Japanese Journal of Cancer and Chemotherapy最新文献

Breast cancer(BC)is the most common cancer among Japanese women aged 30-39 years. In recent years, the impact of oncofertility has become an important issue. In Gifu prefecture, the oncofertility network was established to provide information regarding cancer treatment and fertility preservation. We retrospectively analyzed 42 BC patients(mean age 34.5) who received treatment at Gifu University Hospital and consulted the oncofertility clinic between May 2013 and December 2023. The clinical stages were as follows:Stage 0 in 1 patient(2%), Stage Ⅰ in 14(33%), Stage Ⅱ in 23(56%), Stage Ⅲ in 3(7%), and Stage Ⅳ in 1(2%). The molecular subtypes were:Luminal A in 13 patients(31%), Luminal B in 14 (33%), Luminal/HER2 in 8(19%), HER2-enriched in 2(5%), and triple-negative BC in 5(12%). Fertility preservation was performed in 15 patients, including embryo cryopreservation in 10, oocyte cryopreservation in 4, and ovarian tissue cryopreservation in 1. Among them, 12 patients(80%)were either unmarried or married without children. Offering fertility preservation options and providing appropriate information are essential in supporting the treatment of young BC patients.

The patient was a 53-year-old female diagnosed with right breast cancer cT2N2bM0, cStage ⅢA, and the histopathological findings revelaed invasive ductal carcinoma, NG2, HG2, ER 90%, PgR 30%, HER2 3+, and Ki-67 50%. Cardiac function tests to assess suitability for neoadjuvant chemotherapy revealed a left ventricular ejection fraction of 39.7% and left ventricular hypokinesis. Trastuzumab was the preferred treatment for the breast cancer, and after consultation with the cardiologist, trastuzumab+pertuzumab+paclitaxel was initiated as neoadjuvant chemotherapy, in combination with an angiotensin Ⅱ receptor blocker and a beta-blocker. Post-surgery, histopathological examination revealed a non-pathological complete response, and treatment was continued with a T-DM1+aromatase inhibitor. The patient's cardiac function remained stable during anti-HER2 antibodies. We encountered a case in which anti-HER2 antibodies were administered to a patient with a HER2-positive breast cancer and markedly reduced cardiac function. With regular monitoring, appropriate cardiac care, and cardioprotective medications, anti-HER2 antibodies can be safely administered to patients with impaired cardiac function.

An elderly woman in her 80s with a medical history of rheumatoid arthritis and chronic hepatitis B was diagnosed with Stage Ⅳ, ER-negative, HER2-positive invasive ductal carcinoma of the left breast, with mediastinal lymph node metastases. She received chemotherapy combined with anti-HER2 therapy and achieved a complete remission after 12 months. Three years and 7 months later, FDG-PET/CT revealed enlargement of the left axillary lymph nodes, and they were suggested as recurrences. Radiotherapy was administered, resulting in temporary reduction in lymph node size. However, 10 months later, the lymph nodes re-enlarged and were subsequently surgically resected. Histopathological examination revealed that they were non-caseating granulomas without any evidence of malignancy, consistent with a diagnosis of sarcoid-like reaction. The patient has been followed up postoperatively without recurrence for 12 months.

A 40s woman visited her previous physician with a complaint of bloody stools, and a colonoscopy revealed lower rectal cancer. A close examination by our department revealed an advanced rectal cancer 1 cm to the dentate line, and a diagnosis of cT3N1M0, cStage Ⅲb was made. The circumferential resection margin(CRM)and distal margin(DM)were extremely close, making upfront surgery challenging in securing a surgical resection margin while also preserving the anus. This situation posed a high risk of local recurrence, leading to the decision for neoadjuvant therapy. After chemoradiation therapy (CRT), the patient showed a response of ycT3N0M0, ycStage Ⅱa and subsequently underwent robotic very low anterior resection. The anastomosis was performed using double stapling technique(DST)in the anal canal during robotic surgery. The pathology results revealed no residual tumor and no lymph node metastasis. We report a case in which a pathological complete response(pCR)was achieved after preoperative CRT, while successfully preserving the anus through intra-anal DST under robotic surgery.

Case 1:An 80-year-old man underwent laparoscopic low anterior resection and subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection for rectal cancer and cholangiocarcinoma, respectively. After the operation, he complained of pain around his left shoulder and was pathologically diagnosed as cervical spine metastasis(C6)from cholangiocarcinoma. He requested only pain relief rather than aggressive medication and died 5 months after surgery. Case 2:A 66-year-old woman was diagnosed as initially unresectable locally advanced gallbladder cancer. She received 3 courses of chemotherapy with gemcitabine+cisplatin and underwent conversion surgery(S4a+S5 hepatic resection with extrahepatic bile duct resection, lymph node dissection and partial resection of duodenum). After the operation, she complained of lower limb paralysis and was diagnosed as thoracic spine metastasis(Th6)from gallbladder cancer. Her general condition was worsened rapidly due to the pain and she died 5 months after surgery. Since the prognosis is extremely poor, pain management is the essential of treatment to improve the QOL of patients with bone metastasis from biliary tract cancer.

Cervical cancer remains a major global health burden, with limited therapeutic outcomes in advanced and recurrent settings. For locally advanced disease, cisplatin-based chemoradiotherapy(CRT)has long been the standard of care; however, the advent of immune checkpoint inhibitors(ICIs)and antibody-drug conjugates(ADCs)has recently reshaped the treatment landscape. The phase Ⅲ KEYNOTE-826 trial demonstrated that pembrolizumab combined with chemotherapy significantly improved overall survival(OS)in recurrent or metastatic cervical cancer, establishing a new first-line standard. Moreover, the KEYNOTE-A18 trial showed that pembrolizumab in combination with CRT followed by maintenance therapy achieved a 36-month OS rate of 82.6%, marking the first major breakthrough in locally advanced disease in approximately 25 years. In parallel, the ADC tisotumab vedotin significantly prolonged OS to 11.5 months in previously treated recurrent or metastatic cases in the phase Ⅲ innovaTV 301 trial and received approval in Japan in March 2025. Current guidelines, including NCCN v1, 2025 and the ESMO/ESGO/ESTRO joint recommendations, endorse ICI-combined CRT for locally advanced disease, ICI plus chemotherapy as first-line treatment for recurrent/metastatic disease, and ADC therapy as the standard second-line option, reflecting a global reorganization of therapeutic algorithms. Future directions include the establishment of predictive biomarkers, deeper understanding of the tumor microenvironment, and optimization of ICI-ADC combination strategies, aiming to realize a personalized treatment paradigm grounded in immune and molecular targeting.

A 41-year-old woman presented with persistent dizziness. A neurological exam revealed rapid, multidirectional saccades, suggestive of opsoclonus-myoclonus syndrome(OMS). CT incidentally revealed a right breast mass, and further evaluation confirmed Stage ⅢC(cT2N3aM0), HR-positive/HER2-negative breast cancer, considered the underlying cause of OMS. Neoadjuvant chemotherapy with AC followed by weekly paclitaxel improved OMS and achieved partial tumor response. She underwent breast-conserving surgery with axillary dissection. Postoperatively, tamoxifen, a CDK4/6 inhibitor, and radiotherapy were administered. Five months after surgery, multiple liver metastases developed. Despite initiating weekly paclitaxel plus bevacizumab, the disease progressed rapidly, and she died 4 months later. Notably, OMS symptoms did not recur. This case highlights paraneoplastic OMS as an initial manifestation of breast cancer, with neurological improvement following systemic therapy.

The patient is a 66-year-old man. He underwent posterior and antero-dorsal segmentectomy for hepatocellular carcinoma(HCC)detected at physical examination. Early postoperatively, he developed a single S3 metastasis in the left lung and started combination therapy with atezolizumab plus bevacizumab. During the ninth course of treatment, recurrence was also observed in S2 of the remaining liver. A partial resection of the left upper lobe of the left lung was performed by open thoracotomy and partial resection of the outer hepatic segment through a diaphragmatic approach. Histopathological analysis suggested that the lung metastasis was distant metastasis from the first posterior segment tumor and that the liver S2 was multicentric carcinoma. He was treated with lenvatinib for a short period of time postoperatively, but recurred multiple metastases in both lungs on CT scan 3 months later. He has been treated with a combination of durvalumab plus tremelimumab while submitting to cancer genome testing, which revealed TMB-high and MSI-high. Tissue sampling is essential for the diagnosis of inter-hepatic metastasis or multicentric occurrence, and in the case of ipsilateral hepatopulmonary metastasis, trans-diaphragmatic approach surgery is effective for less incision surgery. Combined immunoadjuvant therapy for resected HCC has shown efficacy in short-term results.

Malignant lymphoma(ML)occurring in the oral cavity are often difficult to diagnose, as their clinical presentation is non- specific and may resemble that of other malignancies or inflammatory conditions. We report a case of diffuse large B-cell lymphoma(DLBCL)detected as a result of ill-fitting dentures. The patient was an 80-year-old man. He had a medical history of chronic heart failure(NYHA class Ⅲ, after CABG), COPD, and benign prostatic hyperplasia. In the middle of February 2018, he visited a dental clinic with a chief complaint of ill-fitting dentures and was subsequently referred to our department for further examination and treatment. At the initial examination, the patient exhibited bilateral facial asymmetry and swelling extending from the right cheek to the right submandibular region, with palpable induration. These findings strongly suggested that the patient had a malignant tumor, and we clinically diagnosed him as having ML(Ann Arbor staging, Stage Ⅳ)based on various imaging studies. Histopathological examination confirmed the diagnosis of DLBCL. In consultation with the hematology department, the patient began treatment with R-CEOP therapy(administered at 50% dose due to severe cardiac dysfunction): rituximab 375 mg/m2, etoposide 50 mg/m2, vincristine 1.4 mg/m2, and cyclophosphamide 750 mg/ m2), and the patient underwent 6 courses of this therapy. However, the tumor continued to increase in size, and radical treatment was deemed difficult. In late August 2019, the patient developed ventricular tachycardia, followed by ventricular fibrillation, and subsequently died from cardiopulmonary arrest. Although oral ML are rare, it is critical for oral surgeons to promptly recognize suspicious clinical signs and initiate appropriate diagnostic procedures, including imaging and biopsy, to ensure early diagnosis and treatment.

We report a case of breast bleeding caused by breast cancer without skin invasion. A woman in her 70s was aware of a mass in her right breast but left it untreated. About 6 months after noticing the mass, she visited our hospital due to bleeding from the right breast. Although needle biopsy did not reveal a diagnosis of breast cancer, we diagnosed her as having breast cancer based on clinical findings and recommended her to have surgery. Her consent was not obtained. Approximately 1 year later, she experienced bleeding from her right breast and visited our hospital. A tumor was identified, a biopsy was performed, and a diagnosis of breast cancer was made. A right lumpectomy and sentinel lymph node biopsy was carried out. Pathological diagnosis was invasive ductal carcinoma. No skin invasion was observed. The final diagnosis was pT1c, pN0 (sn), M0, pStageⅠ. After surgery, the patient was treated with tamoxifen and radiation therapy, and is currently free of recurrence.