s-1-(combination) and Pain

S-1 is a fourth-generation oral fluoropyrimidine that was developed to mimic the effects achieved with protracted continuous infusion of 5-fluorouracil (5-FU). This phase II study evaluated the efficacy and safety of S-1 salvage chemotherapy in patients with paclitaxel- and cisplatin-refractory gastric cancer. The primary end point was progression-free survival; secondary end points were overall survival, safety, and clinical benefit.. Patients were eligible for the study if they had histologically documented gastric adenocarcinoma previously treated with paclitaxel and cisplatin, age > or = 18 years, Eastern Clinical Oncology Group performance status < or =2, adequate organ function, and no evidence of gastrointestinal obstruction or passage disturbance. Patients were treated with a dose of S-1 based on body surface area (BSA) as follows: BSA < 1.25 m(2), 80 mg/day; 1.25 < or = BSA < 1.5 m(2), 100 mg/day; BSA > or= 1.5 m(2), 120 mg/day. The total dose was divided in two and administered twice daily for 4 weeks followed by a 2-week rest period.. Of the 53 patients enrolled in this study, 49 were evaluable. A total of 190 chemotherapy cycles were administered, and the median number of cycles was 2. Five patients (9.4%) had a partial response, and 18 (34%) had stable disease. Median progression-free survival and overall survival were 4.9 and 10.4 months, respectively. Grade 3/4 hematological toxicities included neutropenia in six patients (11%) but no cases of febrile neutropenia were found. Most of the non-hematological toxicities were diarrhea, asthenia, and mucositis, but none reached grade 3 or grade 4 in severity. Improvement of pain was observed in 17 patients (32.1%).. S-1 monotherapy provides active and safe salvage chemotherapy for patients with advanced gastric cancer who have been previously treated with paclitaxel and cisplatin.

Topics: Adenocarcinoma; Adult; Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Agents, Phytogenic; Cisplatin; Disease-Free Survival; Drug Combinations; Female; Fever; Humans; Male; Middle Aged; Neutropenia; Oxonic Acid; Paclitaxel; Pain; Salvage Therapy; Severity of Illness Index; Stomach Neoplasms; Survival Rate; Tegafur; Treatment Outcome

A 59-year-old man had received chemotherapy with gemcitabine for nonresectable pancreatic cancer. After 14 months, he was hospitalized for obstructive jaundice and severe pain. Cholangioduodenostomy was performed, and the dose of opioids was increased. Although jaundice improved, the uncontrollable pain persisted. Chemotherapy with S-1 was initiated, and a dramatic improvement in the pain was observed. Consequently, the patient could be discharged from the hospital.

Topics: Analgesics, Opioid; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Endoscopy, Gastrointestinal; Humans; Male; Middle Aged; Oxonic Acid; Pain; Pancreatic Neoplasms; Tegafur; Tomography, X-Ray Computed; Ultrasonography