S-1-Induced, Prolonged Complete Regression of Lung Metastasis from Gastric Cancer Refractory to 5′-DFUR: a Case Report with Pharmacokinetic Study

• Published in: Japanese journal of clinical oncology 2004-05, Vol.34 (5), p.282-286
• Main Authors: Ueda, Yuji, Yamagishi, Hisakazu, Yamashita, Tetsuro, Itoh, Norio, Itoi, Hirosumi, Shirasaka, Tetsuhiko, Ajani, Jaffer A.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma, Mucinous - drug therapy; Adenocarcinoma, Mucinous - secondary; Adenocarcinoma, Mucinous - surgery; Administration, Oral; Antimetabolites, Antineoplastic - pharmacokinetics; Antimetabolites, Antineoplastic - therapeutic use; Chemotherapy, Adjuvant; Drug Administration Schedule; Drug Combinations; Esophagectomy; Female; Floxuridine - administration & dosage; Fluorouracil - blood; Gastrectomy; Humans; Key words: gastric cancer – S-1 – lung metastasis – complete response – pharmacokinetic study; Lung Neoplasms - drug therapy; Lung Neoplasms - metabolism; Lung Neoplasms - secondary; Middle Aged; Oxonic Acid - pharmacokinetics; Oxonic Acid - therapeutic use; Pyridines - pharmacokinetics; Pyridines - therapeutic use; Radiography, Thoracic; Remission Induction; Stomach Neoplasms - drug therapy; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Tegafur - pharmacokinetics; Tegafur - therapeutic use; Tomography, X-Ray Computed
• ISSN: 0368-2811; 1465-3621; 1465-3621
• DOI: 10.1093/jjco/hyh044

S-1 is an oral fluoropyrimidine reported to be most active for gastric cancer. However, few studies have documented a complete response (CR) of lung metastasis to S-1 treatment. We describe a 66-year-old woman in whom S-1 induced complete regression of lung metastasis from gastric cancer, that had been refractory to another oral fluoropyrimidine, 5′-deoxy-5-fluorouridine (5′-DFUR). After preoperative chemotherapy with a combination of etoposide, adriamycin and cisplatin and with methotrexate plus 5-fluorouracil, the patient underwent a total gastrectomy with lower esophagectomy for advanced diffuse-type gastric cancer with invasion of the esophagus in May 1993. She received postoperative adjuvant chemotherapy with 5′-DFUR (600 mg/day) for 3 years. However, a solitary metastasis to the left lung was detected in November 1996 and she underwent partial resection of the left lung. Chemotherapy with 5′-DFUR was reinitiated after operation, but re-metastasis to the left lung with elevation of the serum carcinoembryonic antigen (CEA) level was diagnosed in June 1999. Treatment with S-1 was started in August. S-1 was given orally in a dose of 100 mg/day for 28 consecutive days, followed by a 14-day recovery; treatment was repeated every 6 weeks. The metastatic lesion in the left lung completely regressed after two courses of S-1 and the serum CEA level returned to the normal range. The patient received a total of 10 courses of S-1. The dose of S-1 was reduced to 80 mg/day from the sixth course because of grade 2 skin rash. Pharmacokinetic studies after administration of S-1 revealed high and prolonged plasma 5-FU levels. Nearly 4 years have passed since complete regression of the lung metastasis. This may be the first report to document a prolonged complete response of lung metastasis from gastric cancer induced by single-agent chemotherapy with S-1.