Phase II trial of nafamostat mesilate/gemcitabin/S-1 for unresectable pancreatic cancer.

Abstract

PURPOSE:

To assess the efficacy of combination chemotherapy with nafamostat mesilate, gemcitabine and S-1 for unresectable pancreatic cancer patients.

MATERIALS AND METHODS:

The study was conducted as a single-arm, single center, institutional review board-approved phase II trial. Patients received nafamosntat mesilate (4.8 mg/kg continuous transregional arterial infusion) with gemcitabine (1000 mg/m2 transvenous) on days 1 and15, and with oral S-1 [(80 mg/day (BSA<1.25 m2), 100 mg/day (1.25 ≤ BSA<1.5 m2), or 120 mg/day (BSA ≥1.5 m2)] on days 1-14 or, days 1-7 and 15-21. This regimen was repeated at 28-day intervals.

RESULTS:

Forty-seven evaluable patients (Male/Female: 31/16, Age (median): 66 (range 35-78) yrs, Stage III/IV 10/37.) were candidates in this study. Two patients in stage III (20%) could undergo conversion surgery. Twenty-four patients (51%) underwent subsequent treatment (1st line/ 2nd line / 4th line, 13/ 10/ 1, FOLFIRINOX: 12, GEM/nab-PTX: 18, TAS-118: 3, chemoradiation with S-1: 2, GEM/Erlotinib: 1, nal-IRI: 1, surgery: 2). Median PFS and OS were 9.7 (95% CI, 8.9-14.7 mo) and 14.2 months (99% CI, 13.3-23.9 mo), respectively. Median PFS in stage IV patients was 9.2 months (95% CI, 8.4-12.0 mo). Median OS in patients without subsequent treatment was 10.8 months (95% CI, 9.1-13.8 mo). Median OS in patients with subsequent treatment was 19.3 months (95% CI, 18.9-31.9 mo). Grade 4 treatment-related hematological toxicities were encountered in 7 patients. Two patients developed grade 3 allergic reaction after 6 cycles or later. No febrile neutropenia has been observed.

CONCLUSION:

NAM/GEM/S-1 therapy is safe and could be promising option for unresectable pancreatic cancer, especially for stage IV cancer.

• Authors: Tadashi Uwagawa, Taro Sakamoto, Takeshi Gocho, Hiroaki Shiba, Shinji Onda, Jungo Yasuda, Yoshihiro Shirai, Ryoga Hamura, Kenei Furukawa, Katsuhiko Yanaga, Toru Ikegami
• Journal: PloS one (PLoS One) Vol. 17 Issue 5 Pg. e0267623 ( 2022) ISSN: 1932-6203 [Electronic] United States
• PMID: 35544539 (Publication Type: Clinical Trial, Phase II, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Benzamidines
• Guanidines
• Deoxycytidine
• nafamostat
• Gemcitabine

Topics

• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Benzamidines
• Deoxycytidine (analogs & derivatives)
• Female
• Guanidines
• Humans
• Male
• Pancreatic Neoplasms (surgery)
• Treatment Outcome
• Gemcitabine