The Outcome of Treatment for Patients with Borrmann Type 4 Advanced Gastric Cancer

Introduction: The survival rate of patients with Borrmann type 4 advanced gastric cancer is extremely poor in comparison to patients with gastric cancers of other histological types. An optimal chemotherapeutic regimen has yet to be determined. Patients and Methods: We retrospectively examined the outcome of patients who were treated for Borrmann type 4 advanced gastric cancer from July 2011 and June 2015. Results: The data from 42 cases were collected for this study. Of the 42 cases, 13 cases (31.0%) were locally advanced and 29 cases (69.0%) were metastatic advanced. Median Overall Survival (OS) for locally advanced cancer was 29.6 months and for metastatic advanced cancer was 11.5 months. The presence or absence of peritoneal metastases did not affect survival (8.9 and 11.5 months, respectively;p = 0.831). In the 23 patients who received chemotherapy, S-1 plus cisplatin was prescribed as first-line treatment in 16 cases (69.5%). Other treatment regimens included capecitabine plus cisplatin and S-1 plus oxaliplatinin one each (4.3%), S-1 monotherapy in two (8.6%), and capecitabine monotherapy, paclitaxel, and docetaxel in one each (4.3%). We found no median OS difference between S-1 plus cisplatin and other treatments (20.7 and 19.3 months;p = 0.094). Conclusion: We found that S-1 plus cisplatin treatment does not improve OS in patients with Borrmann type 4 advanced gastric cancer compared with other chemotherapeutic regimens.

Considering FOLFOXIRI plus bevacizumab for metastatic colorectal cancer with left-sided tumors

A recent subgroup analysis of the TRIBE trial suggested that FOLFOXIRI plus bevacizumab may be a preferred option for the first-line treatment of only right-sided metastatic colorectal cancer(mCRC), regardless of RAS or BRAF status. Our subanalysis of a phase Ⅱ trial of the FOLFOXIRI triplet regimen plus bevacizumab in patients with mCRC who had RAS mutant tumors showed that tumor shrinkage was better and the duration of treatment was longer in patients with leftsided tumors than in those with right-sided tumors, leading to a higher rate of conversion to surgery in mCRC patients with left-sided tumors. The early and deep responses to the triplet-regimen in patients with left-sided tumors might facilitate conversion treatment resulting in favorable survival. Our data suggest that the FOLFOXIRI plus bevacizumab might be a promising treatment for left-sided mCRC involving RAS mutant tumors.

Feasibility of Outpatient Chemotherapy with S-1 and Cisplatin for Gastric Cancer

Objective: To evaluate the feasibility of S-1 and high-dose cisplatin short hydration regimens for outpatients with unresectable metastatic gastric cancer. Methods: Data for individual outpatients treated in our institution were retrospectively pooled to assess the feasibility of an S-1 and highdose cisplatin short hydration regimen (S-1: 80 to 120 mg on Days 1 to 21;cisplatin: 60 mg/m2?on Day 8, every 5 weeks), which included 2250 ml of intravenous fluids and 1000 ml oral hydration. Ten consecutive patients were treated with S-1 and high-dose cisplatin short hydration for unresectable metastatic gastric cancer from July 2011 to May 2012 and were included in the analysis. Results: With a median of 3.5 medication cycles, unscheduled admission occurred in two patients for 5 days each due to paralytic ileus and cerebral infarction. Four patients required dose reduction, in both S-1 and cisplatin in two patients, and in S-1 alone and cisplatin alone in one patient each. Renal function transiently declined after administration of cisplatin, but serum creatinine level and estimated glomerular filtration rate were both improved by the time of the next administration. Conclusion: This study suggests that an S-1 and high-dose cisplatin short hydration strategy for outpatients with unresectable metastatic gastric cancer might be feasible.

Short Hydration in Chemotherapy with Cisplatin plus S-1 for Advanced or Recurrent Gastric Cancer: A Retrospective Study

Background: Despite there are a few reports that assessed the S-1 + CDDP regimen with short hydration regimen for unresectable or metastatic gastric cancer, there is no consensus on the best regimen for short hydration. The aim of study was to evaluate the safety and the efficacy of S-1 plus cisplatin doublet chemotherapy with short hydration. Methods: S-1 was administered orally (p.o.) twice daily for the first 3 weeks of a 5-week cycle. Dose of S-1 administered was calculated according to the body surface area. CDDP was given as an intravenous (i.v.) infusion of 60 mg/m2 on day 8 of each cycle. Patients received the total of 1900 ml infusion containing 1000 ml of acetate Ringer’s solution as pre- and post-hydraion. 300 ml of 20% mannitol was administered as a diuretic. Results: 35 patients with unresectable or recurrent gastric cancer were enrolled. The reasons for termination of S-1 + CDDP were as follows: 21 (63.6%) by progressive disease;12 (31.4%) by toxicity. Even though 12 of 35 patients (34.2%) were discontinued S-1 + CDDP chemotherapy, only one patient was discontinued by Grade 2 of increased creatinine. TTF (time to progression) was 174 days (3 - 586 days), and the median of the total number of treatment cycles of S-1 + CDDP was 3.31. Median overall survival, as secondary endpoint, was 518 days. Conclusions: Our study suggested that the short hydration regimen is as safe and efficient as the continuous hydration regimen.