title: Irinotecan as the key chemotherapeutic agent in second-line treatment of metastatic gastric cancer after failure of first-line S-1 or S-1/CDDP therapy.
abstract: BACKGROUND
  S-1, an oral fluoropyrimidine, is one of the standard chemotherapeutic agents for the treatment of metastatic gastric cancer(MGC). However, the most effective second-line regimen after failure of treatment with first-line agents such as S-1 is yet to be determined. The aim of this study was to investigate the various second-line chemotherapy regimens in MGC patients.
  
  
  METHODS
  We retrospectively studied patients with MGC who received second-line treatment after failure of the first-line S-1 or S-1/cisplatin treatment. The overall survival times with each second-line regimen were determined using the Kaplan-Meier method, and the effect on overall survival was analyzed using Cox regression analysis.
  
  
  RESULTS
  The median survival time for all patients was 14. 2 months(95% confidence interval(CI): 12. 88-15. 43 months)with a 1-year survival rate of 60. 4%. Kaplan-Meier analysis revealed that the second-line regimens containing irinotecan significantly improved the median survival time as compared to regimens without irinotecan(median survival time: 16. 5 and 13. 8 months, respectively). Cox regression analysis showed that irinotecan-containing regimens were associated with improved overall survival(hazard ratio: 0. 165; 95% CI: 0. 041-0. 665).
  
  
  CONCLUSIONS
  The use of irinotecan-containing regimens as second-line chemotherapy after failure of first-line S-1 therapy may be beneficial for MGC patients.
authors.affiliation: Dept. of Gastroenterology, Kushiro City General Hospital.
authors.forename: Akira
authors.initials: A
authors.lastname: Goto
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Sukawa
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Igarashi
authors.forename: Kei
authors.initials: K
authors.lastname: Onodera
authors.forename: Yuka
authors.initials: Y
authors.lastname: Aoki
authors.forename: Kazuya
authors.initials: K
authors.lastname: Suzuki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yonezawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yawata
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kaneto
authors.forename: Haruo
authors.initials: H
authors.lastname: Shimizu
authors.forename: Hideki
authors.initials: H
authors.lastname: Wakasugi
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Matsunaga
authors.forename: Miki
authors.initials: M
authors.lastname: Itoh
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okuda
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Arimura
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Shinomura
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D004338:Drug Combinations; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D000077146:Irinotecan; D008297:Male; D009362:Neoplasm Metastasis; D010094:Oxonic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D016879:Salvage Therapy; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005641:Tegafur / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000077146:Irinotecan; D002945:Cisplatin; D002166:Camptothecin