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Metastatic Diffuse Gastric Cancer Including Carcinoma of the Gastro-esophageal JunctionPhase 3DIGESTNCT01285557

Diffuse Gastric and Esophagogastric Junction Cancer S-1 Trial

A Phase 3 study testing S-1 (Tegafur+Gimeracil+Oteracil) /cisplatin (investigational arm) in people with Metastatic Diffuse Gastric Cancer Including Carcinoma of the Gastro-esophageal Junction, run by Taiho Oncology, Inc. at 87 sites in 20 countries.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial 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. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
S-1 (Tegafur+Gimeracil+Oteracil) /cisplatin (investigational arm)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
361 participants
Where
87 sitesin 20 countries
Study dates
14 Apr 2011to 15 Aug 2014
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 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).

Who cannot join

  • 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/exclusion criteria may apply.

Trial locations and contacts

87 sites in 20 countries.

87 sites in 20 countries

Ukraine11 sites
  • Study site

    Cherkassy, 18009

  • Study site

    Chernivtsiy, 58013

  • Study site

    Dnipro, 49102

  • Study site

    Donetsk, 83092

  • Study site

    Kharkiv, 61070

  • Study site

    Kyiv, 3115

  • Study site

    Lutsk, 43018

  • Study site

    Lviv, 79031

  • Study site

    Sumy, 40005

  • Study site

    Uzhhorod, 88000

  • Study site

    Zaporizzhya, 69040

Other trials in Ukraine

Brazil10 sites
  • Study site

    Barretos, São Paulo, 14784-400

  • Study site

    Belo Horizonte, 31110-580

  • Study site

    Fortaleza, 60160-230

  • Study site

    Ijuí, 98700-000

  • Study site

    Porto Alegre, Rio Grande do Sul, 90610-000

  • Study site

    Porto Alegre, 90050-170

  • Study site

    Ribeirão Preto, São Paulo, 14015-130

  • Study site

    Salvador, Estado de Bahia, 41820-021

  • Study site

    São Paulo, São Paulo, 01246-000

  • Study site

    São Paulo, São Paulo, 01406-100

Other trials in Brazil

Spain9 sites
  • Study site

    Barcelona, 08035

  • Study site

    Barcelona, 08036

  • Study site

    Barcelona, 08907

  • Study site

    Madrid, 28007

  • Study site

    Madrid, 28033

  • Study site

    Madrid, 28034

  • Study site

    Madrid, 28046

  • Study site

    Madrid, 28050

  • Study site

    Sabadell, Barcelona, 08208

Other trials in Spain

Hungary7 sites
  • Study site

    Budapest, 1032

  • Study site

    Budapest, 1122

  • Study site

    Győor, 9024

  • Study site

    Nyíregyháza, 4400

  • Study site

    Pécs, 7624

  • Study site

    Szeged, 6720

  • Study site

    Székesfehérvár, 8000

Other trials in Hungary

Italy7 sites
  • Study site

    Ancona, 60020

  • Study site

    Candiolo, 10060

  • Study site

    Milan, 20141

  • Study site

    Modena, 41100

  • Study site

    Potenza, 85100

  • Study site

    Reggio Emilia, 42100

  • Study site

    Rimini, 47900

Other trials in Italy

Russia7 sites
  • Study site

    Barnaul, 656049

  • Study site

    Krasnodar, 350040

  • Study site

    Moscow, 115478

  • Study site

    Pyatigorsk, 357502

  • Study site

    Saint Petersburg, 194214

  • Study site

    Saint Petersburg, 197022

  • Study site

    Saint Petersburg, 197758

Other trials in Russia

United States4 sites
  • Study site

    Albuquerque, New Mexico, 87131

  • Study site

    Alexandria, Louisiana, 71301

  • Study site

    Dallas, Texas, 75390

  • Study site

    Houston, Texas, 77030

Other trials in United States

Portugal4 sites
  • Study site

    Aveiro, 3814-501

  • Study site

    Coimbra, 3000-226

  • Study site

    Lisbon, 1649-035

  • Study site

    Porto, 4200-072

Other trials in Portugal

Romania4 sites
  • Study site

    Baia Mare, 430031

  • Study site

    Cluj-Napoca, 400015

  • Study site

    Craiova, 200385

  • Study site

    Iași, 700106

Other trials in Romania

South Africa4 sites
  • Study site

    Cape Town, Western Cape, 7500

  • Study site

    Durban, KwaZulu-Natal, 4091

  • Study site

    Groenkloof Pretoria, Gauteng, 0181

  • Study site

    Pretoria, Gauteng, 0002

Other trials in South Africa

Belgium3 sites
  • Study site

    Brussels, 1200

  • Study site

    Edegem, 2650

  • Study site

    Ghent, 9000

Other trials in Belgium

Mexico3 sites
  • Study site

    Chihuahua City, 31000

  • Study site

    Mexico City, 14080

  • Study site

    Oaxaca City, 68000

Other trials in Mexico

Argentina2 sites
  • Study site

    Buenos Aires, 1264

  • Study site

    Rosario, Santa Fe Province, S2000KZE

Other trials in Argentina

Bulgaria2 sites
  • Study site

    Pleven, 5800

  • Study site

    Vratsa, 3000

Other trials in Bulgaria

Croatia2 sites
  • Study site

    Osijek, 31000

  • Study site

    Zagreb, 10000

Other trials in Croatia

Estonia2 sites
  • Study site

    Tallinn, 11312

  • Study site

    Tallinn, 13419

Other trials in Estonia

Poland2 sites
  • Study site

    Szczecin, 71-730

  • Study site

    Warsaw, 02-781

Other trials in Poland

United Kingdom2 sites
  • Study site

    London, W12 0NN

  • Study site

    Rhyl, Wales, LL18 5UJ

Other trials in United Kingdom

Germany1 site
  • Study site

    Essen, 45147

Other trials in Germany

Israel1 site
  • Study site

    Tel Aviv, 64239

Other trials in Israel

About this study

Official title: 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

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.

Read the 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).

Being tested
S-1 (Tegafur+Gimeracil+Oteracil) /cisplatin (investigational arm), Fluorouracil/cisplatin (control arm)
Keywords
Gastric Cancer , S-1, Phase 3
Medical subject headings
Stomach Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • S-1 (Tegafur+Gimeracil+Oteracil) /cisplatin (investigational arm)Drug

    Also called TS-1, Tegafur+Gimeracil+Oteracil

    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.

  • Fluorouracil/cisplatin (control arm)Drug

    Also called TS-1, Tegafur+Gimeracil+Oteracil

    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.

Study groups in NCT01285557
Study groupRoleWhat they receive
S-1+CisplatinExperimentalParticipants received S-1 25 milligrams per meter square (mg/m^2) orally twice daily (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 intravenous (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 progression of disease (PD), adverse event (AE), withdrawal of consent, or other reason for discontinuation, whichever happened earlier.
Receives: Drug: S-1 (Tegafur+Gimeracil+Oteracil) /cisplatin (investigational arm)
5FU+CisplatinActive comparatorParticipants received 5-Fluorouracil (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.
Receives: Drug: Fluorouracil/cisplatin (control arm)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 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.

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

Secondary outcomes (7)
  1. 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.

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

  2. 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.

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

  3. 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]).

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

  4. 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]).

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

  5. 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.

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

  6. 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.

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

  7. 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.

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

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Jan 2011 (estimated)
  2. Study start14 Apr 2011
  3. Primary completion15 Aug 2014
  4. Study completion15 Aug 2014

Why it stopped: Due to significant changes in investigational and clinical practice landscape of frontline advanced gastric cancer, which challenged viability of trial and increased use of modified chemotherapeutic triplets led to slow participant accrual in study.

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
361 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01285557
Sponsor's protocol ID
TPU-S1303
Acronym
DIGEST
Status last verified
Aug 2024
First submitted
26 Jan 2011
Last updated
19 Sep 2024
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Ajani JA, Abramov M, Bondarenko I, Shparyk Y, Gorbunova V, Hontsa A, Otchenash N, Alsina M, Lazarev S, Feliu J, Elme A, Esko V, Abdalla K, Verma U, Benedetti F, Aoyama T, Mizuguchi H, Makris L, Rosati G; DIGEST Study Group. A phase III trial comparing oral S-1/cisplatin and intravenous 5-fluorouracil/cisplatin in patients with untreated diffuse gastric cancer. Ann Oncol. 2017 Sep 1;28(9):2142-2148. doi: 10.1093/annonc/mdx275.

    PubMed 28911091

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing S-1 (Tegafur+Gimeracil+Oteracil) /cisplatin (investigational arm) in people with Metastatic Diffuse Gastric Cancer Including Carcinoma of the Gastro-esophageal Junction, run by Taiho Oncology, Inc. at 87 sites in 20 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 19 Sep 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 87 sites in Ukraine, Brazil, Spain, Hungary, Italy and 15 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 17 May 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Overall Survival (OS) (time frame: From the date of randomization until disease progression or death, cut-off date: 15 August 2014 (approximately 40 months)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01285557, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Sep 2024.

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