Abstract
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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Parkin DM et al. (2005) Global cancer statistics, 2002. CA Cancer J Clin 55: 74–108
van Cutsem E et al. (2006) Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol 24: 4991–4997
Cunningham D et al. (2008) Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 358: 36–46
Koizumi W et al. (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9: 215–221
Sakuramoto S et al. (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357: 1810–1820
Ajani JA (2006) Rapid development of S-1 in the west for therapy of advanced gastric carcinoma. Gan To Kagaku Ryoho 33 (Suppl 1): 117–120
Ajani JA et al. (2006) Multicenter phase II trial of S-1 plus cisplatin in patients with untreated advanced gastric or gastroesophageal junction adenocarcinoma. J Clin Oncol 24: 663–667
Author information
Authors and Affiliations
Ethics declarations
Competing interests
The author has received grant/research support from Ascenta, Bristol-Myers Squibb Oncology, Novartis, Sanofi-Aventis and Taiho Pharma.
Rights and permissions
About this article
Cite this article
Ajani, J. Is the addition of cisplatin to S-1 better than S-1 alone for patients with advanced gastroesophageal cancer?. Nat Rev Clin Oncol 5, 508–509 (2008). https://doi.org/10.1038/ncponc1200
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ncponc1200