Japanese Journal of Cancer and Chemotherapy最新文献

Oral anticancer drugs are standard treatments for many cancers and are expected to remain widely used. Owing to the super-aged nature of the Japanese society, the number of elderly patients with cancer is rapidly increasing. Poor adherence to oral medications owing to physical limitations and swallowing difficulties in elderly patients with cancer is a major problem affecting treatment. Therefore, a survey was conducted on the size of oral anticancer drugs marketed in Japan, and the actual prescription patterns were investigated using receipt data. The total diameter of oral anticancer drugs increased with the year of launch, with a significant increase in the long diameter of tablets. In Japan, oral anticancer drugs in tablet form with a long diameter of ≥7 mm and a total diameter of ≥21 mm accounted for 84.2% and 56.8%, respectively, of all oral anticancer drugs in tablet form. In addition, 96.8% and 42% of oral anticancer drugs in tablet form prescribed to people aged ≥65 years had a long diameter of ≥7 mm and a total diameter of ≥21 mm, respectively. Most drugs were larger than those that can be easily taken by the elderly. Furthermore, information on tablet crushing or simple suspension administration was lacking; these methods are clinically used when elderly patients have difficulty taking their medications. The results of this study suggest that adherence to oral anticancer medications may be reduced in elderly patients. Future studies should evaluate adherence to oral anticancer medicines among elderly patients.

An 80-year-old woman with epigastric pain and weight loss presented to our hospital with cancer of the ascending colon and cholelithiasis. Initially hospitalized for a suspected gallstone attack, she later developed gangrenous cholecystitis. She underwent a laparoscopic cholecystectomy, which revealed abscess formation and necrosis extending into the gallbladder duct. The patient was discharged on the 10th postoperative day but was readmitted for a laparoscopic right hemicolectomy. During this surgery, extensive adhesions were encountered, which prolonged the procedure; however, it was completed with a D3 dissection. She had a successful postoperative recovery and was discharged on the 9th postoperative day. The incidence of gallstones in patients with colorectal cancer is high, and acute cholecystitis can occur. In this case, we performed a two-stage surgery and achieved a radical cure without any postoperative complications. Two-stage surgery may be an option for patients with severe symptoms and inflammation associated with acute cholecystitis.

Advance care planning(ACP)was officially incorporated into Japan's healthcare system in 2018 with the revision of the "Guidelines for the Decision-Making Process in End-of-Life Care"by the Ministry of Health, Labor and Welfare. This revision mandated that the government designated cancer hospitals and comprehensive community care wards establish systems for implementing ACP. Consequently, the implementation and promotion of ACP have become significant issues in the healthcare field. When conducting ACP, 3 essential points must be considered: 1)the process must be entirely based on the patient's autonomous will; 2)discussions regarding treatment and care goals should be prioritized; and 3)to prepare for potential declines in the patient's decision-making capacity, it is crucial to involve trusted family members or other individuals in these discussions.

In the field of cancer care, it is still difficult to say that advance care planning(ACP)has been fully integrated, and the perceptions of ACP vary depending on the individual's role. Since oncologists have a deeper understanding of the patient's condition and prognosis than the patients themselves, they are often the first to recognize the future need for ACP. It is important to gather and incorporate patients' preferences and relevant information regarding ACP early in the course of daily cancer treatment. However, many oncologists and medical staffs still lack sufficient understanding of ACP or find it difficult because they do not understand the procedure. To address this, we have established an in-hospital working group to organize how to share information with medical staff, such as nurses, who play a crucial role in ACP. While many oncologists find it difficult to deliver bad news to patients, oncologists are the only ones who can introduce ACP at the appropriate time. With the advent of cancer genomic medicine, there have been cases where patients, previously considered terminal under conventional care, have gained new opportunities for improvement. It is essential to integrate ACP into cancer care by recognizing the unique advantage oncologists have in adapting to the rapid changes in cancer treatment.

Objective: To describe the actual communication of patients with breast cancer on oral abemaciclib treatment and the motivating factors to continue treatment.

Methods: An online survey was conducted in July and August 2023 across Japan among patients aged ≥18 years who were undergoing or had prior experience with abemaciclib treatment and physicians who had prescribed abemaciclib during the past year.

Results: Responses from 80 patients and 78 physicians were obtained. The main explanations patients received from their physicians before/after starting treatment were related to side effects (90%)and effectiveness(88%). Regarding management of side effects, both patients(66%)and physicians(54%) responded that"easy-to-understand explanations on how to deal with side effects"is necessary. The proportion of patients who received an explanation from their physician on how to deal with side effects was relatively low. A notable challenge experienced by patients when they had side effects was "I don't know how severe my symptoms should be before contacting or visiting the hospital".

Conclusions: The results of this survey suggest that specific, easy-to-understand information from healthcare professionals on adverse events and how to deal with them could help patients more appropriately self-manage abemaciclib treatment.

In this study, we report the case of a patient with triple-negative breast cancer who achieved a pathological complete response(pCR)following neoadjuvant chemotherapy but experienced early recurrence and had a poor prognosis. A 46-year-old woman with a diagnosis of triple-negative breast cancer(cT2cN3cM0, cStage ⅢC)received neoadjuvant chemotherapy with dose-dense doxorubicin and cyclophosphamide, followed by weekly paclitaxel. The patient underwent a mastectomy and axillary lymph node dissection, achieving pCR. Subsequently, she received postmastectomy radiation therapy. As the patient was diagnosed with a pathogenic BRCA2 variant, a risk-reducing salpingo-oophorectomy was scheduled. However, liver metastases were detected on a preoperative PET-CT scan 7 months after surgery. Therefore, the patient was treated with olaparib followed by chemotherapy but died 15 months after surgery because of treatment inefficacy. Certain studies describe early TNBC recurrence in patients with pCR within 3 years after surgery, with cN1 or higher being common. Clinicians should be aware of potential TNBC recurrence in patients with pCR, especially within 3 years. Additionally, in the KEYNOTE-522 study, the hazard ratio for the pembrolizumab group compared to the placebo group was 0.73 in the event-free survival analysis of patients with pCR. Therefore, it is recommended that patients receive chemotherapy in combination with pembrolizumab.

An 80-year-old woman presented with blood-stained sputum. Computed tomography revealed the presence of multiple lung nodules. The patient underwent surgery for left breast cancer at 48 years of age. A transbronchial lung biopsy was performed to identify the primary tumor. The pathological diagnosis was adenocarcinoma and immunohistochemical staining indicated that the lung nodules were breast cancer metastases. Positron emission tomography revealed multiple metastases to the bones, skin, peritoneum, and mesenteric lymph nodes. The patient indicated that the quality of life was a critical factor in selecting therapy. Denosumab and an aromatase inhibitor were selected as the first-line systemic chemotherapies. The treatment resulted in tumor shrinkage that lasted for 3 years, after which the peritoneal metastases started to regrow. We recommended tegafur/gimeracil/oteracil as second-line chemotherapy, which the patient discontinued within 1 month because of severe side effects. We next administered fulvestrant, which resulted in the long-term shrinkage of most tumors without regrowth. This treatment did not negatively affect patients' quality of life. Some breast cancers recur ≥5 years after the primary surgery. Therefore, this is a very rare case of breast cancer recurrence with an interval of 32 years after the initial treatment.

A 61-year-old woman underwent an open right hemicolectomy for perforated ascending colon cancer. Later, the patient underwent R2 surgery for duodenal invasion. Chemotherapy was initiated with mFOLFOX6 and panitumumab post-surgery. Subsequently, oral minocycline was administered for the acne-like rash caused by panitumumab 19 days after the first treatment course. The patient showed a significant decrease in platelet count to 2.3×104/μL 18 days after oral medication initiation. However, platelet count improved to 10.6×104/wL 1 week after stopping minocycline. The timing of the decrease in platelet and white blood cell counts indicated minocycline as the suspected cause of thrombocytopenia, possibly during its administration to treat the acne-like rash, which was caused due to the anti-EGFR inhibitor side effects. Overall, this study highlights the need to monitor and manage minocycline-induced thrombocytopenia during chemotherapy.