title: Second-line chemotherapy with irinotecan plus cisplatin after the failure of S-1 monotherapy for advanced gastric cancer.
abstract: BACKGROUND
  For advanced gastric cancer (AGC), second-line chemotherapy after the failure of S-1 has not yet been established. The present study aimed to retrospectively evaluate the efficacy and safety of irinotecan plus cisplatin (IP) therapy after the failure of S-1 in patients with AGC.
  
  
  METHODS
  The subjects included 87 patients with AGC who received IP therapy as second-line chemotherapy. Irinotecan (70 mg/m(2)) was administered by intravenous infusion followed by an intravenous infusion of cisplatin (80 mg/m(2)) on day 1. On day 15, irinotecan (70 mg/m(2)) alone was administered. The treatment was repeated every 4 weeks until disease progression, patient refusal, or severe adverse events.
  
  
  RESULTS
  The median patient age was 62 years (range, 39-75 years), and the median number of treatment cycles was 3 (range, 1-9). Out of the 87 patients, 70 were assessable for clinical response. There were 2 complete responses and 18 partial responses. The overall response rate was 28.6% (95% confidence interval [CI], 18.4%-40.6%) and the disease control ratio was 70.0%. The median time to progression and median survival time from the first day of IP therapy were 4.3 months and 9.4 months, respectively. The 1-year survival rate was 34.6%. Severe (grade 3/4) leukopenia, neutropenia, anemia, and thrombocytopenia were observed in 34%, 40%, 28%, and 8% of patients, respectively. Grade 3/4 nonhematologic toxicities included anorexia (17%), febrile neutropenia (10%), diarrhea (6%), fatigue (5%), nausea (2%), and elevated creatinine (1%).
  
  
  CONCLUSIONS
  The combination of irinotecan plus cisplatin as second-line chemotherapy for AGC appears to be an effective and feasible treatment option after S-1 failure.
authors.affiliation: Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takahari
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimada
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Takeshita
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nishitani
authors.forename: Atsuo
authors.initials: A
authors.lastname: Takashima
authors.forename: Natsuko
authors.initials: N
authors.lastname: Okita
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hirashima
authors.forename: Ken
authors.initials: K
authors.lastname: Kato
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hamaguchi
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Yamada
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Shirao
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use*; D016001:Confidence Intervals; D018450:Disease Progression; D004338:Drug Combinations; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007262:Infusions, Intravenous; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D010094:Oxonic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy*; D005641:Tegafur / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000077146:Irinotecan; D002945:Cisplatin; D002166:Camptothecin
references.citation: Gastric Cancer. 2006;9(3):203-7
references.pmid: 16952039
references.citation: N Engl J Med. 2007 Nov 1;357(18):1810-20
references.pmid: 17978289
references.citation: Gan To Kagaku Ryoho. 1994 Jun;21(7):1033-8
references.pmid: 8210254
references.citation: Jpn J Clin Oncol. 2007 Dec;37(12):936-41
references.pmid: 18211985
references.citation: Am J Clin Oncol. 2005 Dec;28(6):581-5
references.pmid: 16317268
references.citation: Anticancer Res. 2005 Mar-Apr;25(2B):1257-62
references.pmid: 15865075
references.citation: Lancet Oncol. 2009 Nov;10(11):1063-9
references.pmid: 19818685
references.citation: J Clin Oncol. 1999 Jan;17(1):319-23
references.pmid: 10458249
references.citation: Oncology (Williston Park). 2002 May;16(5 Suppl 5):16-8
references.pmid: 12109800
references.citation: Lancet Oncol. 2008 Mar;9(3):215-21
references.pmid: 18282805
references.citation: Gastric Cancer. 2006;9(1):14-8
references.pmid: 16557431