Is the addition of cisplatin to S-1 better than S-1 alone for patients with advanced gastroesophageal cancer?
Jaffer A Ajani
Correspondence Department of Gastrointestinal Medical Oncology, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Mail stop 426, Houston, TX 77030, USA
Email jajani@mdnaderson.org
The investigators of the recent phase III SPIRITS trial found that the addition of cisplatin to S-1 (a fourth generation oral fluoropyrimidine) provided a significant overall survival advantage (P = 0.04) over treatment with S-1 alone among previously untreated patients with advanced gastric cancer. In addition, the combination had an acceptable safety profile. This trial establishes a new first-line standard treatment for patients with advanced gastric cancer in Japan. Level 1 evidence for prolonged survival of patients with advanced gastroesophageal cancer has been established for docetaxel (V-325 trial) and cisplatin (SPIRITS trial) but not for S-1. Fluoropyrimidines (S-1 included) have been considered part of standard front-line therapy without the establishment of level 1 evidence for prolonging survival. The future lies in the rapid incorporation of biologic agents in combination with cytotoxics, with a continued focus on safety and convenience, and efforts to individualize therapy for each patient. Individualized therapy may be defined as the selection of optimum treatment for a specific patient on the basis of knowledge of the cancer's genetic and epigenetic alterations and the patient's genotype.
Full text of this article is available with one of the following:
- Personal subscription Purchase your own personal subscription to this journal. Already a subscriber? Please log in for immediate access.
- 7 day single article pass for US$18 In order to purchase this article you must be a registered user. Please register or log in.
- Site licence Learn more about institutional site licences
Current Subscribers
Please log in to access the full text article using the login box at the top of the page.