiharu Yamamoto
- Department of Clinical Research, Kurashiki Central Hospital, Okayama, Japan
| | - Ayuko Takahashi
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Takashi Nakashima
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Tomoaki Matsuoka
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Kotaro Kameyama
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan
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Soh J, Okumura N, Nakata M, Nakamura H, Fukuda M, Kataoka M, Kajiwara S, Sano Y, Aoe M, Kataoka K, Hotta K, Matsuo K, Toyooka S, Date H. Randomized feasibility study of S-1 for adjuvant chemotherapy in completely resected Stage IA non-small-cell lung cancer: results of the Setouchi Lung Cancer Group Study 0701. Jpn J Clin Oncol 2016; 46:741-7. [PMID: 27207886 PMCID: PMC5025397 DOI: 10.1093/jjco/hyw062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/17/2016] [Indexed: 11/13/2022] Open
Abstract
The feasibility of the S-1 administration schedules (the 4-week versus the 2-week) showed no significant difference for adjuvant chemotherapy among pathological-Stage IA non–small-cell lung cancer patients. Objective The aim of this multicenter study was to determine the appropriate administration schedule for S-1, an oral fluoropyrimidine, for adjuvant chemotherapy in patients with completely resected pathological-Stage IA (tumor diameter, 2–3 cm) non–small-cell lung cancer. Methods Patients were randomly assigned to receive adjuvant chemotherapy consisting of either the 4-week oral administration of S-1 (80–120 mg/body/day) followed by a 2-week rest (Group A), or the 2-week oral administration of S-1 (80–120 mg/body/day) followed by a 1-week rest (Group B). The duration of adjuvant chemotherapy was 1 year in both arms. The primary endpoint was compliance, namely drug discontinuation-free survival, which was calculated using the Kaplan–Meier method with log-rank test. Results Eighty patients were enrolled in this study, and 76 patients actually received S-1 treatment. The drug discontinuation-free survival rates at 1 year were 49.1% in Group A and 52.7% in Group B (P = 0.373). The means of the relative dose intensities were 55.3% in Group A and 64.6% in Group B (P = 0.237). There were no treatment-related deaths. Patients with grade 3/4 toxicities were significantly more frequent in Group A (40.5%) than in Group B (15.4%, P = 0.021). The 2-year relapse-free survival rates were 97.5% in Group A and 92.5% in Group B, and the 2-year overall survival rates were 100% in both groups. Conclusions The feasibility showed no significant difference between the two groups among patients with completely resected Stage IA (tumor diameter, 2–3 cm) non–small-cell lung cancer.
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Affiliation(s)
- Junichi Soh
- Department of Thoracic, Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Norihito Okumura
- Department of Thoracic Surgery, Kurashiki Central Hospital, Kurashiki, Okayama
| | - Masao Nakata
- Department of General Thoracic Surgery, Kawasaki Medical School, Kurashiki, Okayama
| | - Hiroshige Nakamura
- Division of General Thoracic Surgery, Tottori University Hospital, Yonago, Tottori
| | - Minoru Fukuda
- Second Department of Internal Medicine, Nagasaki University Hospital, Nagasaki Clinical Oncology Center, Nagasaki University Hospital, Nagasaki
| | - Masafumi Kataoka
- Department of Surgery, Okayama Saiseikai General Hospital, Okayama
| | | | - Yoshifumi Sano
- Center of Chest Medicine and Surgery, Ehime University, Toon, Ehime
| | - Motoi Aoe
- Department of Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa
| | - Kazuhiko Kataoka
- Department of Thoracic Surgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi
| | - Katsuyuki Hotta
- Department of Hematology, Oncology and Respiratory Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Aichi
| | - Shinichi Toyooka
- Department of Thoracic, Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama Department of Clinical Genomic Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
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Tsuchiya T, Arai J, Matsumoto K, Miyazaki T, Honda S, Tagawa T, Nakamura A, Taniguchi H, Sano I, Akamine S, Muraoka M, Hisano H, Yamasaki N, Nagayasu T. Prognostic Impact of the ABCC11/MRP8 Polymorphism in Adjuvant Oral Chemotherapy with S-1 for Non-Small Cell Lung Cancer. Chemotherapy 2015; 61:77-86. [DOI: 10.1159/000438942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/23/2015] [Indexed: 11/19/2022]
Abstract
Background: Postoperative 1-year administration of S-1, an oral derivative of 5-fluorouracil (5-FU), was shown to be feasible in lung cancer. The 5-year survival rates of postoperative patients treated with S-1 adjuvant chemotherapy and the prognostic impact of clinicopathological factors were examined. Methods: The data of 50 patients with curatively resected pathological stage IB to IIIA non-small cell lung cancer, who were treated with S-1 postoperatively, were analyzed. The prognostic impacts of 22 clinicopathological factors including expressions of the 5-FU pathway enzymes were evaluated. A single-nucleotide polymorphism (SNP), i.e. 538G>A (rs17822931), of ABCC11/MRP8, which encodes a 5-FU excretion enzyme that is known as an earwax type determinant, was also evaluated. Results: The 5-year overall and relapse-free survival rates were 72.5 and 67.5%, respectively. A performance status ≥1, lymphatic vessel invasion, blood vessel invasion, and the A/A type of SNP538, which is responsible for the dry earwax type, were significantly associated with shorter relapse-free survivals. In 34 patients who showed a relative performance of 70% or more for chemotherapy, multivariate survival analysis indicated significant hazard ratios only for the A/A type of SNP538 (p = 0.007). Conclusions: S-1 has sufficient power as adjuvant chemotherapy. However, its effect might be small in the dry earwax type patient group in an adjuvant setting.
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