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Although the prognosis of unresectable gastric cancer remains poor (Hohenberger & Gretshel, 2003), recent advances in chemotherapy for this cancer have considerably improved the therapeutic effects. An oral fluoropyrimidine anticancer agent, S-1, developed in Japan, was designed to enhance the anticancer activity of 5-FU via combination with two modulating substances: gimeracil to inhibit dihydropyrimidine dehydrogenase and potassium oxonate to reduce gastrointestinal toxicities (Shirasaka, et al, 1996). The antitumor effects of fluoropyrimidine are known to be enhanced through biochemical modulation of folate metabolism modified by cisplatin (Scanlon, et al, 1986), and combination therapy using S-1 and cisplatin reportedly achieves high response rates (Koizumi, et al, 2008 ; Lenz, et al, 2007). Therefore, in Japan, S-1 with cisplatin is the standard therapy for advanced gastric cancer. However, disease progression is still observed in up to 40% of cases (Iwase, et al, 2005; Koizumi, et al, 2008) and further improvement of treatment is thus necessary. Taxanes have shown encouraging anti-tumor activities against various malignancies, including gastric cancer (Ohtsu, et al, 1998; Sulkes, et al, 1994). Taxane derivatives, docetaxel and paclitaxel, have a unique mechanism of action that differs from those of fluoropyrimidines and platinum compounds. The docetaxel containing combination regimens are associated with severe neutropenia (Yamaguchi, et al, 2006). Just recently, a phase I/ II study of docetaxel combined with S-1 plus cisplatin (DSC triple therapy) was conducted for advanced gastric cancer, and a very high tumor response rate was achieved with febrile neutropenia developing in approximately 20 % of patients (Nakayama, et al, 2008; Sato, et al, 2010). Paclitaxel combined with other drugs reportedly has tolerable toxicity (Kang, et al, 2008). In addition, continuous infusion of cisplatin for 24 hours has

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Prospective Study of Triple Combination Chemotherapy Consisting of Paclitaxel, S-1, and 24-Hour Infusion of Cisplatin (PSC) for Inoperable Highly Advanced Gastric Cancer