Tegafur, gimeracil and oteracil (S-1)
Teysuno (S-1) is an oral chemotherapy combining a fluorouracil pro-drug with two protectors. It is a standard in Japan and approved in Europe for stomach cancer with cisplatin and for bowel cancer when other fluoropyrimidines cause hand-foot syndrome or heart problems.
Overview
S-1 has been a mainstay of gastric, pancreatic, colorectal and lung cancer treatment in Japan since 1999 (ACTS-GC established adjuvant S-1 in gastric cancer). The European Commission authorised Teysuno in March 2011 for advanced gastric cancer with cisplatin, on the FLAGS trial in which S-1 plus cisplatin was non-inferior to fluorouracil plus cisplatin with less toxicity, and in 2022 for metastatic colorectal cancer as monotherapy or with oxaliplatin or irinotecan, with or without bevacizumab, in patients who cannot continue another fluoropyrimidine because of hand-foot syndrome or cardiovascular toxicity. Because Western patients metabolise tegafur faster through CYP2A6 polymorphisms, doses differ from Japan. It is not approved in the US, where a trial of S-1 versus fluorouracil failed to show superiority. Diarrhoea, neutropenia and stomatitis are the main toxicities.
Approvals
| Region | Year | Indication |
|---|---|---|
| JP | 1999 | Gastric cancer; later colorectal, head and neck, lung, pancreatic, biliary and breast cancer (TS-1) |
| EU | 2011 | Advanced gastric cancer with cisplatin; metastatic colorectal cancer intolerant of other fluoropyrimidines added 2022 (Teysuno) |
Trials
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Latest papers
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