Phase I/II trial of chemoradiotherapy with concurrent S‐1 and cisplatin for clinical stage II/III esophageal carcinoma (JCOG 0604)

Cancer Science

Makoto Tahara⁴  Nozomu Fuse⁹  Junki Mizusawa⁵  Akihiro Sato¹  Keiji Nihei⁶  Keisuke Kanato²  Ken Kato¹⁰  Kentaro Yamazaki³  Kei Muro⁷  Hiromasa Takaishi^4,8  Narikazu Boku¹⁰ 

[1] Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan;Japan Clinical Oncology Group Operations Office, National Cancer Center, Tokyo, Japan;Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan;Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan;Japan Clinical Oncology Group Data Center, National Cancer Center, Tokyo, Japan;Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan;Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan;Keio Cancer Center, Keio University Hospital, Tokyo, Japan;Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan;Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan

关键词: Chemoradiotherapy;    cisplatin;    esophageal carcinoma;    S‐1;    stage II/III;   

DOI  :  10.1111/cas.12764

来源: Wiley

【 摘 要 】

Abstract

We carried out a phase I/II trial of chemoradiotherapy concurrent with S-1 and cisplatin to determine the maximum tolerated dose and recommended dose and to evaluate the efficacy and safety of this treatment in patients with esophageal carcinoma. Thoracic esophageal cancer patients with clinical stage II/III disease, excluding T4, were eligible. Chemotherapy consisted of S-1 at a dose of 60–80 mg/m²/day on days 1–14, and cisplatin at 75 mg/m² on day 1, repeated twice every 4 weeks. Single daily radiation of 50.4 Gy was given in 28 fractions concurrently starting on day 1. Patients achieving an objective response after chemoradiotherapy underwent two additional cycles of chemotherapy. Patient accrual was terminated early due to slow enrolment after 44 patients were accrued. In the phase I part, two of six patients experienced dose-limiting toxicities at each level of S-1 (S-1 60 or 80 mg/m²/day). Considering treatment compliance, the recommended dose was determined to be S-1 60 mg/m²/day. The complete response rate, the primary endpoint of phase II, was 59.5% (22/37; 90% confidence interval, 44.6–73.1%; weighted threshold, 57.2%; P = 0.46 by the exact binomial test) on central review. In the phase II part, 3-year progression-free survival was 48.4%, with a 3-year overall survival of 61.9%. Grade 3 or 4 toxicity in phase II included leukopenia (57.9%), neutropenia (50%), hyponatremia (28.9%), anorexia (21.1%), anemia (18.4%), thrombocytopenia (18.4%), and febrile neutropenia (2.6%). No treatment-related deaths were observed. Although this combination showed acceptable toxicity and favorable 3-year survival, the study did not meet its primary endpoint. This trial was registered at the UMIN Clinical Trials Registry as UMIN000000710.

【 授权许可】

CC BY-NC-ND   
© 2015 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Cancer Association.

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