Yagi Shusuke, Yamada Kazuhiko, Terayama Masayoshi, Wake Hitomi, Enomoto Naoki, Nohara Kyoko, Takemura Nobuyuki, Kiyomatsu Tomomichi, Kokudo Norihiro
Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
Glob Health Med. 2021 Feb 28;3(1):31-36. doi: 10.35772/ghm.2020.01075.
The most common treatment for advanced gastric cancer (AGC) is systemic chemotherapy. The standard treatment for advanced gastric cancer differs worldwide. In Japan, two phase III clinical trials demonstrated the non-inferiority of S-1 compared with 5-fluorouracil (5-FU) and superiority of cisplatin plus S-1 (CS), compared with S-1, with respect to overall survival (SPIRITS trial). Oxaliplatin (L-OHP) has a favorable toxicity profile compared with cisplatin; hence, a phase III clinical trial (G-SOX trial) demonstrated the progression-free survival (PFS) and overall survival in CS was 5.4 and 13.1 months and those in SOX was 5.5 and 14.1 months, respectively. Serious adverse events were more frequently seen in CS than in SOX. So, SOX is as effective as CS for advanced gastric cancer with favorable safety profile. After the publication of this G-SOX trial, the combination of oral or intravenous 5-FU and various doses of L-OHP have been reported. And FOLFOX6 regimen (FOLFOX: a combination of 1-LV and FU with L-OHP) was approved for the treatment of AGC in Japan in 2017. FOLFOX was promising for patients with severe peritoneal metastasis from AGC, because the FOLFOX regimen does not require hydration and does not include oral agents. This review summarizes the efficacy and safety of doublet combinations of platinum and fluoropyrimidines using L-OHP for advanced gastric cancer.
晚期胃癌（AGC）最常见的治疗方法是全身化疗。晚期胃癌的标准治疗方法在全球范围内有所不同。在日本，两项III期临床试验表明，S-1与5-氟尿嘧啶（5-FU）相比具有非劣效性，顺铂加S-1（CS）与S-1相比在总生存期方面具有优越性（SPIRITS试验）。与顺铂相比，奥沙利铂（L-OHP）具有良好的毒性特征；因此，一项III期临床试验（G-SOX试验）表明，CS组的无进展生存期（PFS）和总生存期分别为5.4个月和13.1个月，SOX组分别为5.5个月和14.1个月。CS组比SOX组更频繁地出现严重不良事件。所以，SOX对于晚期胃癌的疗效与CS相当，且安全性良好。在这项G-SOX试验发表后，已经报道了口服或静脉注射5-FU与不同剂量L-OHP的联合应用。FOLFOX6方案（FOLFOX：1-LV和FU与L-OHP的联合）于2017年在日本被批准用于治疗AGC。FOLFOX对于AGC伴有严重腹膜转移的患者很有前景，因为FOLFOX方案不需要水化且不包括口服药物。本综述总结了使用L-OHP的铂类和氟嘧啶双联组合治疗晚期胃癌的疗效和安全性。
