Treating Advanced Gastric Cancer Patients: Should the Alternative Formulation S-1 Replace 5-Fluorouracil?

In the U.S., the combination of 5-fluorouracil (5-FU) plus cisplatin is considered conventional treatment for patients with advanced gastric cancers, but outcomes typically are poor. Adding docetaxel or epirubicin to the two-drug standard regimen offers little advantage. Other approaches replace intravenous 5-FU with related oral drugs; for example, capecitabine is noninferior to infusional 5-FU (JW Oncol Hematol Jan 22 2008).

S-1 is another oral formulation of 5-FU that combines the 5-FU prodrug tegafur with gimeracil (an agent that inhibits 5-FU degradation) and oteracil (a bowel protectant). S-1 is approved in several Asian countries for treatment of patients with advanced gastric adenocarcinomas. In Japanese studies, evidence suggests th…