Japanese Journal of Cancer and Chemotherapy最新文献

Perioperative fluorouracil, epirubicin and cyclophosphamide(FEC)therapy is a standard treatment for breast cancer. However, more than 20% of patients with breast cancer who undergo FEC therapy experience febrile neutropenia(FN), for which pegfilgrastim is commonly recommended as primary prophylaxis. Although the efficacy and safety of pegfilgrastim were verified at the time of drug approval, there are still no reports on its long-term safety. In this study, we assessed the long-term safety of pegfilgrastim and changes in blood cell components, further assessing the incidence of FN. There were no significant differences in the leukocyte count, neutrophil count, lymphocyte count, hemoglobin concentration, or platelet count with or without the use of pegfilgrastim at 1 year. No long-term effects of pegfilgrastim on blood cell components were observed. The incidence of FN was 6.5% with pegfilgrastim administration and 22.8% without pegfilgrastim administration(p=0.020). Primary prophylaxis with pegfilgrastim can reduce the incidence of FN and can be safely used for 1 year after initial administration in patients with breast cancer undergoing chemotherapy.

We report a case of pathological complete response to neoadjuvant chemotherapy for abscess-forming rectal cancer. A woman in her 60s visited her primary care physician because she noticed an increase in the quantity of vaginal discharge. An irregular mass of goose-egg size found on the right vaginal wall was diagnosed as adenocarcinoma on biopsy, and she was referred to our hospital. After further examination, the mass was diagnosed as RbP, cT4b(vaginal), cN1a, cM0, cStage Ⅲc rectal cancer with abscess formation. After 6 courses of CAPOX as neoadjuvant chemotherapy, rectal resection(combined resection of the posterior vaginal wall) was performed. Pathological diagnosis showed no tumor cells and lymph node metastasis. Four courses of CAPOX were administered as postoperative adjuvant chemotherapy. The patient is still alive 4 years after surgery, without recurrence. When neoadjuvant chemotherapy is successful, radical resection is possible, even in cases with abscess formation, and long-term survival can be expected.

A 70-year-old man who developed recurrent Stage ⅣA1 Sézary syndrome after first-line treatment received 6 cycles of mogamulizumab treatment. After mogamulizumab treatment completion, persistent effects on peripheral blood lesions were observed. Although Sézary syndrome is a relatively uncommon cutaneous lymphoma, it is important to recognize that the effects of mogamulizumab may not be limited to the treatment course and might be sustained even after treatment completion.

A 49-year-old man underwent an open cholecystectomy for advanced gallbladder cancer in 2021. Three months after surgery, the patient underwent an additional resection, which showed no malignant findings, but 12 months after surgery, contrast-enhanced CT and MRI showed a new mass lesion in segment 8 of the liver, and the patient was diagnosed with postoperative hepatic metastatic recurrence of gallbladder cancer. After referral to our institution, he received 1 course of gemcitabine+cisplatin(GC)therapy and 8 courses of gemcitabine+cisplatin+durvalumab(GCD)therapy. Contrast- enhanced CT and MRI showed that the metastases had shrunk, and PET scan showed no FDG accumulation. Two months after completion of chemotherapy, there was no evidence of metastatic enlargement and new metastasis including distant metastasis, and the patient was referred to our department. Since curative resection was expected, a laparoscopic partial hepatectomy of segment 8 of the liver was performed. Pathological diagnosis revealed no residual tumor. If the metastases could be well controlled by systemic chemotherapy, hepatectomy for hepatic metastases of biliary tract cancer could be a treatment option.

Patients undergoing outpatient cancer chemotherapy are prescribed"as-needed"medication(antiemetics, laxatives, and antibiotics)as a form of self-care for early response to side effects. We conducted a questionnaire survey to clarify whether prescribed"as-needed"medication contributes to the relief of patients' anxiety about cancer chemotherapy. We obtained responses from 80 breast cancer patients who received neoadjuvant or adjuvant chemotherapy from 2019-2021". As- needed"medication was used by 68(85.0%)of patients. Fifty patients(73.5%)who used"as-needed"medication experienced relief of anxiety associated with chemotherapy. Also, 10 patients(83.3%)who did not use"as-needed"medication experienced relief of anxiety associated with chemotherapy". As-needed"medication may contribute to the relief of anxiety associated with chemotherapy in breast cancer patients.

The patient was a 35-year-old man who saw his first doctor with the chief complaint of painful urination. A contrast- enhanced CT scan of the abdomen revealed a diagnosis of abscess-forming appendicitis with inflammatory spread to the bladder, and conservative treatment was decided. Since antibiotic treatment failed to reduce the size of the abscess, he underwent surgery. The bladder wall was highly inflamed, only appendectomy was performed. Pathology revealed appendiceal mucinous carcinoma invading the bladder, so he was referred to our department. Because a total cystectomy was required for curative resection and there was concern about seeding associated with the initial surgery, he was judged to be unresectable, and received chemotherapy. After 6 courses of CAPOX+bevacizumab therapy, he was able to have a bladder- sparing curative resection because of the absence of distant metastasis and shrinkage of the tumor. He remains stable without recurrence 6 months after surgery. We herein report, with some discussion of the literature, this case of bladder-invading appendiceal mucinous carcinoma arising from abscess-forming appendicitis, for which a curative resection was possible after chemotherapy.

Cancer treatment has made remarkable progress in recent years, particularly in the field of drug therapy. However, the high-cost of new drugs has led to active discussions about cost-effectiveness in cancer treatment. This article examines the pharmacoeconomics of drug therapy in cancer treatment from both macro and micro perspectives. From a macro perspective, Japan's drug pricing system determines prices based on the presence or absence of similar drugs. The system aims to balance the incentives for developing innovative new drugs with the sustainability of healthcare costs. The increasing share of drug costs in overall healthcare expenditure, especially for anticancer drugs, poses a significant challenge. From a micro perspective, hospitals face challenges in managing their revenue structure due to the low profit margins on anticancer drugs and the complex diagnosis-related group(DPC)classification system. The use of expensive anticancer drugs, such as immune checkpoint inhibitors, increases the drug cost burden on hospitals. While the high-cost medical care benefit system sets an upper limit on patient out-of-pocket expenses, the increasing use of high-priced drugs remains a concern for both patients and healthcare providers. Balancing patient access to innovative treatments with the sustainability of healthcare costs is a critical issue in cancer drug therapy. Addressing this challenge requires a comprehensive approach that considers both macro and micro perspectives.

Conducting"health economic evaluation"is one of the most important issues for the efficient allocation of healthcare costs. Although the Central Social Insurance Medical Council in Japan(Chuikyo)introduced a cost-effectiveness evaluation system for drugs and medical devices in 2019, there are no reports of the system being officially utilized for medical procedures, including surgical treatments. Because it is often required to provide the best possible treatment to save lives, cancer care is an area where it is difficult to adapt"health economic evaluation". In addition, surgical treatment is more invasive than medical checkups or drug therapy, and complications and hospitalization costs vary widely from case to case, so the cooperation of the medical affairs department is essential in examining medical costs for health economic evaluation. Although QOL surveys are important for the evaluation of invasiveness, there are almost no large-scale studies that reflect the actual conditions of treatment, and none for Japanese and for patients undergoing cancer treatment. It is essential to conduct QOL surveys for future health economic evaluation. We will explain"health economic evaluation"of surgical treatment for cancer, using as examples the results of medical technology evaluation of surgical techniques that we have reviewed. In considering the"health economic evaluation"of surgical treatment for cancer, the medical cost and QOL surveys were considered to be particularly important. We look forward to future research.