Meeting
2019 Gastrointestinal Cancers Symposium
Long-term outcome of preoperative docetaxel with cisplatin plus S-1 therapy for advanced gastric cancer with extensive nodal metastasis (JCOG1002).
Authors
Shinji Morita
Division of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
Shinji Morita , Seiji Ito , Takeshi Sano , Daisuke Takahari , Hiroshi Katayama , Junki Mizusawa , Mitsuru Sasako , Yoichi Tanaka , Takahiro Kinoshita , Masanori Terashima , Atsushi Nashimoto , Hiroki Yamaue , Norimasa Fukushima , Makoto Yamada , Yoshiyuki Fujiwara , Yutaka Kimura , Atsuki Ikeda , Tsunehiro Yoshimura
Organizations
Division of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan, Aichi Cancer Center Hospital, Aichi, Japan, Japanese Foundation for Cancer Research Cancer Institute Hospital, Tokyo, Japan, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan, JCOG Data Center/ Operation Office, National Cancer Center, Tokyo, Japan, Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan, Division of Upper Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan, Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan, Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan, Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan, Niigata Cancer Center Hospital, Niigata, Japan, Second Department of Surgery, Wakayama Medical University, Wakayama, Japan, Yamagata Prefectural Central Hospital, Yamagata, Japan, Department of Surgery, Gifu Municipal Hospital, Gifu, Japan, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan, Sakai City Medical Center, Sakai, Japan, Kobe University School of Medicine, Kobe, Japan, Department of Surgery, Tenri Hospital, Tenri, Japan
Research Funding
Other Foundation
Background: Neoadjuvant chemotherapy (NAC) with cisplatin plus S-1 (CS) followed by gastrectomy with D2 plus para-aortic lymph node (PAN) dissection is regarded as a standard treatment in Japan for advanced gastric cancer with bulky lymph node (BN) and/or PAN metastasis based on the results of JCOG0405. In JCOG1002, we added docetaxel to CS (DCS) to further improve the long-term outcome. However the primary endpoint, clinical response rate (RR), did not meet the expected level (Ito S, Gastric Cancer. 2017). Herein we report the long-term survival. Methods: Patients with BN and/or PAN metastasis received two or three cycles of DCS therapy (docetaxel at 40 mg/m2 and cisplatin at 60 mg/m2 on day 1, S-1 at 40 mg/m2 twice daily for 2 weeks, were administered every four weeks) followed by gastrectomy with D2 plus PAN dissection and postoperative S-1 for 1 year. Results: Between July 2011 and May 2013, 53 patients were enrolled. Clinically, 17.0% of patients had both PAN and BN metastasis, and remaining patients had either PAN (26.4%) or BN (56.6%) metastasis. The clinical response rate (RR) was 57.7 % as assessed by RECIST v1.0, and the R0 resection rate was 84.6%, which did not exceed those in JCOG0405 (64.7% and 82.3%, respectively). The pathological RR defined as residual tumor corresponding to less than one-third the size of the original tumor was 34.6% in 52 eligible patients, which was slightly higher than in JCOG0405 (28.6%). Among all eligible patients, 5-year overall survival was 54.9% (95% confidence interval 40.3–67.3%) at the date cut-off of May 2018. Among 44 eligible patients with R0 resection, 5-year progression-free survival was 47.7% (95% confidence interval 32.5–61.5%). These were similar to the results of JCOG0405 (52.8% and 50.0%). Twenty patients developed cancer recurrence. The most frequent site of recurrence was lymph nodes (50.0% of all recurrences). Conclusions: Adding docetaxel to CS in NAC for extensive lymph node metastasis did not improve not only short-term outcomes but also long-term survival. NAC with CS followed by D2 + PAN dissection and postoperative S-1 remains standard for patients with extensive nodal metastasis. Clinical trial information: UMIN000006069.
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Abstract Details
Session Type
Poster Session
Session Title
Poster Session A: Cancers of the Esophagus and Stomach
Track
Cancers of the Esophagus and Stomach
Sub Track
Multidisciplinary Treatment
Clinical Trial Registration Number
UMIN000006069
Citation
J Clin Oncol 37, 2019 (suppl 4; abstr 141)
DOI
10.1200/JCO.2019.37.4_suppl.141
Abstract #
141
Poster Bd #
L13
Abstract Disclosures
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