Gastric Cancer

, Volume 21, Issue 5, pp 811–818 | Cite as

A phase II trial of capecitabine plus cisplatin (XP) for patients with advanced gastric cancer with early relapse after S-1 adjuvant therapy: XParTS-I trial

  • Kazuhiro NishikawaEmail author
  • Akira Tsuburaya
  • Takaki Yoshikawa
  • Masazumi Takahashi
  • Kazuaki Tanabe
  • Kensei Yamaguchi
  • Shigefumi Yoshino
  • Tsutomu Namikawa
  • Toru Aoyama
  • Yasushi Rino
  • Junji Kawada
  • Akihito Tsuji
  • Koichi Taira
  • Yutaka Kimura
  • Yasuhiro Kodera
  • Yoshinori Hirashima
  • Hiroshi Yabusaki
  • Naoki Hirabayashi
  • Kazumasa Fujitani
  • Yumi Miyashita
  • Satoshi Morita
  • Junichi Sakamoto
Original Article



In Japan, standard regimens for advanced gastric cancer (AGC) include S-1 chemotherapy. The standard treatment for early relapse after adjuvant chemotherapy with fluoropyrimidine alone is platinum-based chemotherapy, while the standard treatment for early relapse after adjuvant chemotherapy with fluoropyrimidine plus platinum is second-line chemotherapy. To evaluate the efficacy and safety of capecitabine plus cisplatin (XP) treatment for AGC patients who relapse within 6 months after S-1-based therapy, we conducted a multicenter phase II trial (NCT01412294).


HER2-negative gastric cancer patients treated with adjuvant chemotherapy including S-1 for more than 12 weeks and relapsed within 6 months were treated with capecitabine 1000 mg/m2 bid for 14 days plus cisplatin 80 mg/m2 on day 1 of a 3-week cycle. The primary endpoint was PFS; secondary endpoints were OS, time to treatment failure, overall response rate (ORR) and safety.


Forty patients (median age 64) were enrolled; of those, 37 (92.5%) received adjuvant S-1 monotherapy. Median PFS was 4.4 months (95% CI 3.6–5.1), which was longer than the 2-month protocol-specified threshold (p < 0.001). Median OS was 13.7 months (95% CI 9.0–17.7) and ORR was 8/30 (26.7%) (95% CI 14.2–44.4). Most common grade ≥ 3 adverse events were neutropenia (23%), anemia (18%), elevated serum creatinine (18%), fatigue (13%), diarrhea (7.5%), and anorexia (7.5%).


XP was safe and effective in patients with early relapse after S-1 adjuvant chemotherapy for curatively resected gastric cancers. XP may be a good option for the treatment of patients after early failure after adjuvant S-1.

Trial registration



Advanced gastric cancer Capecitabine plus cisplatin (XP) S-1 adjuvant therapy Early relapse Fluoropyrimidine switching 



We thank the investigators from the following institutions who enrolled patients for this trial: Osaka General Medical Center, Yokohama Municipal Citizen’s Hospital, Hiroshima University Graduate School of Medicine, Saitama Cancer Center, Yokohama City University, Yamaguchi University Graduate School of Medicine, Kochi Medical School, Kanagawa Cancer Center, Yokohama City University, Kobe City Medical Center General Hospital, Osaka City General Hospital, Sakai Municipal Hospital, Nagoya University Graduate School of Medicine, Oita University Faculty of Medicine, Hiroshima City Asa Hospital, and Niigata Cancer Center Hospital. Furthermore, we deeply appreciate all patients who participated in the trial. We acknowledge Dr Mark Abramovitz of Edanz Medical Writing for editorial support, which was funded by the non-profit organization Epidemiological and Clinical Research Information Network (ECRIN).


This work was supported by the non-profit organization Epidemiological and Clinical Research Information Network (ECRIN).

Compliance with ethical standards

Conflict of interest

The individual conflict of interest disclosure is as follows: K. Nishikawa has received honoraria from Chugai, Taiho, Yakult, Eli Lilly, Tsumura, and EA Pharma, and research funding from Yakult and Taiho, outside the submitted work. T. Yoshikawa has received lecture fees from Chugai, Taiho, Yakult, Eli Lilly and Ono, and for advisory work from Ono and MSD, outside the submitted work. K. Yamaguchi has received personal fees from Chugai, Taiho, Yakult, Takeda, Merck and Eli Lilly, and research funding from MSD, Merck, Bristol, Ono, Dainippon Sumitomo, Taiho, Daiichi-Sankyo and Yakult, outside the submitted work. S. Yoshino has received honoraria from Chugai, Taiho, Ono and Eli Lilly, outside the submitted work. Y. Kodera has received research funding from Chugai, Taiho, Daiichi-Sankyo, Bristol-Myers, Eli Lilly, Otsuka, Takeda, Yakult, CSL Behring, Pfizer, Ono, Kaken, Tsumura, EA Pharma, Novartis, KCI and the Japan Blood Products Organization, outside the submitted work. S. Morita has received honoraria from Chugai and Taiho, outside the submitted work. J. Sakamoto has received consultant fee from Takeda, and Honoraria from Tsumura and Chugai, outside the submitted work. None of the remaining authors have potential conflicts of interest to declare.

Ethical statements

This trial was conducted in compliance with the ethical principles of the Declaration of Helsinki and the Ethical Guidelines for Clinical Studies of the Japanese Ministry of Health, Labour and Welfare. This trial was approved by the institutional review boards or ethics committees at all participating centers. This trial was registered with (NCT01412294).


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Kazuhiro Nishikawa
    • 1
    Email author
  • Akira Tsuburaya
    • 2
  • Takaki Yoshikawa
    • 3
  • Masazumi Takahashi
    • 4
  • Kazuaki Tanabe
    • 5
  • Kensei Yamaguchi
    • 6
  • Shigefumi Yoshino
    • 7
  • Tsutomu Namikawa
    • 8
  • Toru Aoyama
    • 3
  • Yasushi Rino
    • 9
  • Junji Kawada
    • 10
  • Akihito Tsuji
    • 11
  • Koichi Taira
    • 12
  • Yutaka Kimura
    • 13
  • Yasuhiro Kodera
    • 14
  • Yoshinori Hirashima
    • 15
  • Hiroshi Yabusaki
    • 16
  • Naoki Hirabayashi
    • 17
  • Kazumasa Fujitani
    • 10
  • Yumi Miyashita
    • 18
  • Satoshi Morita
    • 19
  • Junichi Sakamoto
    • 20
  1. 1.Department of SurgeryOsaka National HospitalOsakaJapan
  2. 2.Department of SurgeryTsuboi Cancer Center HospitalKoriyamaJapan
  3. 3.Department of Gastrointestinal SurgeryKanagawa Cancer CenterYokohamaJapan
  4. 4.Department of SurgeryYokohama Municipal Citizen’s HospitalYokohamaJapan
  5. 5.Department of Gastroenterological and Transplant SurgeryHiroshima UniversityHiroshimaJapan
  6. 6.Division of GastroenterologySaitama Cancer CenterKita-Adachi-GunJapan
  7. 7.Oncology CenterYamaguchi University HospitalUbeJapan
  8. 8.Department of Surgery IKochi Medical SchoolNankokuJapan
  9. 9.Department of SurgeryYokohama City UniversityYokohamaJapan
  10. 10.Department of SurgeryOsaka General Medical CenterOsakaJapan
  11. 11.Department of Clinical OncologyKobe City Medical Center General HospitalKobeJapan
  12. 12.Department of GastroenterologyOsaka City University Graduate School of MedicineOsakaJapan
  13. 13.Department of Surgery, Faculty of MedicineKindai UniversityOsakasayamaJapan
  14. 14.Department of Gastroenterological SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  15. 15.Department of Medical Oncology and Hematology, Faculty of MedicineOita UniversityOitaJapan
  16. 16.Department of Gastroenterological SurgeryNiigata Cancer Center HospitalNiigataJapan
  17. 17.Department of SurgeryHiroshima City Asa HospitalHiroshimaJapan
  18. 18.Epidemiological and Clinical Research Information Network (ECRIN)OkazakiJapan
  19. 19.Department of Biomedical Statistics and Bioinformatics, Graduate School of MedicineKyoto UniversityKyotoJapan
  20. 20.Tokai Central HospitalKakamigaharaJapan

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