Three-Weekly S-1 Monotherapy as First-Line Treatment in Elderly Patients with Recurrent or Metastatic Gastric Cancer
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Background/Aims: Elderly patients with advanced gastric cancer (AGC) have generally been excluded from clinical trials, and there are few data available on the treatment of these patients. The efficacy of palliative S-1 monotherapy as a first-line treatment regimen for elderly patients has not been well elucidated. Methods: For this study, 25 AGC patients were enrolled between January 1, 2007 and March 31, 2009; 4 cases were recurrent AGC and 21 cases were metastatic AGC at the time of diagnosis. These patients received S-1 therapy at a dose of 40 mg/m2twice daily for 14 days every 3 weeks. All of the patients were older than 70 years. Results: The median follow-up duration, the median progression-free survival,and the overall survival time were 8.7 months (range, 4.9 to 12.5 months), 4.9 months (range, 3.5to 6.3 months), and 10.8 months (range, 6.6 to 15.0months), respectively. Grade 3/4 nonhematologic toxicities were rare. Grade 3/4 neutropenia was noted in two patients. The partial response rate was 21.7%and stable disease was observed in 34.8% of the patients. Two patients (8%) died due to chemotherapy-associated toxicity during treatment (septic shock/intracranial hemorrhage). Conclusions: Oral S-1chemotherapy seems to be effective as a first-line treatment regimen for elderly patients with metastatic or recurrent AGC. However, elderly patients receiving S-1 treatment should undergo continuous toxicity monitoring,since they are highly susceptible to adverse effects.
Abstract
Background/Aims: Elderly patients with advanced gastric cancer (AGC) have generally been excluded from clinical trials, and there are few data available on the treatment of these patients. The efficacy of palliative S-1 monotherapy as a first-line treatment regimen for elderly patients has not been well elucidated. Methods: For this study, 25 AGC patients were enrolled between January 1, 2007 and March 31, 2009; 4 cases were recurrent AGC and 21 cases were metastatic AGC at the time of diagnosis. These patients received S-1 therapy at a dose of 40 mg/m2twice daily for 14 days every 3 weeks. All of the patients were older than 70 years. Results: The median follow-up duration, the median progression-free survival,and the overall survival time were 8.7 months (range, 4.9 to 12.5 months), 4.9 months (range, 3.5to 6.3 months), and 10.8 months (range, 6.6 to 15.0months), respectively. Grade 3/4 nonhematologic toxicities were rare. Grade 3/4 neutropenia was noted in two patients. The partial response rate was 21.7%and stable disease was observed in 34.8% of the patients. Two patients (8%) died due to chemotherapy-associated toxicity during treatment (septic shock/intracranial hemorrhage). Conclusions: Oral S-1chemotherapy seems to be effective as a first-line treatment regimen for elderly patients with metastatic or recurrent AGC. However, elderly patients receiving S-1 treatment should undergo continuous toxicity monitoring,since they are highly susceptible to adverse effects.
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