Abstract
S-1, an oral anticancer drug, is comprised of tegafur (a prodrug of 5-fluorouracil) and two biochemical modulators that have effect-enhancing and adverse reaction-reducing activities. Neoadjuvant chemotherapy (NAC) using S-1 has not been reported. Between April 2003 and March 2008, 103 patients with previously untreated oral squamous cell carcinoma (OSCC) received some courses of S-1 NAC (S-1 80 mg/m2/day as the NAC until 1 week preoperatively). Tumor size and histopathologic effect were evaluated before and after treatment. Among 103 cases, 10 cases had complete responses and 53 cases had partial responses (overall response rate [RR], 61.2%). Twenty-two (21.4%) patients had adverse events. Most patients had mild toxicities in the bone marrow and digestive tract (grade 1, 19 cases). Only three patients (2.9%) had grade 2 neutropenia or grade 4 thrombocytopenia. We examined the relationship between the RR and the clinicopathologic behaviors. The RR of the pN2 cases (33.3%) was significantly lower than that of the pN0 cases (69.4%). The RR was not correlated with tumor size, differentiation type, distant metastasis, and the period of administration. The data indicates that S-1 caused only mild toxicity and had highly effective antitumor activity. Furthermore, the RR of S-1 NAC might predict regional lymph node metastasis.
Highlights
Oral squamous cell carcinomas (OSCCs), the most common cancer of the head and neck, accounts for over 300,000 new cancer cases worldwide annually (Lippman et al, 2005)
The most important prognosticator of survival in OSCC is the presence of regional lymph node metastasis (Spiro and strong, 1971)
S-1 is an oral anticancer drug comprised of tegafur (FT), a prodrug of 5-fluorouracil (5-FU), 5-chloro-2, 4-dihydroxypyridine (CDHP), and potassium oxonate (Oxo)
Summary
Oral squamous cell carcinomas (OSCCs), the most common cancer of the head and neck, accounts for over 300,000 new cancer cases worldwide annually (Lippman et al, 2005). The surgery, including neck dissection, has been the mainstay of treatment for primary OSCCs. S-1 is an oral anticancer drug comprised of tegafur (FT), a prodrug of 5-fluorouracil (5-FU), 5-chloro-2, 4-dihydroxypyridine (CDHP), and potassium oxonate (Oxo). Oxo is selectively distributed to the gastrointestinal tract, where high concentrations inhibit orotate phosphoribosyltransferase, which phosphorylates 5-FU to an active metabolite in humans. Inhibition of this enzyme reduces gastrointestinal toxicity. S-1 has been used for adjuvant chemotherapy after primary treatment of head and neck cancer (Tsukuda et al, 2005). Other groups have reported that advanced gastric cancer was tried to use S-1 NAC (Kochi et al, 2004; Yano et al, 2002). We retrospectively examined 103 patients with primary OSCC to evaluate the effect of NAC with S-1 monochemotherapy on clinical behavior
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