According to a new study published in the journal Annals of Oncology, S-1, a novel oral dihydropyrimidine dehydrogenase inhibitory fluoropyrimidine, plus oxaliplatin (SOX) is as effective as S-1 plus cisplatin (CS) for the first-line treatment of patients with advanced gastric cancer and is well tolerated.
For the open-label, multicenter phase 3 study, 685 patients with newly diagnosed gastric cancer were randomly assigned to receive S-1 120mg/day for 2 weeks plus oxaliplatin 100mg/m2 on day 1 every 3 weeks or S-1 120mg/day for 3 weeks plus cisplatin 60mg/m2 on day 8 every 5 weeks.
Results showed that in the per-protocol population, the median progression-free survival was 5.5 and 5.4 months for SOX and CS, respectively (HR = 1.004; 95% CI: 0.840 - 1.199). The median overall survival for SOX was 14.1 months compared with 13.1 months for CS (HR = 0.958; 95% CI: 0.803 - 1.142).
In the intention-to-treat population, the hazard ratio for progression-free survival was 0.979 (95% CI: 0.821 - 1.167) and for overall survival was 0.934 (95% CI: 0.786 - 1.108). Patients receiving CS experienced grade 3 or higher neutropenia, anemia, hyponatremia, and febrile neutropenia more often than those receiving SOX, while those in the the SOX arm experienced grade 3 or higher sensorty neuropathy more often.
The findings suggest that SOX is noninferior to CS for patients with advanced gastric cancer, and therefore, SOX can be used in place of CS.
The authors evaluated the efficacy and safety of S-1 plus oxaliplatin (SOX) as an alternative to cisplatin plus S-1 (CS) in first-line chemotherapy for advanced gastric cancer (AGC). SOX is as effective as CS for AGC with favorable safety profile, therefore SOX can replace CS.