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Diffuse Gastric and Esophagogastric Junction Cancer S-1 Trial

An Open-Label, Multicenter, Randomized, Phase 3 Study of S-1 and Cisplatin Compared With 5-FU and Cisplatin in Patients With Metastatic Diffuse Gastric Cancer Previously Untreated With Chemotherapy

Status
Terminated
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01285557
Acronym
DIGEST
Enrollment
361
Registered
2011-01-28
Start date
2011-04-14
Completion date
2014-08-15
Last updated
2024-09-19

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Metastatic Diffuse Gastric Cancer Including Carcinoma of the Gastro-esophageal Junction

Keywords

Gastric Cancer , S-1, Phase 3

Brief summary

The purpose of this study is to evaluate the safety and efficacy of S-1 and Cisplatin compared to 5-FU and Cisplatin in treatment of patients with metastatic diffuse gastric and gastro-esophageal junction cancer previously untreated with chemotherapy.

Detailed description

This is an open-label, international, Phase 3 study evaluating the efficacy and safety of the S-1/cisplatin regimen versus the 5-FU/cisplatin regimen in chemotherapy-naïve patients with metastatic diffuse gastric carcinoma including carcinoma of the gastro-esophageal junction. Patients will be randomly assigned to S-1/cisplatin (experimental regimen, Arm A) or 5-FU/cisplatin (control regimen, Arm B).

Interventions

DRUGS-1 (Tegafur+Gimeracil+Oteracil) /cisplatin (investigational arm)

25 mg/m² body surface area (BSA) orally 2 times daily from Days 1 through 21 followed by a 7 day rest period, plus cisplatin 75 mg/m2 BSA on Day 1 each 28 day cycle Number of Cycles: until progression or unacceptable toxicity develops. Treatment with cisplatin is limited to a maximum of 8 cycles.

DRUGFluorouracil/cisplatin (control arm)

5-FU: 800 mg/m2 BSA/24 hours by continuous intravenous infusion (CIV) from Days 1 through 5 plus cisplatin 80 mg/m2 BSA on Day 1 each 21 day cycle. Number of Cycles: until progression or unacceptable toxicity develops. Treatment with cisplatin is limited to a maximum of 8 cycles.

Sponsors

Taiho Oncology, Inc.
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Has given written Informed Consent. * Histologically confirmed, unresectable, metastatic diffuse gastric cancer including carcinoma of the gastro-esophageal junction. * No prior chemotherapy for gastric cancer except adjuvant and/or neo-adjuvant chemotherapy more than 12 months ago. * Life expectancy of at least 3 months. * Able to take medications orally. * Eastern Cooperative Oncology Group performance status 0 to 1. * Adequate organ function (bone marrow, kidney and liver).

Exclusion criteria

* Certain type(s) of non-measurable lesion(s), if the only one(s). * Certain serious illness or medical condition(s). * Lost greater than or equal to 10% of body weight in the 3 months proceeding signing the Informed Consent Form. * Treatment with drugs interacting with S-1, 5-FU, or cisplatin. * Pregnant or lactating female. * Known hypersensitivity to fluoropyrimidines or cisplatin. Other protocol-defined inclusion/

Design outcomes

Primary

MeasureTime frameDescription
Overall Survival (OS)From the date of randomization until disease progression or death, cut-off date: 15 August 2014 (approximately 40 months)OS was defined as the time from randomization to the date of death for the ITT population. Participants who did not die were censored at the date last known to be alive. Analysis was performed by using Kaplan-Meier method.

Secondary

MeasureTime frameDescription
Time to Treatment Failure (TTF)From date of randomization until disease progression, cut-off date: 07 March 2014 (approximately 34.7 months)TTF was defined as the time from date of randomization until date of PD (clinical or radiologic), or permanent discontinuation of study treatment (S-1 or 5-FU), or death due to any cause. Participates who were still on study treatment at the time of the analysis were censored at the last date the participants was known to be on treatment.
Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAE)From first dose of study medication up to 30 days of last study medication (maximum duration: 35.7 months)AE was defined as any untoward medical condition that occurs in a participants while participating in a clinical study and does not necessarily had to have a causal relationship with the use of the study medication. A serious adverse event (SAE) was defined as any untoward medical occurrence that resulted in any of the following outcomes: death, life-threatening, required initial or prolonged in-patient hospitalization, persistent or significant disability/incapacity, congenital anomaly/birth defect, or considered as medically important event. TEAEs were defined as AEs that developed or worsened or became serious during on-treatment period (from first dose of study medication up to 30 days of last study medication \[maximum duration: 35.7 months\]).
Number of Participants With TEAEs With Severity Greater Than or Equal to (>=) Grade 3From first dose of study medication up to 30 days of last study medication (maximum duration: 35.7 months)An AE was any untoward medical condition that occurred in a participants while participating in a clinical study and does not necessarily had to have a causal relationship with the use of the study medication. TEAEs were defined as AEs that developed or worsened or became serious during on-treatment period (from first dose of study medication up to 30 days of last study medication \[maximum duration: 35.7 months\]).
Progression-free Survival (PFS)From date of randomization until disease progression or death, cut-off date: 07 March 2014 (approximately 34.7 months)PFS was defined as the time from date of randomization until date of radiological disease progression or death due to any cause. Disease Progression was defined according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, where any of the 3 criteria have been met: 1) at least 20% increase in the sum of diameters of the target lesions, taking as reference the smallest sum on study, including the baseline sum, 2) Progression in no-target lesion(s), 3) appearance of new lesion(s) Participants who were alive with no PD were censored at the date of the last tumor assessment. Participants who received new anticancer therapy before disease progression were censored at the date of the last evaluable tumor assessment before new anticancer therapy was initiated. Analysis was performed by using Kaplan-Meier method.
Duration of Response (DR)From date of first study medication until cut-off date: 07 March 2014 (approximately 34.7 months)Duration of response was defined as the time (in months) from date of first confirmed response (CR or PR) to date of first progressive disease (PD) or death. Per the RECIST criteria, definitions were as follows: CR was defined as the disappearance of all target or non-target lesions. Any pathological lymph nodes for target lesions or all lymph nodes for non-target lesions were non-pathological morphologically that was reduced in size in short axis to \<10 mm. Analysis was performed by using Kaplan-Meier method.
Time to Tumor Response (TTR)From date of first study medication until cut-off date: 07 March 2014 (approximately 34.7 months)TTR was defined as the time (in months) from the date of randomization to the date of first observation of response (PR or CR) (whichever status was recorded first). TTR was assessed based on investigator assessment utilizing RECIST 1.1. CR was defined as the disappearance of all target or non-target lesions. Any pathological lymph nodes for target lesions or all lymph nodes for non-target lesions were non-pathological morphologically that was reduced in size in short axis to \<10 mm. PR was defined as target lesions with at least 30% decrease in the sum of diameters, taking baseline sum diameters as reference. Analysis was performed by using Kaplan-Meier method.
Overall Response Rate (ORR): Percentage of Participants With Overall ResponseFrom date of first study medication until cut-off date: 07 March 2014 (approximately 34.7 months)ORR was defined as the percentage of participants with objective evidence of complete response (CR) or partial response (PR) based on the Investigator review of the images and application of Response Evaluation Criteria in Solid Tumors (RECIST) criteria. CR was defined as the disappearance of all target or non-target lesions. Any pathological lymph nodes for target lesions or all lymph nodes for non-target lesions were non-pathological morphologically that was reduced in size in short axis to less than (\<) 10 millimeter (mm). PR was defined as target lesions with at least 30% decrease in the sum of diameters, taking baseline sum diameters as reference.

Countries

Argentina, Belgium, Brazil, Bulgaria, Croatia, Estonia, Germany, Hungary, Israel, Italy, Mexico, Poland, Portugal, Romania, Russia, South Africa, Spain, Ukraine, United Kingdom, United States

Participant flow

Recruitment details

A total of 690 participants were screened from 14 April 2011 to 25 February 2014, of which 361 participants enrolled in the study. The data cut-off date for all clinical data except overall survival was 07 Mar 2014 and for overall survival was 15 Aug 2014. The participants were randomized using interactive Voice/Web randomization system(2:1 ratio) to receive S-1/cisplatin or 5-Fluorouracil (5-FU)/cisplatin. A total of 329 participants failed screening due to failure to meet inclusion criteria.

Pre-assignment details

Randomization was stratified by the histologic subtype (adenocarcinoma, diffuse type or signet ring cell adenocarcinoma); extent of metastasis (1 versus more than 1 metastatic site); Eastern Cooperative Oncology Group (ECOG) performance status (0 or 1) and region (North America, Western Europe, Eastern Europe, Rest of world). Cut-off dates for all clinical data collection was 07 March 2014 and for overall survival analysis was 15 August 2014.

Participants by arm

ArmCount
S-1+Cisplatin
Participants received S-1 25 mg/m\^2 orally BID every 12 hours from Day 1 through Day 21, 1 hour before or after meal with a glass of water; followed by a 7-day rest period from Day 22 to Day 28 in a 28-day cycle. Participants received a single dose of cisplatin 75 mg/m\^2 as a 1- to 3-hour IV infusion on Day 1 following the morning dose of S-1 for a maximum of 8 cycles (each cycle of 28 days). Participants received study medication until PD, AE, withdrawal of consent, or other reason for discontinuation, whichever happened earlier.
239
5FU+Cisplatin
Participants received 5-FU 800 mg/m\^2 per 24 hours as continuous IV infusion over 120 hours from Day 1 through Day 5 followed by a 16-day rest period on Days 6 through 21 in a 21-day cycle. Participants received a single dose of cisplatin 80 mg/m\^2 as a 1- to 3-hour IV infusion on Day 1 prior to the start of the 5-FU infusion on Day 1 for a maximum of 8 cycles (each cycle of 21 days). Participants received study medication until PD, AE, withdrawal of consent, or other reason for discontinuation, whichever happened earlier.
122
Total361

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyDeath17390
Overall StudyLost to Follow-up62
Overall StudyRandomized but not treated11
Overall StudySponsor Decision21
Overall StudySponsor Study Termination2313
Overall StudyStudy follow-up ongoing2814
Overall StudyWithdrew Consent61

Baseline characteristics

CharacteristicS-1+Cisplatin5FU+CisplatinTotal
Age, Continuous55.1 years
STANDARD_DEVIATION 11.01
55.8 years
STANDARD_DEVIATION 11.8
55.4 years
STANDARD_DEVIATION 11.27
Eastern Cooperative Oncology Group (ECOG) Performance Status
ECOG Grade 0
75 Participants38 Participants113 Participants
Eastern Cooperative Oncology Group (ECOG) Performance Status
ECOG Grade 1
164 Participants83 Participants247 Participants
Eastern Cooperative Oncology Group (ECOG) Performance Status
Missing
0 Participants1 Participants1 Participants
Race/Ethnicity, Customized
American Indian or Alaska Native
2 Participants0 Participants2 Participants
Race/Ethnicity, Customized
Asian/Oriental
4 Participants0 Participants4 Participants
Race/Ethnicity, Customized
Black
4 Participants2 Participants6 Participants
Race/Ethnicity, Customized
Caucasian/White
226 Participants117 Participants343 Participants
Race/Ethnicity, Customized
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race/Ethnicity, Customized
Other
3 Participants3 Participants6 Participants
Sex: Female, Male
Female
115 Participants62 Participants177 Participants
Sex: Female, Male
Male
124 Participants60 Participants184 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
173 / 23990 / 122
other
Total, other adverse events
210 / 230110 / 118
serious
Total, serious adverse events
63 / 23031 / 118

Outcome results

Primary

Overall Survival (OS)

OS was defined as the time from randomization to the date of death for the ITT population. Participants who did not die were censored at the date last known to be alive. Analysis was performed by using Kaplan-Meier method.

Time frame: From the date of randomization until disease progression or death, cut-off date: 15 August 2014 (approximately 40 months)

Population: Analysis was performed on the ITT population that included all randomized participants.

ArmMeasureValue (MEDIAN)
S-1+CisplatinOverall Survival (OS)7.5 months
5FU+CisplatinOverall Survival (OS)6.6 months
Comparison: S-1+Cisplatin and 5FU+Cisplatin were compared using the unstratified log-rank test. The hazard ratio was estimated using a Cox's regression approach and survival was summarized using Kaplan Meier estimates along with 2-sided 95% confidence intervals (CI) for the estimates.p-value: 0.931295% CI: [0.76, 1.28]Unstratified Log-rank
Secondary

Duration of Response (DR)

Duration of response was defined as the time (in months) from date of first confirmed response (CR or PR) to date of first progressive disease (PD) or death. Per the RECIST criteria, definitions were as follows: CR was defined as the disappearance of all target or non-target lesions. Any pathological lymph nodes for target lesions or all lymph nodes for non-target lesions were non-pathological morphologically that was reduced in size in short axis to \<10 mm. Analysis was performed by using Kaplan-Meier method.

Time frame: From date of first study medication until cut-off date: 07 March 2014 (approximately 34.7 months)

Population: Analysis was performed on the ITT population. Here, 'overall number of participants analyzed' signifies participants with available data for the outcome measure.

ArmMeasureValue (MEDIAN)
S-1+CisplatinDuration of Response (DR)5.1 months
5FU+CisplatinDuration of Response (DR)4.2 months
Secondary

Number of Participants With TEAEs With Severity Greater Than or Equal to (>=) Grade 3

An AE was any untoward medical condition that occurred in a participants while participating in a clinical study and does not necessarily had to have a causal relationship with the use of the study medication. TEAEs were defined as AEs that developed or worsened or became serious during on-treatment period (from first dose of study medication up to 30 days of last study medication \[maximum duration: 35.7 months\]).

Time frame: From first dose of study medication up to 30 days of last study medication (maximum duration: 35.7 months)

Population: Analysis was performed on the as treated (AT) population.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
S-1+CisplatinNumber of Participants With TEAEs With Severity Greater Than or Equal to (>=) Grade 3157 Participants
5FU+CisplatinNumber of Participants With TEAEs With Severity Greater Than or Equal to (>=) Grade 378 Participants
Secondary

Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAE)

AE was defined as any untoward medical condition that occurs in a participants while participating in a clinical study and does not necessarily had to have a causal relationship with the use of the study medication. A serious adverse event (SAE) was defined as any untoward medical occurrence that resulted in any of the following outcomes: death, life-threatening, required initial or prolonged in-patient hospitalization, persistent or significant disability/incapacity, congenital anomaly/birth defect, or considered as medically important event. TEAEs were defined as AEs that developed or worsened or became serious during on-treatment period (from first dose of study medication up to 30 days of last study medication \[maximum duration: 35.7 months\]).

Time frame: From first dose of study medication up to 30 days of last study medication (maximum duration: 35.7 months)

Population: Analysis was performed on the as treated (AT) population that included all participants who initiated treatment with either of the 2 regimens with treatment assignment designated according to actual treatment received.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
S-1+CisplatinNumber of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAE)TEAE214 Participants
S-1+CisplatinNumber of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAE)TESAE63 Participants
5FU+CisplatinNumber of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAE)TEAE111 Participants
5FU+CisplatinNumber of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAE)TESAE31 Participants
Secondary

Overall Response Rate (ORR): Percentage of Participants With Overall Response

ORR was defined as the percentage of participants with objective evidence of complete response (CR) or partial response (PR) based on the Investigator review of the images and application of Response Evaluation Criteria in Solid Tumors (RECIST) criteria. CR was defined as the disappearance of all target or non-target lesions. Any pathological lymph nodes for target lesions or all lymph nodes for non-target lesions were non-pathological morphologically that was reduced in size in short axis to less than (\<) 10 millimeter (mm). PR was defined as target lesions with at least 30% decrease in the sum of diameters, taking baseline sum diameters as reference.

Time frame: From date of first study medication until cut-off date: 07 March 2014 (approximately 34.7 months)

Population: Analysis was performed on the ITT population. Here, 'overall number of participants analyzed' signifies participants with available data for the outcome measure.

ArmMeasureValue (NUMBER)
S-1+CisplatinOverall Response Rate (ORR): Percentage of Participants With Overall Response34.7 percentage of participants
5FU+CisplatinOverall Response Rate (ORR): Percentage of Participants With Overall Response19.8 percentage of participants
Secondary

Progression-free Survival (PFS)

PFS was defined as the time from date of randomization until date of radiological disease progression or death due to any cause. Disease Progression was defined according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, where any of the 3 criteria have been met: 1) at least 20% increase in the sum of diameters of the target lesions, taking as reference the smallest sum on study, including the baseline sum, 2) Progression in no-target lesion(s), 3) appearance of new lesion(s) Participants who were alive with no PD were censored at the date of the last tumor assessment. Participants who received new anticancer therapy before disease progression were censored at the date of the last evaluable tumor assessment before new anticancer therapy was initiated. Analysis was performed by using Kaplan-Meier method.

Time frame: From date of randomization until disease progression or death, cut-off date: 07 March 2014 (approximately 34.7 months)

Population: Analysis was performed on the ITT population.

ArmMeasureValue (MEDIAN)
S-1+CisplatinProgression-free Survival (PFS)4.4 months
5FU+CisplatinProgression-free Survival (PFS)3.9 months
Comparison: S-1+Cisplatin and 5FU+Cisplatin were compared using the log-rank test. The hazard ratio was estimated using a Cox's regression approach and survival was summarized using Kaplan Meier estimates along with 2-sided 95% confidence intervals (CI) for the estimates.p-value: 0.303995% CI: [0.65, 1.14]Log Rank
Secondary

Time to Treatment Failure (TTF)

TTF was defined as the time from date of randomization until date of PD (clinical or radiologic), or permanent discontinuation of study treatment (S-1 or 5-FU), or death due to any cause. Participates who were still on study treatment at the time of the analysis were censored at the last date the participants was known to be on treatment.

Time frame: From date of randomization until disease progression, cut-off date: 07 March 2014 (approximately 34.7 months)

Population: Analysis was performed on the ITT population.

ArmMeasureValue (MEDIAN)
S-1+CisplatinTime to Treatment Failure (TTF)4.2 months
5FU+CisplatinTime to Treatment Failure (TTF)3.8 months
Comparison: S-1+Cisplatin and 5FU+Cisplatin were compared using the log-rank test. The hazard ratio was estimated using a Cox's regression approach and survival was summarized using Kaplan Meier estimates along with 2-sided 95% confidence intervals (CI) for the estimates.p-value: 0.168395% CI: [0.66, 1.08]Log Rank
Secondary

Time to Tumor Response (TTR)

TTR was defined as the time (in months) from the date of randomization to the date of first observation of response (PR or CR) (whichever status was recorded first). TTR was assessed based on investigator assessment utilizing RECIST 1.1. CR was defined as the disappearance of all target or non-target lesions. Any pathological lymph nodes for target lesions or all lymph nodes for non-target lesions were non-pathological morphologically that was reduced in size in short axis to \<10 mm. PR was defined as target lesions with at least 30% decrease in the sum of diameters, taking baseline sum diameters as reference. Analysis was performed by using Kaplan-Meier method.

Time frame: From date of first study medication until cut-off date: 07 March 2014 (approximately 34.7 months)

Population: Analysis was performed on the ITT population. Here, 'overall number of participants analyzed' signifies participants with available data for the outcome measure.

ArmMeasureValue (MEDIAN)
S-1+CisplatinTime to Tumor Response (TTR)1.8 months
5FU+CisplatinTime to Tumor Response (TTR)1.9 months

Source: ClinicalTrials.gov · Data processed: Mar 9, 2026