Outcomes of preoperative S-1 and docetaxel combination chemotherapy in patients with locally advanced gastric cancer

PurposeThe therapeutic outcomes of stage III gastric cancer patient receiving D2 gastrectomy and adjuvant chemotherapy remain unsatisfactory. To improve the long-term outcomes in this population, the combination of docetaxel and S-1 (DS) therapy can be expected to be a useful regimen as neoadjuvant chemotherapy (NAC). This study aimed to prospectively evaluate the efficacy of NAC-DS for clinical stage III gastric cancer.MethodsBetween January 2010 and December 2013, 26 patients were enrolled. Patients with clinical stage III gastric cancer received two courses of docetaxel 40mg/m(2) on day 1, 15 and S-1 40mg/m(2) bid orally on day 1-7, 15-21 every 4 weeks, followed by radical D2 gastrectomy. Short- and long-term outcomes were evaluated. This study was approved by the ethics committee of Yokohama City University, and was registered in the University Hospital Medical Information Network (UMIN) database (ID: 000011521).ResultsOf 26 patients, 24 (92.3%) patients completed two courses of NAC. After NAC-DS, Grade 3 neutropenia was observed in 5 (19.2%) patients including one patient with febrile neutropenia, anemia in 1 (3.8%) patient and diarrhea in 1 (3.8%) patient. All patients underwent R0 gastrectomy and pathological response was found in 15 (57.6%) patients. Postoperatively, Clavien-Dindo grade II complication occurred in 8 (30.7%) patients and no mortality was observed. The 5-year overall survival (OS) was 57.7%, median OS was 78.7months and recurrence free survival (RFS) was 49.0%, median RFS was 45.4months with 66.5months median follow-up. Pathological response (HR=0.091, 95% CI 0.011-0.730, p=0.016) and >5% body weight loss before NAC-DS (HR=0.133, 95% CI 0.023-0.765, p=0.024) were independent risk factors for recurrence, >5% body weight loss before NAC-DS (HR=0.133, 95% CI 0.023-0.765, p=0.024) were independent risk factors for overall survival by multivariate analysis.ConclusionsNAC-DS demonstrated acceptable toxicity with a high R0 resection rate in clinical stage III gastric cancer patients, especially in patients with good nutritional status. Further prospective study is warranted to compare the long-term outcomes between with and without NAC-DS.