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S-1 is an oral chemotherapy agent that combines a prodrug of fluorouracil with two enzyme inhibitors—one to stop the active drug being degraded and the other to help protect against gastrointestinal toxicity. Japanese oncologists use it to treat advanced gastric cancer, and researchers now report that S-1 prolongs survival after potentially curative surgery.
Their trial included more than 1000 Japanese adults with stage II and III cancers, most of which had spread to local lymph nodes but no further. All participants had extensive surgery that included lymph node dissection, and half of them then had S-1 for up to a year. Around 80% of participants given S-1 survived for three years, compared with 70% of controls (hazard ratio 0.68, 95% CI 0.52 to 0.87). Relapse-free survival was also longer in the S-1 group. Serious side effects were uncommon, but included anorexia (6.0%), nausea (3.7%), and diarrhoea (3.1%). The results were so clear cut that a monitoring committee stopped the trial early.
Japanese doctors are good at diagnosing and treating gastric cancer, and outcomes tend to be better in Japan than anywhere else, says an editorial (p 1863). Even so, this study and trials of other forms of chemotherapy for gastric cancer show that surgery alone is no longer a reasonable treatment option.