International Journal of Clinical Oncology

, Volume 24, Issue 10, pp 1197–1203 | Cite as

Systemic chemotherapy for gastric cancer with early recurrence after adjuvant S-1 monotherapy: a multicenter retrospective study

  • Seiichiro Mitani
  • Shigenori KadowakiEmail author
  • Hiroko Hasegawa
  • Takeru Wakatsuki
  • Hiroki Hara
  • Masahiro Tajika
  • Kazuhiro Nishikawa
  • Motohiro Hirao
  • Daisuke Takahari
  • Keisho Chin
  • Kei Muro
Original Article



S-1 monotherapy is one of the standard adjuvant treatments for patients with stage II and III gastric cancers. Early recurrence after S-1 adjuvant therapy has a poor prognosis. This study aimed to clarify the treatment outcomes of systemic chemotherapy and explore encouraging regimens.


This was a multicenter retrospective study. Among gastric cancer patients who underwent curative gastrectomy followed by adjuvant S-1 monotherapy, patients who experienced a recurrence while receiving adjuvant therapy or within 6 months after completion and started systemic chemotherapy at four institutions between 2005 and 2015 were eligible.


A total of 112 patients were included. The main treatment regimens were weekly paclitaxel (n = 38, 34%), irinotecan plus cisplatin (n = 31, 28%), capecitabine plus cisplatin (n = 7, 6%), and irinotecan monotherapy (n = 6, 5%). For all patients, median progression-free survival and overall survival were 3.7 and 11.4 months, respectively. Among 77 patients with measurable lesions, the overall response and disease control rates were 24.7% and 62.3%, respectively. Multivariate analyses for overall survival showed that Eastern Cooperative Oncology Group performance status 2 [hazard ratio (HR) 3.71; 95% confidence interval (CI) 1.78–7.73] and undifferentiated histological type (HR 2.04; 95% CI 1.35–3.44) were independent prognostic factors, and treatment regimens were not prognostic. Exploratory comparisons did not show statistically significant differences between treatment regimens.


This study of the largest number of patients with early recurrence after S-1 adjuvant monotherapy demonstrated that the prognosis for patients treated by all regimens was similar and poor.


Gastric cancer Adjuvant chemotherapy Recurrence 



The authors would like to thank Enago ( for the English language review.


This study was conducted with no funding.

Compliance with ethical standards

Conflict of interest

Seiichiro Mitani has received honoraria from Eli Lilly. Shigenori Kadowaki has received honoraria from Eli Lilly, Bayer, Bristol-Myers, Chugai, Ono, and Yakult, and research funding from Eli Lilly, Boehringer Ingelheim, Bristol-Myers, Ono, and Taiho. Hiroki Hara has received honoraria from Chugai, Taiho, Merck Serono, Yakult, Eli Lilly, Ono, Takeda, Bristol-Myers, and research funding from AstraZeneca, Chugai, Merck Serono, MSD, Ono, Taiho, Takeda, Boehringer Ingelheim, Dainippon Sumitomo, Daiichi Sankyo, Eli Lilly, Pfizer, LSK BioPharma, Eisai, and Incyte. Kazuhiro Nishikawa has received honoraria from Chugai, Taiho, Yakult, Eli Lilly, Tsumura, and EA Pharma, and research funding from Yakult and Taiho. Kei Muro has received honoraria from Eli Lilly, Chugai, Merck Serono, Ono, Taiho, Takeda, and Yakult, and research funding from Daiichi Sankyo, Gilead Sciences, Kyowa Hakko Kirin, MSD, Ono, and Shionogi. None of the remaining authors have potential conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  • Seiichiro Mitani
    • 1
  • Shigenori Kadowaki
    • 1
    Email author
  • Hiroko Hasegawa
    • 2
  • Takeru Wakatsuki
    • 3
  • Hiroki Hara
    • 4
  • Masahiro Tajika
    • 5
  • Kazuhiro Nishikawa
    • 6
  • Motohiro Hirao
    • 6
  • Daisuke Takahari
    • 3
  • Keisho Chin
    • 3
  • Kei Muro
    • 1
  1. 1.Department of Clinical OncologyAichi Cancer Center HospitalNagoyaJapan
  2. 2.Department of GastroenterologyOsaka National HospitalOsakaJapan
  3. 3.Department of Gastroenterology, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
  4. 4.Department of GastroenterologySaitama Cancer CenterSaitamaJapan
  5. 5.Department of EndoscopyAichi Cancer Center HospitalNagoyaJapan
  6. 6.Department of SurgeryOsaka National HospitalOsakaJapan

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