Japanese Journal of Cancer and Chemotherapy最新文献

For epidermal growth factor receptor(EGFR)gene mutation-positive advanced non-small-cell lung cancer, molecular targeted therapy with EGFR tyrosine kinase inhibitors(EGFR-TKIs)is the mainstay of treatment. In Japan, 5 EGFR-TKIs[gefitinib and erlotinib(first-generation), afatinib and dacomitinib(second-generation), and osimertinib(third-generation)]have been approved, and only ramucirumab, an anti-angiogenic agent, has been approved for use in combination with the first-generation EGFR-TKIs. Since only osimertinib is approved for use in second-line therapy in the patients with confirmed T790M mutation after EGFR-TKI treatment, any other EGFR-TKI than osimertinib has to be selected as the first-line therapy of sequential treatment using EGFR-TKIs both as first-line and second-line therapy. Treatment options vary widely, and it is therefore important to select an optimal treatment based on clinical information such as a subtype of the EGFR gene mutation, as well as the patient's preference to potentially use molecular targeted therapy for second-line therapy. This article outlines clinical study data on the use of EGFR-TKIs as first- and second-line therapies and the use in combination with anti-angiogenic agents. It also describes our clinical experience with a successful shift from first-line therapy with an EGFR-TKI to second-line therapy with EGFR-TKI in sequential treatment.

We describe the background, current status, status of competing countries, and future prospects of the project to develop remote robotic surgery via a commercial 5G network using the hinotoriTM Surgical Robot System.

The patient was a 60-year-old woman. She was diagnosed with hypertension, symptomatic epilepsy, renal failure, and cerebral infarction. During follow-up, she was found to have a mass in her left breast and was referred to our department. An irregular mass measuring 5 cm in diameter was palpated in the C region of the left breast. Multiple enlarged lymph nodes, thought to be metastases, were also palpated in the ipsilateral axillary lymph nodes. A needle biopsy revealed invasive ductal carcinoma, ER positive, PgR positive, HER2 negative, Ki-67 12%. A systemic examination revealed bone metastasis. Surgery was not possible due to comorbidities, so fulvestrant(500 mg/month)+denosumab(120 mg/month)was started. Furthermore, as the tumor markers were elevated, abemaciclib(300 mg/day)was added, which resulted in a decrease in the tumor markers. After 1 month of administration, grade 3 neutropenia was observed, so the dosage was reduced to 200 mg/day. During the course of treatment, the tumor markers rose again, so the dose was increased to 250 mg/day, which resulted in a decrease in the tumor markers and good tolerability. At present, 36 months after the start of treatment, long SD has continued, no adverse events of grade 3 or higher have been observed, and the drug has been well tolerated.

[Objective]To clarify the effect of immunotherapy on unresectable gastric cancer. [Subjects and methods]The study included all 67 patients with gastric cancer cStage ⅣB treated with systemic chemotherapy at Yarita Hospital between January 2016 and December 2022. The following 2 groups were compared: early patients treated between 2016 and 2017 and late patients treated between 2018 and 2022. [Results]Nivolumab was used in 20 patients(30%), and there were no cases of discontinuation due to irAE. The median overall survival was 11 months(0-91 months), with a duration of 13 months in the early group and 8.5 months in the late group(p=0.02). The transition rate to the third-line or later treatments increased from 6 of 27 patients(22%)in the early group to 13 of 40 patients(33%)in the late group(p=0.02). [Discussion]For patients evaluated in this study, the first and second treatment courses were introduced in the short-term, with the hope of subsequent treatment, even for patients with large ascites, poor PS, or complications. In recent years, drugs for the fourth-line and later treatments have been introduced, and we have observed patients for whom the latter treatment was effective.[Conclusion]The transition rate to the third-line or later treatments of patients with unresectable gastric cancer is increasing.

An 88-year-old man was referred to our hospital for further examination of an asymptomatic liver tumor. MRI showed low-intensity regions on T1-weighted images, high-intensity regions on T2-weighted images, high-intensity regions on diffusion-weighted images, and low-intensity regions in the arterial, portal, and hepatocyte phases of Gd-EOB-DTPA. PET scan of the tumor was positive, while endoscopy exhibited no malignant findings. The CT and MRI findings showed that the tumor could be a metastatic liver tumor, cholangiocellular carcinoma, or hepatic inflammatory pseudotumor. Considering the possibility of a malignant tumor, laparoscopic partial hepatectomy was performed as a diagnostic treatment. The patient was discharged on the 8th postoperative day. The histopathological diagnosis was diffuse large B-cell lymphoma. Since the lesion was localized to the liver, a diagnosis of malignant lymphoma originating from the liver was made. Six courses of R-THP-COP therapy were administered. No indication of recurrence was noted 18 months after surgery. Although primary hepatic lymphoma is difficult to diagnose, laparoscopic hepatectomy allows for an accurate diagnosis and early postoperative recovery, enabling rapid administration of chemotherapy.

We report encapsulated papillary carcinoma and mucinous carcinoma in a case of local advanced bilateral breast cancer. The patient was 78-year-old woman who had bilateral breast tumor. The right palpable tumor was 6 cm in diameter and left tumor was 7 cm in a diameter. Ultrasonography revealed a low echoic mass in both side breast. A core needle biopsy was performed for the bilateral tumor. Pathological diagnoses were suspicious of papillary carcinoma(right side), mucinous carcinoma(left side). She underwent a bilateral total mastectomy and sentinel lymph node biopsy. The final permanent pathological diagnoses were encapsulated papillary carcinoma(right side)and mixed type mucinous carcinoma(left side). After operation, she was administrated an aromatase inhibitor. The patient has been well and remained disease-free during a follow-up period of 1 years. The surgical excision was useful for locally advanced breast cancer patients who were possible to perform operation.

Hyperthermia is known to enhance the effects of radiotherapy and chemotherapy. We have previously shown that hyperthermia also enhances the effects of molecular targeted therapy, immune cell therapy, and immune checkpoint inhibitors (ICI). Here, we present the recent clinical data and research results that suggest the mechanism of enhancement. Clinical data: We treated 3,419 advanced or recurrent cancer patients between June 2005 to December 2023. The effective rate (CR+PR+long term SD)was 19.7%. The effective rate of 2,329 patients treated with dendritic cells was 25.4%. The effective rate of 140 patients treated with combined dendritic cell therapy and ICI was high at 56.4%, and increased from 40.0 to 57.7% by the addition of hyperthermia. Clinical tissue: Hyperthermia promoted immune cell infiltration and enhanced MHC-class Ⅰ and PD-L1. Animal experiments: We have previously reported that hyperthermia promotes immune cell infiltration and increases MHC-class Ⅰ and PD-L1. We showed that hyperthermia increased p-STAT1 and IRF1 followed by PD-L1 expression. This study suggested that hyperthermia increased ICI through immune cell infiltration and expression of p-STAT1 and IRF1 pathways.

The patient was a 47-year-old woman. She had been aware of abdominal distension for several months and visited our hospital. Contrast CT revealed a 30 cm tumor with uneven contrast effect. MRI showed uniform low signal intensity on T1 weighted images and a mixture of low and high signal intensity on T2 weighted images. She was diagnosed with a giant ovarian tumor and underwent surgery at the gynecology department. Laparotomy revealed that the tumor originated in the small intestine mesentery rather than the ovary, and she was referred to our department during surgery. The tumor had involved the ileocolic artery and vein, and was removed by right hemicolectomy. The specimen was 32×32×27 cm and weighed approximately 8 kg. Histopathological examination showed proliferation of spindle cells. Immunohistochemistry showed negative staining for c-kit and positive staining for β-catenin. The tumor was diagnosed as an intra-abdominal desmoid tumor. Intra-abdominal desmoid is a rare disease, and diagnosis and surgical procedure are often difficult. We report a case of resection of a giant mesenteric desmoid tumor with a review of the literature.