Abstract
ObjectiveStudies have rarely explored the efficacy of S‐1 in treating advanced pancreatic cancer outside Japan. This study compared the survival outcomes of patients with advanced pancreatic cancer treated with S‐1 with the survival outcomes of those without S‐1 treatment before and after S‐1 reimbursement was introduced in Taiwan in June of 2014.MethodWe retrospectively analyzed 838 patients with locally advanced or metastatic pancreatic cancer who underwent palliative chemotherapy from 2010 to 2016 at 4 institutes in Taiwan. For survival analysis, patients were categorized into two groups according to whether they received S‐1 treatment as palliative chemotherapy after diagnosis: (a) S‐1‐treated (n = 335) and (b) non‐S‐1‐treated (n = 503) groups.ResultsThe median overall survival was longer in the S‐1‐treated group than in the non‐S‐1‐treated group (10.7 vs 6.0 mo, P < 0.001). Subgroup survival analyses showed that the S‐1‐treated group had more favorable outcomes than the non‐S‐1‐treated group in terms of stage III (19.6 vs 10.1 mo, P < 0.001) and stage IV (8.5 vs 5.3 mo, P < 0.001) disease. The disease control rates were 43.6% and 32.8% (P < 0.001) in patients treated with and without S‐1 in the first‐line setting, respectively. In multivariate analysis, exposure to S‐1 treatment was an independent prognosticator for survival.ConclusionOur results support the clinical use of S‐1 as the treatment of choice for patients with locally advanced or metastatic pancreatic cancer, particularly in resource‐limited situations.
Highlights
Pancreatic cancer was the 12th most common cancer and the 7th leading cause of cancer death worldwide in 2015,1 and it has an extremely poor prognosis
S‐1 has been widely used in Japan for treating various types of solid cancer since 1996 and received approval in Japan in 1999.9 A randomized phase III Gemcitabine and S‐1 Trial (GEST) study was conducted in both Japan and Taiwan to compare the clinical efficacy of S‐1 monotherapy, gemcitabine monotherapy, and S‐1 and gemcitabine combined therapy as first‐line chemotherapy for advanced pancreatic cancer.[10]
We demonstrated that stage III disease, female sex, nonsmoking history, favorable Eastern Cooperative Oncology Group performance status (ECOG PS), no comorbidity, and receiving S‐1 treatment were suitable independent prognostic factors for survival outcome in advanced pancreatic cancer
Summary
Pancreatic cancer was the 12th most common cancer and the 7th leading cause of cancer death worldwide in 2015,1 and it has an extremely poor prognosis. In Taiwan, gemcitabine monotherapy or a gemcitabine– platinum combination regimen[11] has become treatment of choice for advanced pancreatic cancer since the National Health Insurance (NHI) program started providing reimbursement for it in 2003. On the basis of the GEST study results revealing that S‐1 was not inferior to gemcitabine monotherapy in terms of OS,[10] the NHI program began providing reimbursement for S‐1 used in treating advanced pancreatic cancer in June of 2014. The aim of the present study was to compare the survival outcomes of patients with advanced pancreatic cancer treated with S‐1 with the survival outcomes of those treated without S‐1 before and after the NHI program began providing reimbursement for S‐1 in Taiwan in June of 2014. All statistical assessments were 2 sided, and a P value of
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