Togawa Akira, Yoshitomi Hideyuki, Ito Hiroshi, Kimura Fumio, Shimizu Hiroaki, Ohtsuka Masayuki, Yoshidome Hiroyuki, Kato Atsushi, Sawada Shigeaki, Miyazaki Masaru
Department of General Surgery, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba, 260-0856, Japan.
Int J Clin Oncol. 2007 Aug;12(4):268-73. doi: 10.1007/s10147-007-0674-x. Epub 2007 Aug 20.
This study set out to evaluate, in patients with gemcitabine-resistant pancreatic cancer, the response rate and toxicity of S-1 plus cisplatin (CDDP).
Seventeen patients with histologically diagnosed invasive ductal pancreatic cancer were enrolled in this study. All patients had growing recurrent pancreas cancer despite the administration of gemcitabine. Thirteen patients underwent pancreatectomy, and 2 underwent choledochojejunostomy and gastrojejunostomy without pancreatectomy. S-1 (80 mg/m(2) per day) was orally administered for 21 consecutive days, followed by a 14-day rest period. CDDP (40 mg/m(2)) in 500 ml saline was administered by intravenous drip on day 8. This schedule was repeated every 5 weeks until the occurrence of disease progression, unacceptable toxicities, or the patient's refusal to continue.
Five (29.4%) patients achieved a partial response and 2 (11.8%) had stable disease. In 5 of 15 patients (33.3%) who had elevated serum carbohydrate antigen (CA)19-9 levels at the start of treatment the CA19-9 was reduced by more than 50%. The median survival time was 10 months (range, 20 months), with 63.7% and 31.9% of patients alive at 6 and 12 months, respectively. Major adverse reactions in the 15 patients included gastrointestinal toxicities of grade 1 or 2. Only one patient (5.9%) developed grade 3 leucopenia.
S-1 with CDDP has a promising effect against gemcitabine-resistant pancreatic cancer, with easily manageable toxicities. Further investigation of this regimen is warranted in patients with pancreatic cancer, especially in comparison with gemcitabine.
本研究旨在评估吉西他滨耐药的胰腺癌患者中，S-1联合顺铂（CDDP）的缓解率和毒性。
17例经组织学诊断为浸润性导管腺癌的患者纳入本研究。所有患者尽管接受了吉西他滨治疗，但复发性胰腺癌仍在进展。13例患者接受了胰腺切除术，2例未行胰腺切除术，接受了胆总管空肠吻合术和胃空肠吻合术。S-1（每日80mg/m²）连续口服21天，随后休息14天。第8天，将40mg/m²的CDDP加入500ml生理盐水中静脉滴注。每5周重复此方案，直至疾病进展、出现不可接受的毒性或患者拒绝继续治疗。
5例（29.4%）患者获得部分缓解，2例（11.8%）病情稳定。在治疗开始时血清糖类抗原（CA）19-9水平升高的15例患者中，5例（33.3%）的CA19-9降低了50%以上。中位生存时间为10个月（范围为20个月），6个月和12个月时分别有63.7%和31.9%的患者存活。15例患者的主要不良反应包括1级或2级胃肠道毒性。仅1例患者（5.9%）出现3级白细胞减少。
S-1联合CDDP对吉西他滨耐药的胰腺癌有显著疗效，且毒性易于控制。有必要对该方案在胰腺癌患者中进行进一步研究，尤其是与吉西他滨进行比较。
