Second-line chemotherapy with paclitaxel and doxifluridine after failure of S-1 in elderly patients with unresectable advanced or recurrent gastric cancer

Purpose There is no standard second-line treatment for patients with unresectable advanced or recurrent gastric cancer (URGC) in the event that first-line treatment fails. Moreover, the benefits of second-line chemotherapy in elderly patients remain uncertain. The aim of this study was to identify the benefits of the second-line paclitaxel (PTX) plus doxifluridine (5'-DFUR) regimen for URGC in elderly patients in comparison to nonelderly patients. Methods We retrospectively examined the clinical outcomes of the second-line PTX plus 5'-DFUR regimen in patients with URGC, who had previously been treated with S-1-based first-line chemotherapy. Results A total of 27 patients (10 elderly, >= 70 years old; 17 nonelderly, <70 years old) were enrolled in the study. The clinical benefit rate (complete response, partial response, and stable disease) in the elderly group was 6 of 10 (60%), and that of the nonelderly group was 9 of 17 (53%). Age had no statistically significant influence on the response rate, and no grade 4 adverse events were observed in either group. In addition, the median survival time was 12.2 months in both groups. Conclusion Although it remains unclear whether second-line chemotherapy contributes to survival in patients with URGC, the combination of PTX plus 5'-DFUR might be the treatment of choice for second-line chemotherapy in both elderly and nonelderly patients who have already received an S-1-based first-line treatment.