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. 2017 Mar 15;2(1):e000151.
doi: 10.1136/esmoopen-2016-000151. eCollection 2017.

Health-related quality of life in a randomised phase III study of gemcitabine plus S-1, S-1 alone and gemcitabine alone for locally advanced or metastatic pancreatic cancer: GEST study

Yasuhiro Hagiwara  1 , Yasuo Ohashi  2 , Takuji Okusaka  3 , Hideki Ueno  3 , Tatsuya Ioka  4 , Narikazu Boku  5 , Shinichi Egawa  6 , Takashi Hatori  7 , Junji Furuse  8 , Kazuhiro Mizumoto  9 , Shinichi Ohkawa  10 , Taketo Yamaguchi  11 , Kenji Yamao  12 , Akihiro Funakoshi  13 , Ann-Lii Cheng  14 , Kiyohiro Kihara  1 , Atsushi Sato  15 , Masao Tanaka  16
Affiliations

Health-related quality of life in a randomised phase III study of gemcitabine plus S-1, S-1 alone and gemcitabine alone for locally advanced or metastatic pancreatic cancer: GEST study

Yasuhiro Hagiwara et al. ESMO Open. .

Abstract

Objective: This study was performed to compare health-related quality of life (HRQOL) of gemcitabine plus S-1 (GS), S-1 alone and gemcitabine alone as first-line chemotherapy for locally advanced or metastatic pancreatic cancer in the GEST (Gemcitabine and TS-1 Trial) study and to assess the impacts of adverse events and tumour response on HRQOL.

Methods: Patients were randomly assigned to receive gemcitabine alone (1000 mg/m2 weekly for 3 of 4 weeks), S-1 alone (80, 100 or 120 mg/day twice daily for 4 of 6 weeks) or GS (gemcitabine at 1000 mg/m2 weekly plus S-1 at 60, 80 or 100 mg/day twice daily for 2 of 3 weeks). HRQOL was assessed using the EuroQoL-5D (EQ-5D) questionnaire at baseline and weeks 6, 12, 24, 48 and 72. EQ-5D scores, quality-adjusted life months (QALMs), quality-adjusted progression-free months (QAPFMs) and time until definitive HRQOL deterioration (TUDD) were compared among the three groups. The impacts of adverse events and tumour response on EQ-5D scores were analysed.

Results: Including EQ-5D scores after death as 0, the mean profile was significantly better in the GS than gemcitabine group (difference, 0.069; p=0.003), but not the S-1 group (difference, -0.011; p=0.613). The mean profiles until death were similar in the three groups. QALMs, QAPFMs and TUDD were significantly longer in the GS than gemcitabine group (p<0.001, p<0.001 and p=0.004, respectively), but not the S-1 group (p=0.563, p=0.741 and p=0.701, respectively). Fatigue, anorexia and tumour response were significantly associated with changes in EQ-5D scores.

Conclusions: GS achieved better HRQOL than gemcitabine alone, resulting a good balance between overall survival and HRQOL benefits. S-1 alone provides HRQOL similar to that provided by gemcitabine alone. Preventing fatigue and anorexia and maintaining better response would improve HRQOL.

Keywords: S-1; advanced pancreatic cancer; gemcitabine; health-related quality of life; randomized phase III trial.

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Conflict of interest statement

Competing interests: YH is contractually employed by J-CRSU. YO has a leadership position at Statcom and J-CRSU; has stock in Statcom; received honoraria from Sanofi, Shionogi, Taiho, Kowa, Chugai and Eisai; and received research funding from Eisai. TO received honoraria from Chugai, Pfizer Japan, Novartis, Taiho, Merck Serono, Eli Lilly Japan, Sumitomo Dainippon, Eisai, Bayer, Yakult, Nobelpharma, Nippon Kayaku, Baxter and Astellas; received rewards for an advisory role from Eli Lilly Japan, Sumitomo Dainippon, Taiho, Ono, Nippon Boehringer Ingelheim, Nano Carrier and Zeria; and received research funding from Chugai, Eli Lilly Japan, Eisai, Novartis, Shizuoka Industry, Takeda Bio Development Center, Yakult, Onco Therapy Science, Otsuka, Taiho, Sceti Medical Labo, Nippon Boehringer Ingelheim, Kowa, Kyowa Hakko Kirin, Merck Serono, Ono, Bayer, Pfizer Japan, AstraZeneca, Sumitomo Dainippon, Nobelpharma, Zeria and Glaxo Smith Kline. HU received honoraria from Taiho and Chugai and received research funding from Taiho, NanoCarrier and Baxalta Japan. TI received rewards for an advisory role from Taiho, Yakult, Baxalta and JCRO; served on the speakers’ bureau of Taiho, Yakult, Daiichi Sankyo, Eisai, Mochida and Fujifilm; and received research funding from Taiho, AstraZeneca, Glaxo Smith Kline, Nihon Zouki, Zeria and Merck Sereno. NB received honoraria from Taiho and Eli Lilly. JF received honoraria from Taiho, Yakult, Eli Lilly Japan, Chugai, Eisai, Ono, Daiichi Sankyo, Merck Serono, Bayer, Novartis, Sumitomo Dainippon, Mitsubishi Tanabe, MSD, AstraZeneca, Sawai, Mochida, Takeda, Pfizer and Astellas; received rewards for an advisory role from Taiho, Yakult, Fujifilm, Chugai, Kyowa Hakko Kirin, Otsuka, Zeria and J-Pharma; served on the speakers’ bureau of Taiho and Yakult; and received research funding from J-Pharma, Taiho, Sumitomo Dainippon, Janssen, Daiichi Sankyo, MSD, Yakult, Takeda, Chugai, Ono, Astellas, Zeria, Novartis, Nanocarrier, Shionogi, Onco Therapy Science, Eli Lilly Japan, Bayer, Bristol-Myers Squibb, Merck Serono, Kyowa Hakko Kirin, Eisai and Mochida. SO received honoraria from Eli Lilly, Taiho, Yakult, Otsuka and Sandoz; received rewards for an advisory role from Boehringer Ingelheim; and received research funding from AstraZeneca. ALC received rewards for an advisory role from Bayer, Eisai, Novartis and Merck KGaA. AS received honoraria from Taiho and received rewards for an advisory role from Taiho. MT received honoraria from Taiho and Eli Lilly and received research funding from Eli Lilly. All remaining authors have declared no conflict of interest.

Figures

Figure 1
Figure 1
CONSORT diagram. CONSORT, Consolidated Standards of Reporting Trials. GEM, gemcitabine; GS, gemcitabine plus S-1; HRQOL, health-related quality of life.
Figure 2
Figure 2
Health-related quality of life (HRQOL) results. (A) Longitudinal mean EQ-5D scores including EQ-5D scores after death as 0. (B) Longitudinal mean EQ-5D scores including only EQ-5D scores until death. (C) Kaplan-Meier estimates of time until definitive HRQOL deterioration. Error bars in (A) and (B) represent ±1 SD. EQ-5D, EuroQol-5D-3L; GEM, gemcitabine; GS, gemcitabine plus S-1.
See this image and copyright information in PMC

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