Feasibility of docetaxel, cisplatin and S-1 chemotherapy in elderly patients: Comparison with younger

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Introduction: Choice of the therapy for esophageal cancer(EC) is often decided on a consideration of patient’s age as well as performance status. Elderly patients sometimes tend to be undertreated for safety reasons, therefore the best practice for them is unknown. Standard therapy for unresectable EC in Japan is any of chemotherapy, radiotherapy or concurrent chemoradiotherapy. But the clinical outcome is still limited. Recently, some study showed the effectiveness of triplet induction chemotherapy with docetaxel, cisplatin and fluorouracil(DCF). By taking those results, we have treated EC patients with docetaxel, cisplatin and oral fluorouracil prodrug S-1(DCS) chemotherapy since 2010. In this study, we retrospectively assess the efficacy and safety of this triplet regimen for unresectable EC patients, especially for the elderly. Methods: We enrolled the patients who received DCS for unresectable esophageal cancer. Patients received docetaxel (35mg/m2) plus cisplatin (35mg/m2) intravenously on day1 and 15, and S-1 (80mg/m2) on days 1-14, of a 28-day cycle. If the adverse event was tolerable, patients continued receiving cycles until the progression of the disease was observed or the tumor turned to be resectable. Response rate (RR), progression-free survival (PFS), overall survival (OS), and adverse events(AE) were compared between two age groups. Results: Between May 2011 to November 2017, 55 patients were treated with the systemic regimen. Median age was 63 years (range 47-85). Eleven patients (20%) were more than 70 years old (elderly group) and forty-four were below 70 years (young group). Reasons for unresectable were locally advanced (74.5%), distant metastasis (16.4%) and recurrence (9.1%). The median number of therapy cycles applied was 3. The best clinical response to DCS in elderly group were complete response 0%, partial response 62.5% and stable disease 27.2% (RR 54.5%). Those in young group were 11.4%, 63.6% and 18.2%, respectively (RR 75.0%). Twelve patients of all were converted to surgery. The median PFS in all was 6.7 months (5.3 months in elderly group and 6.7 months in young group, p = 0.85). The median OS was 25.2 months (15.0 months vs 25.3 months, p = 0.4). Grade 3-4 toxicity were observed 90.9% of elderly group and 81.8% of young group, there was no statistical significance between two groups(p = 0.47). There was no treatment related death. Conclusion: In our study, DCS therapy in elderly patients was as effective and feasible as in young. High grade adverse events were observed regardless of age, but still manageable.

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