Japanese Journal of Cancer and Chemotherapy最新文献

In Japan, the practice of advance care planning(ACP)for cancer patients may differ from Western countries due to cultural differences and the significant role of family in decision-making. Healthcare providers must consider the physical, psychological, social, and spiritual aspects of care when engaging in ACP, respecting patient autonomy and individual values. Effective communication skills and an understanding of behavioral economics are essential for navigating these discussions, particularly in the home care setting where family caregivers face unique challenges. The discrepancy between patients preferred and actual place of death highlights the need for improved access to and coordination of home-based end-of-life care. As society ages and healthcare resources become limited, ACP should be implemented not only for patients but also for healthcare providers themselves. Horizontal and vertical care coordination, as well as the integration of both, will be key to ensuring sustainable community-based care. ACP in the home care setting offers valuable insights into patients' and families' preferences, emphasizing the importance of collaboration between hospital and community-based healthcare providers. Ultimately, ACP should aim to support the entire community, including patients, families, and healthcare staff, in preparing for and navigating the complexities of end-of-life care.

There exist many issues concerning human resources development in cancer research. Not a single solution does not work, but correlative issues should be continuously and comprehensively considered. Board certification platform, timing of decisions to go to graduate school of medicine and to study abroad for young researchers: leading to the education for physician scientists, grants(Kakenhi)reduction, the Work System Reform for medical doctors, promotion women researchers for managerial posts, etc. Every researcher can network interdisciplinary and expand the possibility of the carrier to solve unanswered social issues.

A 72-year-old man had been undergoing chemotherapy for advanced gastric cancer for over 4 years. He presented with dysphagia, and esophagogastroduodenoscopy(EGD)revealed esophageal stricture due to tumor growth. Subsequently, he underwent placement of a partially covered esophageal stent(HANAROSTENT® Esophagus, M. I. Tech, Seoul, Korea; length, 15 cm; diameter, 18 mm). Nine days after stent placement, the patient experienced acute back pain. Computed tomography revealed right-sided pneumothorax and empyema. EGD revealed an esophageal perforation in the uncovered portion of the stent on the oral side, and gastrografin fluoroscopy revealed leakage into the thoracic cavity. A covered esophageal stent (HANAROSTENT® Esophagus; length, 8 cm; diameter, 18 mm)was additionally placed on the oral side of the perforation; however, the empyema did not improve. The patient died due to the aggravation of advanced gastric cancer 2 months after placement of the first stent.

Pyoderma gangrenosum(PG)is a rare skin disorder and its diagnosis is often delayed owing to its wound infection mimicking course. A 50-year-old woman presented to our hospital with multiple liver and bone metastases from breast cancer. A port was created on her right upper arm to administer chemotherapy. Although this treatment was successful, the port wound disrupted 10 months after treatment initiation. An infection was suspected, the port was removed, and chemotherapy was discontinued. However, another ulcer with necrotic tissue was observed in the right inguinal region. Skin biopsy revealed dense infiltration of neutrophils into the epidermis and dermis. The patient was administered prednisolone 30 mg/ day, and both wounds recovered. This case shows that, when skin necrotic ulcers are observed in patients with cancer, PG must be considered as a differential diagnosis.

Objectives: To analyze the efficacy, safety, prognostic factors, factors affecting treatment continuation, suitable treatment candidates, and optimal administration schedule in patients with acute myeloid leukemia(AML)treated with venetoclax plus azacitidine(VEN+AZA).

Methods: We performed a retrospective analysis of the data of 39 patients with untreated or relapsed/refractory AML.

Results: The median duration of follow-up was 6 months, and the median number of treatment cycles was 2. The composite complete remission(CRc)achievement rate(complete remission+complete remission with incomplete hematological recovery)was 61.5%. The treatment discontinuation rate was 76.9%, the median overall survival (OS)was 7.7 months, and event-free survival(EFS)was 4.8 months. In subgroup analyses, significant differences in the OS were observed between subgroups stratified according to the cytogenetic risk, CRc achievement rate, and Charlson comorbidity index(CCI)(≤7 vs <7). A significant difference in the EFS was also observed between subgroups stratified according to the cytogenetic risk and CRc achievement rate. The response rate tended to be lower in the adverse cytogenetic risk subgroup. Patients who received VEN for 21 days or less in the first treatment cycle tended to have a better OS.

Conclusions: A lower OS and EFS were associated with a higher treatment discontinuation rate, lower number of treatment cycles, and lower CRc achievement rate than those observed in the VIALE-A trial. We considered that treatment continuation was important to improve the prognosis. We also concluded that it is important to select candidates suitable for VEN+AZA treatment and to modify the administration schedule.

Claudins(CLDNs)are essential components of tight junctions, which are the most apical elements of apical junctional complexes. The family consists of more than 20 members in humans and shows distinct expression patterns in a tissue- and cell-type-specific manner. Recently, many studies have shown that CLDNs overexpressed in cancer cells positively regulate their malignant behavior. First, fusion genes between CLDNs and signaling molecules produce chimeric proteins that act as drivers. Second, cancer and non-cancer cells form heterocellular adhesions via CLDNs and they act as a metastatic niche. Third, CLDNs enhance cancer cell nutrition by conjugating with amino acid transporters on the cell membrane. Fourth, CLDN acts as an activation trigger for signalling cascades. In this review, we present these 4 representative examples of how CLDNs positively regulate cancer progression.

Aim: This study evaluated changes in carcinoembryonic antigen(CEA)values obtained using measurement methods.

Patients and methods: For this analysis, 163 patients with colorectal cancer who underwent new CEA measurements between January and March 2023 were included. Centaur XP or XPT was used as the assay device and ADVIA Centaur CEA was used as the reagent until December 2022(old assay method). The Alinity i system was used as the assay device and CEA-Abbott was used as the reagent after January 2023(new assay method).

Results: Sixteen patients with recurrence and 2 patients with other cancers were excluded. The participants consisted of 76 men and 69 women with a median age of 74 years. The median interval between new and old CEA values was 91 days. The new CEA values were higher than the old CEA values in all but 1 case(99.3%). The mean CEA increased from 2.06 ng/mL to 3.14 ng/mL and was significantly higher when using the new assay method(p<0.0001). An approximate curve was plotted using the old CEA value as x and the new CEA value as y, yielding the following equation: y=1.3281x+0.4112(R2=0.8334).

Conclusion: This study showed that CEA levels differ depending on the measurement method used.

Tight junctions(TJs)are a type of intercellular junction that present in vertebrate epithelial and endothelial cells, and contribute to the barrier function of the epithelium and endothelium by limiting the leakage of water-soluble molecules through the intercellular spaces. Claudins are membrane proteins that play a central role in the structure and function of TJs. Claudins form the claudin family, which consists of more than 20 subtypes. Most epithelial cells express multiple claudin subtypes, and different cell types express different combinations of claudins. Importantly, claudin subtypes can be classified into barrier-forming types, which form TJs that block electrolyte permeation, and pore-forming types, which form small pores in the TJs that allow electrolyte permeation. Different combinations of claudins create functional diversity of TJs, tuning the permeability of the intercellular space according to the physiological requirement for each epithelium. Analyses of the phenotype of various claudin gene knockout mice and genetic diseases caused by claudin genes mutations have led to a better understanding of the organ-level function of TJs and the pathologies caused by TJ dysfunction.