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Yamazaki N, Kiyohara Y, Uhara H, Uehara J, Fujimoto M, Takenouchi T, Otsuka M, Uchi H, Ihn H, Minami H. Efficacy and safety of nivolumab in Japanese patients with previously untreated advanced melanoma: A phase II study. Cancer Sci 2017; 108:1223-1230. [PMID: 28342215 PMCID: PMC5480079 DOI: 10.1111/cas.13241] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/28/2017] [Accepted: 03/02/2017] [Indexed: 12/30/2022] Open
Abstract
Treating advanced or recurrent melanoma remains a challenge. Cancer cells can evade the immune system by blocking T‐cell activation through overexpression of the inhibitory receptor programmed death 1 (PD‐1) ligands. The PD‐1 inhibitor nivolumab blocks the inhibitory signal in T cells, thus overcoming the immune resistance of cancer cells. Nivolumab has shown promising anticancer activity in various cancers. We carried out a single‐arm, open‐label, multicenter, phase II study to investigate the efficacy and safety of nivolumab in previously untreated Japanese patients with advanced melanoma. Twenty‐four patients with stage III/IV or recurrent melanoma were enrolled and received i.v. nivolumab 3 mg/kg every 2 weeks until disease progression or unacceptable toxicity. The primary endpoint was overall response rate evaluated by an independent radiology review committee. The independent radiology review committee‐assessed overall response rate was 34.8% (90% confidence interval, 20.8–51.9), and the overall survival rate at 18 months was 56.5% (90% confidence interval, 38.0–71.4). Treatment‐related adverse events (AEs) of grade 3 or 4 only occurred in three patients (12.5%). Two patients discontinued nivolumab because of AEs, but all AEs were considered manageable by early diagnosis and appropriate treatment. Subgroup analyses showed that nivolumab was clinically beneficial and tolerable regardless of BRAF genotype, and that patients with treatment‐related select AEs and with vitiligo showed tendency for better survival. In conclusion, nivolumab showed favorable efficacy and safety profiles in Japanese patients with advanced or recurrent melanoma, with or without BRAF mutations. (Trial registration no. JapicCTI‐142533.)
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Affiliation(s)
- Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshio Kiyohara
- Dermatology Division, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hisashi Uhara
- Department of Dermatology, Shinshu University School of Medicine, Nagano, Japan
| | - Jiro Uehara
- Department of Dermatology, Asahikawa Medical University, Hokkaido, Japan
| | - Manabu Fujimoto
- Department of Dermatology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tatsuya Takenouchi
- Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Masaki Otsuka
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Uchi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hironobu Minami
- Department Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Hyogo, Japan
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Seino Y, Terauchi Y, Wang X, Watanabe D, Niemoeller E. Safety, tolerability and efficacy of lixisenatide as monotherapy in Japanese patients with type 2 diabetes mellitus: An open-label, multicenter study. J Diabetes Investig 2017; 9:108-118. [PMID: 28195447 PMCID: PMC5754539 DOI: 10.1111/jdi.12646] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 12/16/2022] Open
Abstract
Aim/Introduction To assess the overall safety of lixisenatide monotherapy in Japanese patients with type 2 diabetes mellitus. Materials and Methods Patients with type 2 diabetes mellitus, previously treated with ≤1 oral antidiabetic drug, were enrolled in an uncontrolled, open‐label, single‐arm study over 24 and 52 weeks. Any oral antidiabetic drug treatment was stopped at the start of the 6‐week run‐in period. From baseline, patients received once‐daily lixisenatide monotherapy (10 μg for 1 week, 15 μg for 1 week, 20 μg thereafter) for 52 weeks (first 140 patients enrolled) or 24 weeks (subsequently enrolled patients). The primary end‐point was safety over 24 and 52 weeks. Secondary efficacy end‐points included absolute change in glycated hemoglobin, fasting plasma glucose and bodyweight from baseline. Results Of 428 patients screened, 361 and 140 were treated for 24 and 52 weeks, respectively; 88.4 and 90.0% completed treatment. During the 24‐ and 52‐week treatment periods, 268/361 (74.2%) and 117/140 (83.6%) patients, respectively, had treatment‐emergent adverse events; the most frequently reported was nausea (33.2 and 31.4%, respectively). The risk of severe hypoglycemia was low; only one case was reported. Lixisenatide treatment resulted in a decrease in mean glycated hemoglobin A1c (−0.98 and −0.86%), fasting plasma glucose (−1.05 and −0.85 mmol/L), and bodyweight (−1.33 and −1.48 kg) for the 24‐ and 52‐week treatment periods, respectively. Conclusions Once‐daily lixisenatide monotherapy was associated with a safety profile in line with the glucagon‐like peptide‐1 receptor agonist class, and improved glycemic control in Japanese patients with type 2 diabetes mellitus.
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Seino Y, Stjepanovic A, Takami A, Takagi H. Safety, tolerability and efficacy of lixisenatide in combination with oral antidiabetic treatment in Japanese patients with type 2 diabetes: An open-label, multicenter study. J Diabetes Investig 2017; 9:127-136. [PMID: 28429860 PMCID: PMC5754542 DOI: 10.1111/jdi.12686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/12/2017] [Accepted: 04/18/2017] [Indexed: 11/28/2022] Open
Abstract
AIM/INTRODUCTION To assess the overall safety and efficacy of lixisenatide in combination with background oral antidiabetic drug treatment in Japanese patients with type 2 diabetes, as required by Japanese guidelines. MATERIALS AND METHODS A phase 3, multicenter, uncontrolled, open-label, four-arm, parallel-group study of Japanese outpatients with type 2 diabetes was carried out; patients received once-daily lixisenatide in combination with biguanide, thiazolidinedione, alpha-glucosidase inhibitors or glinide (NCT01940965). The primary end-point was safety over 52 weeks; secondary end-points included absolute change from baseline in glycated hemoglobin A1c at weeks 24 and 52. RESULTS A total of 294 patients were enrolled (biguanide, thiazolidinedione, alpha-glucosidase groups: 73 patients each; glinide group: 75 patients). Overall, 90.4% of patients in the biguanide group, 83.6% in the thiazolidinedione group, 83.6% in the alpha-glucosidase group and 85.3% in the glinide group reported one or more treatment-emergent adverse event, the most common of which were nasopharingitis, nausea and constipation. Symptomatic hypoglycemia was reported in 5.5, 0, 1.4, and 10.7% of patients in the biguanide, thiazolidinedione, alpha-glucosidase and glinide groups, respectively. No severe hypoglycemia was observed. Hemoglobin A1c decreased from baseline at weeks 24 and 52, with mean changes ranging from -0.98 to -1.22%, and from -0.80 to -1.08%, respectively, across all groups. CONCLUSIONS Lixisenatide treatment administered daily over 52 weeks was well tolerated and effective in improving glycemic control in Japanese patients with type 2 diabetes uncontrolled with existing oral antidiabetic drug therapies. The use of lixisenatide in combination with oral antidiabetic drugs is a valuable treatment option for Japanese patients with type 2 diabetes after failure of oral antidiabetic treatment alone.
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Uemura H, Uemura H, Matsubara N, Kinuya S, Hosono M, Yajima Y, Doi T. Safety and efficacy of radium-223 dichloride in Japanese patients with castration-resistant prostate cancer and bone metastases. Int J Clin Oncol 2017; 22:954-963. [PMID: 28478485 PMCID: PMC5608784 DOI: 10.1007/s10147-017-1130-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/26/2017] [Indexed: 11/30/2022]
Abstract
Background Radiation therapy with radium-223 dichloride improves overall survival, reduces symptomatic skeletal events in Caucasian patients with castration-resistant prostate cancer (CRPC) and bone metastases, and is well tolerated. We report here the results of the first efficacy and safety study of radium-223 dichloride in a Japanese population. Methods In this open-label, uncontrolled, non-randomized, phase I trial, radium-223 dichloride was given to Japanese patients with CRPC and ≥2 bone metastases in 4-week cycles. The patients were divided into three cohorts, with cohort 1 and the expansion cohort receiving injections of radium-223 dichloride [55 kBq/kg body weight (BW)] every 4 weeks (Q4W) for up to six injections, and cohort 2 receiving an initial single radium-223 dichloride injection of 110 kBq/kg BW followed by up to five injections of 55 kBq/kg BW Q4W. Safety was determined via adverse event (AE) reporting, and biochemical bone markers were assessed for treatment efficacy. Results In total 19 patients received at least one dose of radium-223 dichloride and 18 patients experienced at least one treatment-emergent AE (TEAE) of which the most common were anemia, thrombocytopenia, and lymphocytopenia. Serious AEs were reported in three patients but none were drug-related. In the patients of cohort 1 + expansion cohort (55 kBq/kg BW Q4W treatment; n = 16), prostate-specific antigen levels remained stable or slightly increased while the bone alkaline phosphatase (ALP) level significantly decreased. The response rates of bone ALP (≥30 and ≥50% reductions) were 81.8 and 36.4% at week 12, and 81.3 and 50.0% at the end of treatment. Conclusions Radium-223 dichloride was well tolerated in these Japanese patients and, at a dose of 55 kBq/kg BW, efficacy on biomarkers was as expected. The outcomes in Japanese patients were consistent with those reported in other non-Japanese populations. Trial registration ClinicalTrials.gov record NCT01565746.
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Affiliation(s)
- Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan.
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nobuaki Matsubara
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Seigo Kinuya
- The Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Makoto Hosono
- The Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Yoko Yajima
- Clinical Development Specialty Medicine, Product Development, Bayer Yakuhin, Ltd., Tokyo, Japan
| | - Toshihiko Doi
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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Yamazaki N, Takenouchi T, Fujimoto M, Ihn H, Uchi H, Inozume T, Kiyohara Y, Uhara H, Nakagawa K, Furukawa H, Wada H, Noguchi K, Shimamoto T, Yokota K. Phase 1b study of pembrolizumab (MK-3475; anti-PD-1 monoclonal antibody) in Japanese patients with advanced melanoma (KEYNOTE-041). Cancer Chemother Pharmacol 2017; 79:651-660. [PMID: 28283736 PMCID: PMC5364262 DOI: 10.1007/s00280-016-3237-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/28/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE This phase I b study evaluated the safety and anti-tumor activity of pembrolizumab in Japanese patients with advanced melanoma. METHODS Pembrolizumab (2 mg/kg) was given every 3 weeks (Q3W) for up to 2 years or until confirmed progression or unacceptable toxicity. The tumor response was assessed as per the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) by both investigator review and central review. RESULTS Forty-two patients with advanced melanoma received pembrolizumab. A primary cutaneous histology was observed in 34 patients (81.0%), while a primary mucosal histology was observed in 8 patients (19.0%). Thirty-four patients (81.0%) experienced treatment-related adverse events (AEs). The most common treatment-related AEs were pruritus, maculopapular rash, malaise, and hypothyroidism. Grade 3-5 treatment-related AEs occurred in 8 patients (19.0%). The only grade 3-5 treatment-related AE reported in at least two patients was anemia. There were two treatment-related deaths (unknown cause and cerebral hemorrhage). Among the 37 evaluable patients, the confirmed overall response rates (ORRs) determined by central review were 24.1% (95% CI 10.3-43.5) for cutaneous melanoma and 25.0% (95% CI 3.2-65.1) for mucosal melanoma. The responses were durable, and the median duration of response was not reached in either population. The median overall survival (OS) was not reached, with a 12-month OS of 82.7% for cutaneous melanoma and 51.4% for mucosal melanoma. CONCLUSION The safety profile of pembrolizumab in Japanese patients was similar to that reported in the previous clinical studies. Pembrolizumab provided promising anti-tumor activity in Japanese patients with advanced melanoma.
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Affiliation(s)
- Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Tatsuya Takenouchi
- Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Uchi
- Department of Dermatology, Kyushu University School of Medicine, Fukuoka, Japan
| | - Takashi Inozume
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yoshio Kiyohara
- Department of Dermatology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hisashi Uhara
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Hiroshi Furukawa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hidefumi Wada
- Department of Dermatology, Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | - Kenji Yokota
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Hayashida K, Yasuda S, Matsumoto T, Amaki M, Mizuno S, Tobaru T, Jujo K, Ootomo T, Yamaguchi J, Fukuda K, Saito S, Foster E, Qasim A, Kitakaze M, Yozu R, Takayama M. AVJ-514 Trial - Baseline Characteristics and 30-Day Outcomes Following MitraClip ® Treatment in a Japanese Cohort. Circ J 2017; 81:1116-1122. [PMID: 28321004 DOI: 10.1253/circj.cj-17-0115] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The MitraClip®system is a transcatheter-based therapeutic option for patients with chronic mitral regurgitation (MR) who are at high risk for surgery. A prospective, multicenter, single-arm study was initiated to confirm the transferability of this system to Japan.Methods and Results:Patients with symptomatic chronic moderate-to-severe (3+) or severe (4+) functional or degenerative MR with a Society of Thoracic Surgery (STS) score ≥8%, or the presence of 1 predefined risk factor were enrolled. Patients with left ventricular (LV) ejection fraction (EF) <30% were excluded. MR severity and LV function were assessed by an independent echocardiography core lab. Primary outcome included major adverse events (MAE) at 30 days and acute procedural success (APS). A total of 30 patients (age: 80±7 years; STS score: 10.3%±6.6%) were treated with the MitraClip®. At baseline, all patients had MR 3+/4+ with 53%/47% patients with degenerative/functional etiology with mean LVEF of 50.2±12.8%, and 37% of patients were NYHA class III/IV. APS was achieved in 86.7% with no occurrence of MAE. At 30 days, 86.7% of patients had MR ≤2+ and 96.7% were NYHA class I/II. CONCLUSIONS The MitraClip®procedure resulted in clinically meaningful improvements in MR severity, function and quality of life measures, and low MAE rates. These early results suggest the transferability of this therapy to appropriately selected Japanese patients. (Trial Registration: clinicaltrials.gov Identifier NCT02520310.).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Atif Qasim
- University of California at San Francisco
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Abstract
The Japanese regulatory agency, the Ministry of Health, Labour and Welfare, requires sponsors to enroll a specific number or proportion of Japanese patients in multiregional clinical trials (MRCTs) in order to allow for the appropriate statistical evaluation of the efficacy and safety of an investigational drug in the Japanese population. This means the actual proportion of Japanese patients to the total sample size would need to be determined by taking into account the proportion of patients in other regions as well as the appropriate statistical considerations. Determining the proportion of Japanese patients that satisfies the regulatory agency's statistical requirement, along with taking into account the practical limitations of patient enrollment, would be difficult for sponsors. We believe that recent studies about the proportion of Japanese patients enrolled in MRCTs provides sponsors with useful information about partitioning sample size into individual regions for MRCTs in oncology. In this study, we investigated the proportion of Japanese patients in MRCTs and further compared the efficacy results from the overall population to that of the Japanese population. The proportion of Japanese patients averaged approximately 10.9%, but the proportion varied depending on the drug type. The results of the primary endpoints in Japanese patients were similar to those of the overall population, regardless of the proportion of Japanese patients.
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Affiliation(s)
- Akihiro Hirakawa
- 1 Statistical Analysis Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Fumie Kinoshita
- 1 Statistical Analysis Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
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Imatoh T, Sai K, Hori K, Segawa K, Kawakami J, Kimura M, Saito Y. Development of a novel algorithm for detecting glucocorticoid-induced diabetes mellitus using a medical information database. J Clin Pharm Ther 2017; 42:215-220. [PMID: 28097680 DOI: 10.1111/jcpt.12499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/05/2016] [Indexed: 01/08/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Glucocorticoid-induced diabetes mellitus (GIDM) increases the risk of diabetes mellitus (DM)-related complications but is generally difficult to detect in clinical settings. The criteria for diagnosing GIDM have not been established. Recently, medical information databases (MIDs) have been used in post-marketing surveillance (PMS) studies. We conducted a pharmacoepidemiological study to develop an algorithm for detecting GIDM using MID. METHODS We selected 1214 inpatients who were newly prescribed with a typical glucocorticoid, prednisolone, during hospitalization from 2008 to 2014 from an MID of Hamamatsu University Hospital in Japan. GIDM was screened based on fasting blood glucose (FBG) and haemoglobin A1c (HbA1c) levels according to the current Japan Diabetes Society (JDS) DM criteria, and its predictability was evaluated by an expert's review of medical records. We investigated further candidate screening factors using receiver operating characteristics analysis. RESULTS Sixty-three inpatients were identified by the JDS DM criteria. Of these, 33 patients were definitely diagnosed as having GIDM by expert's review (positive predictive value = 52·4%). To develop a highly predictive algorithm, we compared the characteristics of inpatients diagnosed with definite GIDM and those diagnosed as non-GIDM. The maximum levels of HbA1c in patients with GIDM were significantly higher than those of patients with non-GIDM (66·9 mmol/mol vs. 58·7 mmol/mol, P < 0·001). The patients with GIDM had significantly higher relative increase in maximum level of HbA1c (RIM-HbA1c) than those with non-GIDM (0·3 vs. 0·03, P < 0·001). However, we did not observe a significant difference in those of fasting blood glucose (FBG) levels. We applied the RIM-HbA1c as a second screening factor to improve the detection of GIDM. It showed that a 13% increase in RIM-HbA1c separated patients with from patients without GIDM. WHAT IS NEW AND CONCLUSIONS Patients with GIDM had significantly higher RIM-HbA1c than patients with non-GIDM. There was a 13% increase in RIM-HbA1c in patients with GIDM compared to the others. Our detection algorithm for GIDM using an MID achieved high sensitivity and specificity, and was superior to one based only on the current JDS DM criteria. Our results suggest that monitoring changes in HbA1c levels is important for detecting GIDM and adds to current diagnostic criteria for type 2 DM.
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Affiliation(s)
- T Imatoh
- Division of Medicinal Safety Science, National Institute of Health Sciences, Tokyo, Japan
| | - K Sai
- Division of Medicinal Safety Science, National Institute of Health Sciences, Tokyo, Japan
| | - K Hori
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - K Segawa
- Division of Medicinal Safety Science, National Institute of Health Sciences, Tokyo, Japan
| | - J Kawakami
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - M Kimura
- Department of Medical Informatics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Y Saito
- Division of Medicinal Safety Science, National Institute of Health Sciences, Tokyo, Japan
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Saida T, Kira JI, Kishida S, Yamamura T, Ohtsuka N, Dong Q, Tibung JT. Natalizumab for Achieving Relapse-Free, T1 Gadolinium-Enhancing-Lesion-Free, and T2 Lesion-Free Status in Japanese Multiple Sclerosis Patients: A Phase 2 Trial Subanalysis. Neurol Ther 2017; 6:153-159. [PMID: 28078634 PMCID: PMC5447555 DOI: 10.1007/s40120-016-0062-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION In a phase 2 trial of natalizumab in Japanese patients with relapsing-remitting multiple sclerosis (RRMS), treatment-related changes in relapses, brain lesions, and disability worsening were found to be comparable with those observed in the phase 3 studies of natalizumab in primarily non-Asian RRMS patients. METHODS This subanalysis of the placebo-controlled phase 2 trial of natalizumab in Japanese RRMS patients (n = 94) evaluated the effects of natalizumab versus placebo on the proportion of patients who achieved relapse-free, T1 gadolinium-enhancing (Gd+) lesion-free, and new/newly enlarged T2 lesion-free status, defined as "no evidence of inflammatory disease activity" (NEDA)-like status, after 24 weeks of treatment. RESULTS In this subanalysis, significantly more natalizumab-treated than placebo-treated patients achieved NEDA-like status (76.6% vs. 31.9%; P < 0.0001). In addition, the odds ratio (95% confidence interval) for patients on natalizumab to reach NEDA-like status was 6.98 (2.80-17.38) compared with placebo patients. CONCLUSION These results confirm previous findings indicating that natalizumab is efficacious in Japanese patients with RRMS. FUNDING Biogen. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT01440101.
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Affiliation(s)
- Takahiko Saida
- Kansai Multiple Sclerosis Center and Kyoto Min-iren Central Hospital, Kyoto, Japan.
| | - Jun-Ichi Kira
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Takashi Yamamura
- National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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Torisu Y, Nakano M, Takano K, Nakagawa R, Saeki C, Hokari A, Ishikawa T, Saruta M, Zeniya M. Clinical usefulness of ursodeoxycholic acid for Japanese patients with autoimmune hepatitis. World J Hepatol 2017; 9:57-63. [PMID: 28105259 PMCID: PMC5220272 DOI: 10.4254/wjh.v9.i1.57] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 09/25/2016] [Accepted: 11/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the therapeutic effects of ursodeoxycholic acid (UDCA) on autoimmune hepatitis (AIH).
METHODS A total 136 patients who were diagnosed with AIH were included in our study. All of the patients underwent a liver biopsy, and had at least a probable diagnosis on the basis of either the revised scoring system or the simplified scores. Initial treatment included UDCA monotherapy (Group U, n = 48) and prednisolone (PSL) monotherapy (Group P, n = 88). Group U was further classified into two subgroups according to the effect of UDCA: Patients who had achieved remission induction with UDCA monotherapy and showed no sign of relapse (Subgroup U1, n = 34) and patients who additionally received PSL during follow-up (Subgroup U2, n = 14). We compared the clinical and histological findings between each groups, and investigated factors contributing to the response to UDCA monotherapy.
RESULTS In Group U, 34 patients (71%) achieved and maintained remission over 49 (range: 8-90) mo (Subgroup U1) and 14 patients (29%) additionally received PSL (Subgroup U2) during follow-up. Two patients in Subgroup U2 achieved remission induction once but additionally required PSL administration because of relapse (15 and 35 mo after the start of treatment). The remaining 12 patients in Subgroup U2 failed to achieve remission induction during follow-up, and PSL was added during 7 (range: 2-18) mo. Compared with Subgroup U2, Subgroup U1 had significantly lower alanine aminotransferase (ALT) levels at onset (124 IU/L vs 262 IU/L, P = 0.023) and a significantly higher proportion of patients with mild inflammation (A1) on histological examination (70.6% vs 35.7%, P = 0.025). When multivariate analysis was performed to identify factors contributing to the response to UDCA monotherapy, only a serum ALT level of 200 IU/L or lower was found to be associated with a significant difference (P = 0.013).
CONCLUSION To prevent adverse events related to corticosteroids, UDCA monotherapy for AIH needs to be considered in patients with a serum ALT level of 200 IU/L or lower.
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Koretsune Y, Ikeda T, Kozuma K, Hirano T, Yasaka M, Kida M, Chachin M, Imura M. Patient satisfaction after switching from warfarin to apixaban in patients with nonvalvular atrial fibrillation: AGAIN study. Patient Prefer Adherence 2017; 11:1987-1996. [PMID: 29290682 PMCID: PMC5735985 DOI: 10.2147/ppa.s152579] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Patients treated with warfarin must adhere to frequent monitoring, dietary restrictions, and complicated dose adjustments. Apixaban, a direct factor Xa inhibitor, is an alternative to warfarin that may reduce patient burdens associated with warfarin therapy. However, there is limited evidence pertaining to patient satisfaction with anticoagulant therapies in Japanese patients. The purpose of this observational study was to investigate changes in patient satisfaction after switching from warfarin to apixaban. PATIENTS AND METHODS Nonvalvular atrial fibrillation (NVAF) patients who were scheduled to switch anticoagulants from warfarin to apixaban were enrolled and treated with apixaban for 12 weeks. Patient satisfaction was assessed before the change in medication and after 12 weeks of treatment with apixaban using the Anti-Clot Treatment Scale (ACTS), a patient-reported instrument for measuring satisfaction with anticoagulation treatment. The ACTS includes a 12-item burden scale (maximum 60 points) and a 3-item benefit scale (maximum 15 points). RESULTS Among 732 NVAF patients enrolled, the full analysis set consisted of 697 patients who completed two ACTS assessments (one before the medication change and one 12 weeks after the change). Mean (±standard deviation) patient age was 76.2±9.1 years and mean CHADS2 score was 2.5±1.3. There were no significant changes in ACTS benefit scores. However, ACTS burden scores showed significant improvements at Week 12 compared to baseline (55.6±5.3 at Week 12 and 49.7±8.7 at baseline; P<0.0001). Factors associated with changes in ACTS burden scores from the multiple logistic regression analysis were age ≥70 years (odds ratio [OR]: 1.86; 95% confidence interval [CI]: 1.12-3.10; P=0.0169), baseline ACTS burden score (OR: 0.79; 95% CI: 0.75-0.82; P<0.0001), and use of non-steroidal anti-inflammatory drugs/antiplatelet drugs (OR: 0.60; 95% CI: 0.36-1.00; P=0.0499). CONCLUSION Switching from warfarin to apixaban improved patient satisfaction with anticoagulant therapy in Japanese patients with NVAF by reducing burden of treatment.
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Affiliation(s)
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Toho University, Tokyo
| | - Ken Kozuma
- Division of Cardiology, Teikyo University School of Medicine, Teikyo University, Tokyo
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, National Hospital Organization, Kyushu Medical Center, Fukuoka
| | - Makoto Kida
- Medical & Development, Bristol-Myers Squibb K.K., Tokyo
| | - Motohiko Chachin
- Pfizer Innovative Health Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Miki Imura
- Pfizer Innovative Health Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
- Correspondence: Miki Imura, Pfizer Innovative Health Medical Affairs, Pfizer Japan Inc., 3-22-7 Yoyogi, Shibuya-ku, Tokyo 151 8589, Japan, Tel +81 80 5001 3070, Fax +81 3 5309 9198, Email
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Hibi T, Imai Y, Senoo A, Ohta K, Ukyo Y. Efficacy and safety of golimumab 52-week maintenance therapy in Japanese patients with moderate to severely active ulcerative colitis: a phase 3, double-blind, randomized, placebo-controlled study-(PURSUIT-J study). J Gastroenterol 2017; 52:1101-1111. [PMID: 28324167 PMCID: PMC5606947 DOI: 10.1007/s00535-017-1326-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/25/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The global phase 3 studies of golimumab [PURSUIT-SC and PURSUIT-maintenance (M)], an anti-tumor necrosis factor-α (anti-TNFα) antibody, have demonstrated clinical efficacy and safety as induction and maintenance therapies in patients with moderate to severely active ulcerative colitis (UC). This study aimed to evaluate the efficacy and safety of golimumab as maintenance therapy in the Japanese population. METHODS In this phase 3, double-blind (DB), placebo-controlled, parallel group, randomized withdrawal study, 144 Japanese patients with moderately to severely active UC received golimumab doses of 200 mg (at week 0) and 100 mg (at week 2) subcutaneously during the 6-week open-label induction phase. Patients who responded to golimumab induction therapy entered the DB maintenance (M) phase and were randomized (1:1) to receive 100 mg of golimumab subcutaneous injection (SC) or placebo every 4 weeks for 52 weeks. The primary endpoint was clinical response through M-week 54; secondary endpoints included clinical remission and mucosal healing at M-week 30 and 54. RESULTS Among induction responders, more patients on golimumab treatment (56.3%) maintained clinical response through M-week 54 versus the placebo group (19.4%). At both M-week 30 and 54, 50% golimumab-treated patients achieved clinical remission versus the placebo group (6.5%) and a higher proportion of patients on golimumab (59.4%) experienced mucosal healing than the placebo group (16.1%). Incidence of treatment-emergent adverse events was 96.9% in the golimumab group and 71% in the placebo group. Overall, the efficacy and safety results in this study were comparable with those observed in global studies. CONCLUSIONS Golimumab SC treatment maintained clinical efficacy through week 54 among induction responders, and no new safety signals were observed in the patients with moderate to severely active UC. CLINICAL TRIAL REGISTRATION The study is registered at ClinicalTrials.gov NCT01863771.
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Affiliation(s)
- Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8462 Japan
| | - Yuya Imai
- Janssen Pharmaceutical K.K., Tokyo, Japan
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Ichinose M, Kato M, Takizawa A, Sakamoto W, Grönke L, Tetzlaff K, Fukuchi Y. Long-term safety and efficacy of combined tiotropium and olodaterol in Japanese patients with chronic obstructive pulmonary disease. Respir Investig 2016; 55:121-129. [PMID: 28274527 DOI: 10.1016/j.resinv.2016.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/23/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The efficacy and safety of once-daily tiotropium+olodaterol (T+O) (2.5/5µg or 5/5µg) for treating chronic obstructive pulmonary disease (COPD) have been demonstrated in the large, multinational, randomized, Phase III studies TONADO® 1 and 2, which included 413 Japanese patients (~80 in each group). This study was conducted to supplement the TONADO® study data to assess long-term safety in ≥100 Japanese patients treated for 1 year in compliance with International Conference on Harmonisation guidelines. Efficacy was evaluated descriptively as a secondary end point. METHODS Patients were randomized to 52 weeks of double-blind treatment with once-daily T+O (2.5/5 or 5/5µg) or O (5µg) monotherapy via the Respimat® inhaler. We report the safety and efficacy data descriptively. RESULTS The incidence of adverse events (AEs) was comparable in the T+O 2.5/5µg (75.0%), T+O 5/5µg (85.4%), and O 5µg (80.5%) groups, with drug-related AEs being reported in 5.0%, 7.3%, and 4.9% of patients, respectively. Serious AEs were reported in 14 patients (11.5%). The change from baseline in forced expiratory volume in 1s (FEV1) area under the curve from 0 to 3h and trough FEV1 were numerically higher in the T+O treatment groups than in the O monotherapy group throughout the study period. Overall safety of T+O was comparable to that in the TONADO® studies. CONCLUSIONS No safety concerns for long-term T+O treatment were identified in Japanese patients with COPD. A numerical improvement in lung function was observed with T+O treatment compared to O monotherapy.
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Affiliation(s)
- Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
| | - Motokazu Kato
- Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka 596-8501, Japan.
| | - Ayako Takizawa
- Nippon Boehringer Ingelheim Co. Ltd, 2-1-1 Osaki, Shinagawa-ku, Tokyo 141-6017, Japan.
| | - Wataru Sakamoto
- Nippon Boehringer Ingelheim Co. Ltd, 2-1-1 Osaki, Shinagawa-ku, Tokyo 141-6017, Japan.
| | - Lars Grönke
- Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Strasse 173, 55216 Ingelheim am Rhein, Germany.
| | - Kay Tetzlaff
- Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Strasse 173, 55216 Ingelheim am Rhein, Germany; Department of Sports Medicine, University of Tübingen, Hoppe-Seyler-Strasse 6, 72076 Tübingen, Germany.
| | - Yoshinosuke Fukuchi
- Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
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Kadohara K, Sato I, Doi Y, Arai M, Fujii Y, Matsunaga T, Kawakami K. Prescription Patterns of Medications for Alzheimer's Disease in Japan from 2010 to 2015: A Descriptive Pharmacy Claims Database Study. Neurol Ther 2017; 6:25-37. [PMID: 27896785 DOI: 10.1007/s40120-016-0057-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Although four kinds of Alzheimer's disease (AD) drugs are available at present there was only one drug until 2011 in Japan. This study aimed to elucidate prescription trends of these medications for AD in Japanese outpatients before and after the new drug releases in 2011. METHODS This descriptive study of pharmacy claims databases analyzed outpatient prescription data from community pharmacies across Japan. The study patients were 20 years or older and first administered medications for AD (donepezil, memantine, rivastigmine, or galantamine) between January 2010 and September 2014. They were grouped on the basis of the year of their initial medications for AD administration into the 2010-2011 and 2012-2014 groups (1 and 2, respectively) and their characteristics and AD treatments were summarized by group. The subanalyses used a multivariable logistic regression model to examine the relationship between patient characteristics and discontinuation or change to combination therapy within a year. RESULTS A total of 103,592 patients (group 1 and 2, 28,581 and 75,011, respectively) were prescribed medications for AD during the study period. The group 1 and 2 mean ± standard deviation (SD) ages were 79.6 ± 7.4 and 80.9 ± 7.3 years while female patients constituted 64.0% and 64.5%, respectively. Furthermore, in groups 1 and 2 patients, 99.0% and 94.3% received a medication for AD monotherapy, 92.3% and 59.6% were prescribed donepezil, and 40.5% and 41.5% discontinued treatment within a year, respectively. The subanalyses suggest that being at least 85 years old strongly correlated with treatment discontinuation and change to combination therapy within a year. CONCLUSION Although the prescription proportions of the various medications for AD have changed since 2011, no apparent changes occurred in the patient characteristics of those who initiated AD treatment between 2010-2011 and 2012-2014.
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Takahashi S, Nakano K, Yokota T, Shitara K, Muro K, Sunaga Y, Ecstein-Fraisse E, Ura T. Phase 1 study of ombrabulin in combination with cisplatin (CDDP) in Japanese patients with advanced solid tumors. Jpn J Clin Oncol 2016; 46:1000-1007. [PMID: 27566973 DOI: 10.1093/jjco/hyw122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE In clinical studies in Western countries, the recommended dose of combination ombrabulin a vascular disrupting agent, with cisplatin is 25 mg/m2 ombrabulin with 75 mg/m2 cisplatin every 3 weeks. Here, we report the first Phase 1 study of this treatment regimen in Japanese patients with advanced solid tumors. METHODS This was an open-label, multicenter, sequential cohort, dose-escalation Phase 1 study of ombrabulin with cisplatin administered once every 3 weeks. The study used a 3 + 3 design without intrapatient dose escalation. The investigated dose levels of ombrabulin were 15.5 and 25 mg/m2 combined with cisplatin 75 mg/m2. The latter dose level was regarded as the maximum administered dose if more than one patient experienced dose-limiting toxicities. RESULTS Ten patients were treated, but no dose-limiting toxicity was observed at both dose levels. Ombrabulin 25 mg/m2 with cisplatin 75 mg/m2 was the maximum administered dose and regarded as the recommended dose in the combination regimen for Japanese patients with cancer. The most frequently reported drug-related adverse events were neutropenia, decreased appetite, constipation, nausea and fatigue. One partial response and five cases of stable disease were reported as the best overall responses. Pharmacokinetic parameters of ombrabulin and cisplatin were comparable with those in non-Japanese patients. CONCLUSIONS Ombrabulin 25 mg/m2 with cisplatin 75 mg/m2 once every 3 weeks was well tolerated and established as the recommended dose in Japanese patients with advanced solid tumors. The safety and pharmacokinetic profiles were comparable between Japanese and Caucasian patients.
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Affiliation(s)
- Shunji Takahashi
- Department of Medical Oncology, Cancer Chemotherapy Center and Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo
| | - Kenji Nakano
- Department of Medical Oncology, Cancer Chemotherapy Center and Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo
| | - Tomoya Yokota
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Aichi, Japan.,Present address: Shizuoka Cancer Center, Japan
| | - Kohei Shitara
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Aichi, Japan.,Present address: National Cancer Center Hospital East, Japan
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | | | | | - Takashi Ura
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Aichi, Japan
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Yamamoto N, Goto K, Nishio M, Chikamori K, Hida T, Maemondo M, Katakami N, Kozuki T, Yoshioka H, Seto T, Tajima K, Tamura T. Final overall survival in JO22903, a phase II, open-label study of first-line erlotinib for Japanese patients with EGFR mutation-positive non-small-cell lung cancer. Int J Clin Oncol 2017; 22:70-8. [PMID: 27659294 DOI: 10.1007/s10147-016-1039-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/27/2016] [Indexed: 10/25/2022]
Abstract
BACKGROUND In Japan, the clinical efficacy of erlotinib monotherapy in epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer was demonstrated in the phase II JO22903 trial, which reported a median progression-free survival of 11.8 months. Here we report final overall survival data from JO22903. METHODS JO22903 (JapicCTI-101085) was a single-arm, multicenter, phase II, open-label, non-randomized study of first-line erlotinib monotherapy in EGFR mutation-positive non-small-cell lung cancer. Eligible patients (≥20 years) with stage IIIB/IV or recurrent non-small-cell lung cancer and confirmed activating mutations of EGFR (exon 19 deletion or L858R point mutation in exon 21) received oral erlotinib 150 mg/day until disease progression or unacceptable toxicity. The primary endpoints were progression-free survival and safety; overall survival was a secondary endpoint. RESULTS At the final analysis, 102 patients were included in the modified intent-to-treat population and 103 in the safety population. Median follow-up was 32.3 months. Median overall survival was 36.3 months (95 % confidence interval 29.4-not reached). Subgroup analyses of overall survival suggested that the presence of brain metastases was a negative prognostic factor (median overall survival 22.7 months, 95 % confidence interval 19.6-29.4). The impact on overall survival of using versus not using EGFR tyrosine kinase inhibitors in any line of treatment following disease progression was unclear (median 32.8 versus 36.3 months, respectively). No new safety issues were observed. CONCLUSION In this survival update, single-agent erlotinib achieved a median overall survival of more than 3 years in patients with EGFR mutation-positive non-small-cell lung cancer.
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117
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Tomida M, Okudaira K, Kamomae T, Oguchi H, Miyake Y, Yoneda K, Itoh Y. Relationship between prostate volume changes and treatment duration of neoadjuvant androgen deprivation during intensity-modulated radiation therapy for Japanese patients with prostate cancer. Nagoya J Med Sci 2016; 78:313-21. [PMID: 27578915 PMCID: PMC4995277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The application of neoadjuvant androgen deprivation (NAD) in prostate cancer leads to a reduction in prostate volume, and the trends in volume reduction differ according to the treatment duration of NAD. A reduction in volume during external beam radiation therapy may lead to the exposure of normal tissues to an unexpected dose. In fact, prostate volume reductions have primarily been reported in European and American institutions. Although the prostate volume of Japanese patients is known to be small, the trends in prostate volume change during radiation therapy remain unclear. In the present study, we aimed to evaluate the changes in prostate volume of Japanese patients during intensity-modulated radiation therapy (IMRT) with NAD. Nineteen Japanese patients with prostate cancer underwent IMRT with NAD. Kilovoltage computed tomography (CT) images were obtained for treatment planning and verification of the treatment position for each treatment fraction. The patients were divided into 3 groups based on the duration of NAD, as follows: NAD < 3 months (short NAD: S-NAD), 3 months ≤ NAD < 6 months (middle NAD: M-NAD), and NAD ≥ 6 months (long NAD: L-NAD). The prostate volume reductions at the 36th treatment fraction, relative to the planning CT, were 7.8%, 2.0%, and 1.7% for the S-NAD, M-NAD, and L-NAD groups, respectively. Prostate volume shrunk greater in the S-NAD group than in the M-NAD and L-NAD groups; this finding was consistent with those of previous studies. The prostate volume changes in Japanese patients were smaller compared to those in European and American patients.
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Affiliation(s)
- Masashi Tomida
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine,
Nagoya, Japan,Radiological Technology, Department of Medical Technique, Nagoya University Hospital, Nagoya, Japan
| | - Kuniyasu Okudaira
- Radiological Technology, Department of Medical Technique, Nagoya University Hospital, Nagoya, Japan
| | - Takeshi Kamomae
- Department of Therapeutic Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Oguchi
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine,
Nagoya, Japan
| | - Yoshikazu Miyake
- Radiological Technology, Department of Medical Technique, Nagoya University Hospital, Nagoya, Japan
| | - Kazuo Yoneda
- Radiological Technology, Department of Medical Technique, Nagoya University Hospital, Nagoya, Japan
| | - Yoshiyuki Itoh
- Department of Therapeutic Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Takeshima F, Yoshikawa D, Higashi S, Morisaki T, Oda H, Ikeda M, Machida H, Matsushima K, Minami H, Akazawa Y, Yamaguchi N, Ohnita K, Isomoto H, Ueno M, Nakao K. Clinical efficacy of adalimumab in Crohn's disease: a real practice observational study in Japan. BMC Gastroenterol 2016; 16:82. [PMID: 27472988 PMCID: PMC4966785 DOI: 10.1186/s12876-016-0501-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 07/26/2016] [Indexed: 02/08/2023] Open
Abstract
Background There are few reports of the efficacy of adalimumab (ADA) for clinical remission and preventing postoperative recurrence in Crohn's disease (CD) in Asian real practice settings. We conducted a Japanese multicenter retrospective observational study. Methods We evaluated patients with CD who were treated with ADA at 11 medical institutions in Japan to investigate the clinical efficacy of remission up to 52 weeks and the associated factors to achieve remission with a CD Activity Index (CDAI) < 150. The effects of preventing postoperative recurrence were also evaluated. Results In 62 patients, the remission rates were 33.9, 74.2, 75.8, 77.4, and 66.1 % at 0, 4, 12, 26, and 52 weeks, respectively. Although 10 patients discontinued treatment due to primary nonresponse, secondary nonresponse, or adverse events, the ongoing treatment rate at 52 weeks was 83.9 %. Comparison of remission and non-remission on univariate analysis identified colonic type and baseline CDAI value as significant associated factors (P < 0.05). In 16 patients who received ADA to prevent postoperative recurrence, the clinical remission maintenance rate was 93.8 % and the mucosal healing rate was 64.3 % during a mean postoperative follow-up period of 32.3 months. Conclusions ADA effectively induced remission and prevented postoperative recurrence in patients with CD in a real practice setting.
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Affiliation(s)
- Fuminao Takeshima
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
| | - Daisuke Yoshikawa
- Department of Gastroenterology and Hepatology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo City, Nagasaki, 857-8511, Japan
| | - Syuntaro Higashi
- Department of Gastroenterology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Ohmura City, Nagasaki, 856-8562, Japan
| | - Tomohito Morisaki
- Department of Gastroenterology and Hepatology, National Hospital Organization Ureshino Medical Center, 2436 Ureshino-cho, Ureshino City, Saga, 843-0393, Japan
| | - Hidetoshi Oda
- Department of Gastroenterology and Hepatology, Sasebo Chuo Hospital, 15 Yamato-cho, Sasebo City, Nagasaki, 857-1195, Japan
| | - Maho Ikeda
- Department of Internal Medicine, Kouseikai Hospital, 1-3-12 Hayama, Nagasaki City, Nagasaki, 852-8053, Japan
| | - Haruhisa Machida
- Department of Internal Medicine, Shunkaikai Inoue Hospital, 6-12 Takara-machi, Nagasaki City, Nagasaki, 850-0045, Japan
| | - Kayoko Matsushima
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Hitomi Minami
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Yuko Akazawa
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Naoyuki Yamaguchi
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Ken Ohnita
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Hajime Isomoto
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Masato Ueno
- Integrated Marketing Department, Eisai Co., Ltd., 13-1 Nishigoken-cho, Shinjuku-ku, Tokyo, 162-0812, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
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Iida S, Tobinai K, Taniwaki M, Shumiya Y, Nakamura T, Chou T. Phase I dose escalation study of high dose carfilzomib monotherapy for Japanese patients with relapsed or refractory multiple myeloma. Int J Hematol 2016; 104:596-604. [PMID: 27460677 DOI: 10.1007/s12185-016-2070-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/14/2016] [Accepted: 07/19/2016] [Indexed: 11/24/2022]
Abstract
We conducted a multicenter, open-label Phase I study of single-agent carfilzomib in Japanese patients with relapsed or refractory multiple myeloma. The primary endpoints were tolerability and safety. Carfilzomib was administrated for 30 min on days 1, 2, 8, 9, 15, and 16 of a 28-day cycle. In cycle 1, doses for days 1 and 2 were 20 mg/m2, followed by 45 or 56 mg/m2. Three and four subjects were enrolled in the 20/45 mg/m2 cohort and 20/56 mg/m2 cohort. No dose-limiting toxicity was observed, and the tolerability of carfilzomib was confirmed. Pyrexia, hypertension, nausea and vomiting were considered as noteworthy adverse events (AE) when carfilzomib was administered at high doses. Moreover, pyrexia, blood creatinine increased, and body weight gain were observed as acute dose effects. These findings suggest that addition of dexamethasone is important to alleviate acute dose effect. The overall response rates of the 20/45 mg/m2 and 20/56 mg/m2 cohort were 66.7 % (two out of three) and 50 % (two out of four), respectively. Carfilzomib administrated at up to 20/56 mg/m2 was well tolerated and seemed active in Japanese patients with relapsed or refractory multiple myeloma. CLINICAL TRIAL REGISTRATION JapicCTI-122020.
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Affiliation(s)
- Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Masafumi Taniwaki
- Division of Hematology and Oncology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshihisa Shumiya
- Department of Oncology Clinical Development Planning, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Toru Nakamura
- Department of Oncology Clinical Development Planning, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Takaaki Chou
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
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Matsuo H, Nakajima Y, Ogawa T, Mo M, Tazaki J, Doi T, Yamada N, Suzuki T, Nakajima H. Evaluation of D-Dimer in Screening Deep Vein Thrombosis in Hospitalized Japanese Patients with Acute Medical Diseases/Episodes. Ann Vasc Dis 2016; 9:193-200. [PMID: 27738461 DOI: 10.3400/avd.oa.16-00034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/22/2016] [Indexed: 01/09/2023] Open
Abstract
Objective: To investigate the usefulness of D-dimer as a screening method as well as to explore potent predictors of deep vein thrombosis (DVT) in hospitalized Japanese patients with acute medical diseases/episodes. Methods and Subjects: This study was a multi-center, prospective, observational study. The inclusion criteria were hospitalized patients at high risk of developing venous thromboembolism with; (1) congestive heart failure, acute exacerbation of chronic obstructive pulmonary disease, infectious diseases, or inflammatory diseases, (2) bed rest ≥4 days, and (3) ≥60 years old. D-dimer was measured on the same day as ultrasonography. Multivariate logistic regression analysis was performed to investigate predictors associated with the presence of DVT. Results: Sixty-nine patients were enrolled. The prevalence of DVT was 33.3% (23/69; 95% C.I., 19.4% to 47.3%). D-dimer was measured in 42 patients and the sensitivity and negative predictive value reached 100%, while the specificity (13.3%) and positive predictive value (31.6%) were low (cut-off value: 0.9 or 1.0 µg/mL). Statistically significant predictor was not assigned. Conclusion: As the sensitivity and negative predictive value of D-dimer reached 100%, D-dimer have a role in excluding patients who might otherwise undergo diagnostic imaging for DVT in hospitalized Japanese patients with acute medical diseases/episodes.
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Affiliation(s)
- Hiroshi Matsuo
- Matsuo Vascular Ultrasound Laboratory, Matsuo Clinic, Suita, Osaka, Japan
| | - Yoshie Nakajima
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomohiro Ogawa
- Cardiovascular Disease Center, Fukushima Daiichi Hospital, Fukushima, Fukushima, Japan
| | - Makoto Mo
- Department of Cardiovascular Surgery, Yokohama Minami Kyousai Hospital, Yokohama, Kanagawa, Japan
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Takahiro Doi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Norikazu Yamada
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Takeo Suzuki
- Development & Medical Affairs Division, GlaxoSmithKline K.K., Shibuya, Tokyo, Japan
| | - Hiromu Nakajima
- Development & Medical Affairs Division, GlaxoSmithKline K.K., Shibuya, Tokyo, Japan
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Shitara K, Muro K, Shimada Y, Hironaka S, Sugimoto N, Komatsu Y, Nishina T, Yamaguchi K, Segawa Y, Omuro Y, Tamura T, Doi T, Yukisawa S, Yasui H, Nagashima F, Gotoh M, Esaki T, Emig M, Chandrawansa K, Liepa AM, Wilke H, Ichimiya Y, Ohtsu A. Subgroup analyses of the safety and efficacy of ramucirumab in Japanese and Western patients in RAINBOW: a randomized clinical trial in second-line treatment of gastric cancer. Gastric Cancer 2016; 19:927-38. [PMID: 26510663 DOI: 10.1007/s10120-015-0559-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 10/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND We evaluated the safety and efficacy of ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients previously treated for advanced gastric or gastroesophageal junction adenocarcinoma in Japanese and Western subgroups from the RAINBOW trial. METHODS Patients received ramucirumab at 8 mg/kg or placebo (days 1 and 15) plus paclitaxel at 80 mg/m(2) (days 1, 8, and 15 of a 28-day cycle). End points were compared between treatment arms within Japanese (N = 140) and Western (N = 398) populations. RESULTS The incidence of adverse events of grade 3 or higher was higher for ramucirumab plus paclitaxel in both populations (Japanese population, 83.8 % vs 52.1 %; Western population, 79.1 % vs 61.9 %). Neutropenia was the commonest adverse event of grade 3 or higher, with a higher incidence for ramucirumab plus paclitaxel (Japanese population, 66.2 % vs 25.4 %; Western population, 32.1 % vs 14.7 %). The incidence of febrile neutropenia was low and was similar between treatment arms in both populations. The overall survival hazard ratio was 0.88 (95 % confidence interval, 0.60-1.28) in the Japanese population and 0.73 (95 % confidence interval, 0.58-0.91) in the Western population. The progression-free survival hazard ratio was 0.50 (95 % confidence interval, 0.35-0.73) in the Japanese population and 0.63 (95 % confidence interval, 0.51-0.79) in the Western population. The objective response rate was higher for ramucirumab plus paclitaxel in both populations (Japanese population, 41.2 % vs 19.4 %; Western population, 26.8 % vs 13.0 %), as was the 6-month survival rate (Japanese population, 94.1 % vs 71.4 %; Western population, 66.0 % vs 49.0 %). CONCLUSIONS Safety profiles of the ramucirumab plus paclitaxel arm were similar between populations, though there was a higher incidence of neutropenia in Japanese patients. Progression-free survival and objective response rate improvements were observed for ramucirumab plus paclitaxel in both populations. CLINICALTRIALS. GOV IDENTIFIER NCT01170663.
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Affiliation(s)
- Kohei Shitara
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Kei Muro
- Aichi Cancer Center, Nagoya, Japan
| | | | | | - Naotoshi Sugimoto
- Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | | | | | | | - Yoshihiko Segawa
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yasushi Omuro
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Takao Tamura
- Kinki University Faculty of Medicine, Sayama, Japan
| | - Toshihiko Doi
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | | | | | | | | | - Taito Esaki
- National Kyushu Cancer Center, Fukuoka, Japan
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Inagaki N, Harashima SI, Maruyama N, Kawaguchi Y, Goda M, Iijima H. Efficacy and safety of canagliflozin in combination with insulin: a double-blind, randomized, placebo-controlled study in Japanese patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2016; 15:89. [PMID: 27316668 PMCID: PMC4912792 DOI: 10.1186/s12933-016-0407-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/07/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Combination therapy with canagliflozin and insulin was investigated in a prescribed substudy of the canagliflozin Cardiovascular Assessment Study (CANVAS); however, it was not evaluated in Japanese patients with type 2 diabetes mellitus (T2DM). Since the usage profile of insulin therapy and pathologic features of Japanese patients differ from those of Caucasian patients, we determined the clinical benefit of such a combination therapy in Japanese patients. METHODS Patients who had inadequate glycemic control despite insulin, diet and exercise therapies were randomized into placebo (n = 70) and canagliflozin 100 mg (n = 76) groups that were administered once daily in addition to their prior insulin therapy in this double-blind, placebo-controlled study. The primary endpoint was the change in glycated hemoglobin (HbA1c) levels from the baseline to week 16. RESULTS There was a statistically significant decrease in HbA1c levels from the baseline in the canagliflozin group (-0.97 ± 0.08 %) compared with the placebo group (0.13 ± 0.08 %) at week 16 [last observation carried forward (LOCF)]. The decrease in HbA1c levels in the canagliflozin group was independent of the insulin regimen (premixed, long-acting and long-acting plus rapid- or short-acting). Compared with the placebo group, canagliflozin significantly decreased fasting plasma glucose levels (-34.1 ± 4.8 vs -1.4 ± 5.0 mg/dL) and body weights (-2.13 ± 0.25 vs 0.24 ± 0.26 %), and significantly increased HDL cholesterol (3.3 ± 1.0 vs -0.5 ± 1.0 mg/dL) and HOMA2- %B (10.15 ± 1.37 vs 0.88 ± 1.42 %). The overall incidence of adverse events was similar between the two groups. The incidence and incidence per subject-year exposure of hypoglycemia (hypoglycemic symptoms and/or decreased blood glucose) were slightly higher in the canagliflozin group (40.0 % and 7.97) than in the placebo group (29.6 % and 4.51). However, hypoglycemic events in both groups were mild in severity and dose-reduction of insulin by <10 % from the baseline following hypoglycemic events decreased the incidence per subject-year exposure in the canagliflozin group. The incidence of hypoglycemia between the groups did not differ according to the insulin regimen. CONCLUSION Canagliflozin in combination with insulin was effective in improving glycemic control and reducing body weight and well tolerated by Japanese patients with T2DM. Trial Registration ClinicalTrials.gov identifier: NCT02220920.
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Affiliation(s)
- Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shin-Ichi Harashima
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuko Maruyama
- Clinical Research Department II, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Yutaka Kawaguchi
- Data Science Department, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Maki Goda
- Medical Science Center, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Hiroaki Iijima
- Medical Science Center, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan.
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Atagi S, Goto K, Seto T, Yamamoto N, Tamura T, Tajima K, Inagaki N. Erlotinib for Japanese patients with activating EGFR mutation-positive non-small-cell lung cancer: combined analyses from two Phase II studies. Future Oncol 2016; 12:2117-26. [PMID: 27267081 DOI: 10.2217/fon-2016-0163] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIMS We evaluated the efficacy and safety of erlotinib, and patient characteristics affecting progression-free survival (PFS), by analyzing data from two Phase II studies of first-line erlotinib in activating EGFR mutation-positive non-small-cell lung cancer. METHODS Data were combined from patients who received first-line erlotinib monotherapy in JO22903 (single-arm study; JapicCTI-101085) and JO25567 (randomized study; JapicCTI-111390). RESULTS Median PFS was 10.9 months in efficacy-evaluable patients (n = 177). Major adverse events were dermatologic; no new safety signals were observed. Baseline pleural/cardiac effusion notably affected PFS (yes median 8.0 months vs no median 15.3 months) as confirmed in multivariate analysis (hazard ratio: 0.38; 95% CI: 0.25-0.58). CONCLUSION Efficacy and safety of erlotinib monotherapy were consistent with previous studies. Baseline pleural/pericardial effusion was associated with shorter PFS.
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Affiliation(s)
| | - Koichi Goto
- National Cancer Center Hospital East, Chiba, Japan
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Koie T, Ohyama C, Fujimoto H, Nishiyama H, Miyazaki J, Hinotsu S, Kikuchi E, Sakura M, Inokuchi J, Hara T, Ohyama C, Nishiyama H, Fujisawa M, Uemura H, Fujimoto H, Suzuki K, Eto M, Hara I, Matsubara A, Nonomura N, Nakanishi H, Koie T, Kanayama H, Miki T, Fukumori T, Naito S. Diversity in treatment modalities of Stage II/III urothelial cancer in Japan: sub-analysis of the multi-institutional national database of the Japanese Urological Association. Jpn J Clin Oncol 2016; 46:468-74. [PMID: 26851754 DOI: 10.1093/jjco/hyw005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/05/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We aimed to survey treatment modalities for the patients with Stage II/III urothelial cancer in Japan. METHODS We used the multi-institutional national database of the Japanese Urological Association from 348 Japanese institutions, in which a total of 3707 patients with muscle-invasive bladder cancer and 1538 with upper urinary tract urothelial carcinoma were registered in 2008 and 2011, respectively. Primary treatment was classified as surgery alone, surgery with chemotherapy, surgery with radiation, radiation alone, chemotherapy alone, combination of radiation and chemotherapy and observation. Overall and cancer-specific survivals were examined using the Kaplan-Meier method, and survival in the subgroups was analyzed using the log-rank test. RESULTS In Stage II/III bladder cancer patients, 49.7% of those were treated with radical operation and 22.3% received observation only. A total 97.2% of Stage II/III upper urinary tract urothelial carcinoma patients treated with radical surgery. A total 30.4% of Stage II/III bladder cancer patients received chemotherapy. Majority of the patients received cisplatin-based regimen, however, regimens of chemotherapy was rich in variety up to 13 regimens. Chemotherapy regimens for the patients with upper urinary tract urothelial carcinoma were also various up to eight regimens. Overall and cancer-specific survivals were statistically significantly stratified according to the clinical stage. The upper urinary tract urothelial carcinoma patients diagnosed with clinical stage T3 had significantly poor prognosis compared with those diagnosed with clinical stage T2. CONCLUSIONS This study demonstrated the variety of treatments used for Japanese patients with Stage II/III urothelial cancer. Treatment standardization for these entities may be necessary.
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Affiliation(s)
- Takuya Koie
- Working Group of the Upper Urinary Tract Urothelial Carcinoma (UTUC) Registration Committee of the Japanese Urological Association Department of Urology, Hirosaki University Graduate School of Medicine, Aomori
| | - Chikara Ohyama
- Working Group of the Upper Urinary Tract Urothelial Carcinoma (UTUC) Registration Committee of the Japanese Urological Association Department of Urology, Hirosaki University Graduate School of Medicine, Aomori
| | - Hiroyuki Fujimoto
- Working Group of the Upper Urinary Tract Urothelial Carcinoma (UTUC) Registration Committee of the Japanese Urological Association Urology Division, National Cancer Center Hospital, Tokyo
| | - Hiroyuki Nishiyama
- Working Group of the Upper Urinary Tract Urothelial Carcinoma (UTUC) Registration Committee of the Japanese Urological Association Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Jun Miyazaki
- Working Group of the Upper Urinary Tract Urothelial Carcinoma (UTUC) Registration Committee of the Japanese Urological Association Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Shiro Hinotsu
- Working Group of the Upper Urinary Tract Urothelial Carcinoma (UTUC) Registration Committee of the Japanese Urological Association Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama
| | - Eiji Kikuchi
- Working Group of the Upper Urinary Tract Urothelial Carcinoma (UTUC) Registration Committee of the Japanese Urological Association Department of Urology, Keio University School of Medicine, Tokyo
| | - Mizuaki Sakura
- Working Group of the Upper Urinary Tract Urothelial Carcinoma (UTUC) Registration Committee of the Japanese Urological Association Department of Urology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo
| | - Junichi Inokuchi
- Working Group of the Upper Urinary Tract Urothelial Carcinoma (UTUC) Registration Committee of the Japanese Urological Association Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiko Hara
- Working Group of the Upper Urinary Tract Urothelial Carcinoma (UTUC) Registration Committee of the Japanese Urological Association Urology Division, National Cancer Center Hospital, Tokyo
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Yoshida K, Fukuoka H, Matsumoto R, Bando H, Suda K, Nishizawa H, Iguchi G, Ogawa W, Webb SM, Takahashi Y. The quality of life in acromegalic patients with biochemical remission by surgery alone is superior to that in those with pharmaceutical therapy without radiotherapy, using the newly developed Japanese version of the AcroQoL. Pituitary 2015; 18:876-83. [PMID: 26123761 DOI: 10.1007/s11102-015-0665-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To develop a Japanese version of the acromegaly quality of life (QoL) questionnaire (AcroQoL) and investigate the factors associated with impaired QoL in patients with acromegaly. METHODS We developed a Japanese version of the AcroQoL by a forward-backward method and evaluated QoL in 38 patients with acromegaly who had been followed up at an outpatient clinic at Kobe University Hospital. Its reliability was examined with Cronbach's alpha and item-total correlations. Second examination was performed for concurrent validity by assessment of correlations with the Short Form-36 (SF-36) and longitudinal analysis of the AcroQoL in 25 patients. RESULTS Cronbach's alpha and item-total correlations showed a range of 0.76-0.93 and 0.20-0.84, respectively, and significant correlations were found between the AcroQoL and the SF-36. Younger age and a history of radiotherapy were associated with worse total score by the multivariate linear regression analysis (p = 0.020 and p = 0.042, respectively). Intriguingly, in the biochemically-controlled group after the exclusion of patients who received radiotherapy, patients who underwent surgery alone exhibited a higher psychological (75.0 vs. 65.7 %, p = 0.036) and appearance (64.3 vs. 53.6 %, p = 0.036) score than those who are treating with pharmaceutical therapy. CONCLUSIONS The reliability of the Japanese version of the AcroQoL was satisfactory. Younger age and a history of radiotherapy were associated with lower QoL in patients with acromegaly. In biochemically-controlled acromegaly, patients who underwent surgery alone exhibited better QoL than those under pharmaceutical therapy.
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Affiliation(s)
- Kenichi Yoshida
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Hidenori Fukuoka
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Ryusaku Matsumoto
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Hironori Bando
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Kentaro Suda
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hitoshi Nishizawa
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Genzo Iguchi
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Susan M Webb
- Endocrinology/Medicine Departments, Center for Biomedical Network Research on Rare Diseases (CIBERER Unit 747), ISCIII, Sant Pau Biomedical Research Institute, Hospital de Sant Pau Universitat Autònoma de Barcelona, C/Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Yutaka Takahashi
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
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Kiyota N, Schlumberger M, Muro K, Ando Y, Takahashi S, Kawai Y, Wirth L, Robinson B, Sherman S, Suzuki T, Fujino K, Gupta A, Hayato S, Tahara M. Subgroup analysis of Japanese patients in a phase 3 study of lenvatinib in radioiodine-refractory differentiated thyroid cancer. Cancer Sci 2015; 106:1714-21. [PMID: 26426092 PMCID: PMC4714672 DOI: 10.1111/cas.12826] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 12/23/2022] Open
Abstract
Lenvatinib significantly prolonged progression-free survival (PFS) versus placebo in patients with radioiodine-refractory differentiated thyroid cancer (RR-DTC) in the phase 3 Study of (E7080) Lenvatinib in Differentiated Cancer of the Thyroid (SELECT) trial. This subanalysis evaluated the efficacy and safety of lenvatinib in Japanese patients who participated in SELECT. Outcomes for Japanese patients (lenvatinib, n = 30; placebo, n = 10) were assessed in relationship to the SELECT population (lenvatinib, n = 261; placebo, n = 131). The primary endpoint was PFS; secondary endpoints included overall survival, overall response rate, and safety. Lenvatinib PFS benefit was shown in Japanese patients (median PFS: lenvatinib, 16.5 months; placebo, 3.7 months), although significance was not reached, presumably due to sample size (hazard ratio, 0.39; 95% confidence interval, 0.10-1.57; P = 0.067). Overall response rates were 63.3% and 0% for lenvatinib and placebo, respectively. No significant difference was found in overall survival. The lenvatinib safety profile was similar between the Japanese and overall SELECT population, except for higher incidences of hypertension (any grade: Japanese, 87%; overall, 68%; grade ≥3: Japanese, 80%; overall, 42%), palmar-plantar erythrodysesthesia syndrome (any grade: Japanese, 70%; overall, 32%; grade ≥3: Japanese, 3%; overall, 3%), and proteinuria (any grade: Japanese, 63%; overall, 31%; grade ≥3: Japanese, 20%; overall, 10%). Japanese patients had more dose reductions (Japanese, 90%; overall, 67.8%), but fewer discontinuations due to adverse events (Japanese, 3.3%; overall, 14.2%). There was no difference in lenvatinib exposure between the Japanese and overall SELECT populations after adjusting for body weight. In Japanese patients with radioiodine-refractory differentiated thyroid cancer, lenvatinib showed similar clinical outcomes to the overall SELECT population. Some differences in adverse event frequencies and dose modifications were observed. Clinical trial registration no.: NCT01321554.
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Affiliation(s)
- Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris-Sud, Villejuif, France
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuichi Ando
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Yasukazu Kawai
- Department of Hematology and Oncology, Fukui Prefectural Hospital, Fukui, Japan
| | - Lori Wirth
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bruce Robinson
- Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Steven Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Takuya Suzuki
- Oncology Clinical Development, Eisai Co., Ltd, Tokyo, Japan
| | | | | | | | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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Yamazaki N, Uhara H, Fukushima S, Uchi H, Shibagaki N, Kiyohara Y, Tsutsumida A, Namikawa K, Okuyama R, Otsuka Y, Tokudome T. Phase II study of the immune-checkpoint inhibitor ipilimumab plus dacarbazine in Japanese patients with previously untreated, unresectable or metastatic melanoma. Cancer Chemother Pharmacol 2015; 76:969-75. [PMID: 26407818 PMCID: PMC4612320 DOI: 10.1007/s00280-015-2870-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/06/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Ipilimumab (IPI), a monoclonal antibody against immune-checkpoint receptor cytotoxic T lymphocyte antigen-4, is designed to enhance antitumor T cell function. IPI 10 mg/kg plus dacarbazine (DTIC) significantly improved overall survival in a phase 3 study involving predominantly Caucasian patients, with an adverse event (AE) profile similar to that of IPI monotherapy. We conducted a single-arm, phase 2 study to evaluate the safety and efficacy of IPI plus DTIC in Japanese patients. METHODS Previously untreated patients with unresectable stage III or IV melanoma received IPI 10 mg/kg plus DTIC 850 mg/m(2) every 3 weeks for four doses (q3w × 4), followed by DTIC q3w × 4 and then IPI every 12 weeks until disease progression or intolerable toxicity. RESULTS All 15 treated patients reported drug-related AEs, the most common of which were increases in alanine aminotransferase (n = 12, 80 %) and aspartate aminotransferase (n = 11, 73 %). Treatment-related serious AEs were reported in 11 (73 %) patients. Nine patients (60 %) discontinued treatment due to drug-related toxicities. Immune-related AEs (irAEs) were reported in 14 patients (93 %). The most frequent irAEs were liver (n = 12, 80 %) and skin (n = 10, 67 %) toxicities. Five deaths were reported; all were caused by progressive disease. Efficacy evaluation showed one complete response, one partial response and four patients with stable disease. Best overall response rate was 13 % (2/15), and the disease control rate was 40 % (6/15). The study was terminated early due to frequent, high-grade liver toxicities. CONCLUSIONS IPI 10 mg/kg plus DTIC 850 mg/m(2) was not considered tolerable in the Japanese patient population. ClinicalTrials.gov identifier: NCT01681212.
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Affiliation(s)
- N Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - H Uhara
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - S Fukushima
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - H Uchi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - N Shibagaki
- Department of Dermatology, Yamanashi University Hospital, Yamanashi, Japan
| | - Y Kiyohara
- Dermatology Division, Shizuoka Cancer Center, Shizuoka, Japan
| | - A Tsutsumida
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - K Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - R Okuyama
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Y Otsuka
- Research and Development, Bristol-Myers K.K., 6-5-1, Nishishinjuku, Shinjuku-ku, Tokyo, 163-1328, Japan
| | - T Tokudome
- Research and Development, Bristol-Myers K.K., 6-5-1, Nishishinjuku, Shinjuku-ku, Tokyo, 163-1328, Japan.
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Yamazaki N, Kiyohara Y, Uhara H, Fukushima S, Uchi H, Shibagaki N, Tsutsumida A, Yoshikawa S, Okuyama R, Ito Y, Tokudome T. Phase II study of ipilimumab monotherapy in Japanese patients with advanced melanoma. Cancer Chemother Pharmacol 2015; 76:997-1004. [PMID: 26410424 DOI: 10.1007/s00280-015-2873-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/09/2015] [Indexed: 10/29/2022]
Abstract
PURPOSE Ipilimumab is designed to block cytotoxic T-lymphocyte antigen-4 to augment antitumor T cell responses. In studies of predominantly Caucasian patients with advanced melanoma, ipilimumab was associated with durable response, long-term survival benefit, and a manageable safety profile. This phase II study assessed the safety of ipilimumab in Japanese patients with unresectable stage III or IV melanoma. METHODS Patients received ipilimumab 3 mg/kg every 3 weeks for four doses. The database lock for the original analysis was in August 2014. Overall survival, progression-free survival, and data on deaths were based on an updated, follow-up analysis (database lock April 2015). RESULTS Data are reported from 20 patients. Fifteen patients (75 %) received all four doses of ipilimumab during induction. Twelve patients (60 %) had at least one drug-related adverse event (AE), and no patients discontinued due to a drug-related AE. There were no deaths related to study drug. The most common drug-related AEs were rash (n = 7), pyrexia (n = 3), increased aspartate aminotransferase (AST; n = 3), and increased alanine aminotransferase (ALT; n = 3). Twelve patients (60 %) reported immune-related AEs (irAEs); most frequent were skin (n = 9) and liver (n = 3) disorders. Grade 3 irAEs were ALT and AST elevation (n = 2) and diabetes mellitus (n = 1). Two patients had a partial response and two had stable disease, yielding a 20 % disease control rate. Median overall survival and progression-free survival were 8.71 and 2.74 months, respectively. CONCLUSION Ipilimumab 3 mg/kg had a manageable AE profile in this Japanese patient population with clinical outcomes similar to that in Caucasian patients. CLINICALTRIALS. GOV IDENTIFIER NCT01990859.
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Iijima H, Kifuji T, Maruyama N, Inagaki N. Pharmacokinetics, Pharmacodynamics, and Safety of Canagliflozin in Japanese Patients with Type 2 Diabetes Mellitus. Adv Ther 2015; 32:768-82. [PMID: 26280756 PMCID: PMC4569680 DOI: 10.1007/s12325-015-0234-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Indexed: 01/29/2023]
Abstract
Introduction Canagliflozin is a sodium glucose co-transporter 2 inhibitor approved worldwide for the treatment of patients with type 2 diabetes mellitus (T2DM). The present study evaluated pharmacokinetics, pharmacodynamics, and safety of canagliflozin in Japanese patients with T2DM. Methods Canagliflozin, at doses of 25, 100, 200, or 400 mg, was administered as a single dose and, after a washout of 1 day, in repeated doses for 14 consecutive days to 61 subjects in a randomized, double-blind, placebo-controlled study. Plasma concentrations of canagliflozin and urinary glucose excretion (UGE) were measured, and renal threshold for glucose excretion (RTG) was calculated. Safety was evaluated on the basis of adverse event (AE) reports, blood and urine laboratory parameters, and vital signs. Results Plasma canagliflozin maximum concentration and area under the concentration–time curve (AUC) values increased in a dose-dependent manner with the time to maximum concentration (tmax) of 1.0 h and elimination half-life (t1/2) of 10.22–13.26 h on Day 1. No significant changes in tmax and t1/2 were observed after multiple-dose administration. The linearity factors, as calculated from the ratios of AUC0–24h on Day 16 to AUC0–∞ on Day 1, were close to 1 in all canagliflozin groups. Canagliflozin increased UGE0–24h (80–110 g/day with canagliflozin ≥100 mg) and decreased RTG from the first day of treatment; these effects were sustained during the entire period of multiple administration. No significant AEs were noted. Urine volume was slightly increased on Day 1, but subsequent changes after repeated doses for 14 days were small. Urinary sodium tended to be higher in the early treatment period, whereas no particular change was observed in serum osmolality and hematocrit. Conclusion Canagliflozin increased UGE, decreased RTG, and was well tolerated throughout the entire period of multiple administrations in Japanese patients with T2DM. Funding Mitsubishi Tanabe Pharma Corporation. Trial registration ClinicalTrials.gov#NCT00707954. Electronic supplementary material The online version of this article (doi:10.1007/s12325-015-0234-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hiroaki Iijima
- Medical Affairs Department, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan.
| | - Takayuki Kifuji
- Development Division, Clinical Pharmacology Department, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Nobuko Maruyama
- Development Division, Clinical Research Department II, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Shimizu H, Horimoto Y, Arakawa A, Sonoue H, Kurata M, Kosaka T, Nakai K, Himuro T, Tokuda E, Takahashi Y, Taira F, Ito M, Abe I, Senuma K, Stork-Sloots L, de Snoo F, Saito M. Application of a 70-Gene Expression Profile to Japanese Breast Cancer Patients. Breast Care (Basel) 2015. [PMID: 26195940 DOI: 10.1159/000376562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND As data on using MammaPrint®, a 70-gene expression profile for molecular subtyping of breast cancer, are limited in Japanese patients, we aimed to determine the gene profiles of Japanese patients using MammaPrint and to investigate its possible clinical application for selecting adjuvant treatments. PATIENTS AND METHODS 50 women treated surgically at our institution were examined. The MammaPrint results were compared with the St Gallen 2007 and intrinsic subtype risk categorizations. RESULTS Of 38 cases judged to be at intermediate risk based on the St Gallen 2007 Consensus, 11 (29%) were in the high-risk group based on MammaPrint. 1 of the 30 luminal A-like tumors (3%) was judged as high risk based on MammaPrint results, whereas 7 of the 20 tumors (35%) categorized as luminal B-like or triple negative were in the low-risk group. There have been no recurrences to date in the MammaPrint group, and this is possibly attributable to most of the high-risk patients receiving chemotherapy that had been recommended on the basis of their MammaPrint results. CONCLUSIONS Our results indicate that MammaPrint is applicable to Japanese patients and that it is of potential value in current clinical practice for devising individualized treatments.
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Affiliation(s)
- Hideo Shimizu
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshiya Horimoto
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Sonoue
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Mami Kurata
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Taijiro Kosaka
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Katsuya Nakai
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takanori Himuro
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Emi Tokuda
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuka Takahashi
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Fumi Taira
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Mayuko Ito
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ikuko Abe
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Koji Senuma
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | | | | | - Mitsue Saito
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
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Kaku K, Enya K, Nakaya R, Ohira T, Matsuno R. Efficacy and safety of fasiglifam (TAK-875), a G protein-coupled receptor 40 agonist, in Japanese patients with type 2 diabetes inadequately controlled by diet and exercise: a randomized, double-blind, placebo-controlled, phase III trial. Diabetes Obes Metab 2015; 17:675-81. [PMID: 25787200 PMCID: PMC4676912 DOI: 10.1111/dom.12467] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/03/2015] [Accepted: 03/12/2015] [Indexed: 12/11/2022]
Abstract
AIM To assess the efficacy and safety of fasiglifam 25 and 50 mg in Japanese patients with type 2 diabetes inadequately controlled by diet and exercise. METHODS This phase III, double-blind, placebo-controlled, multicentre study included 192 patients randomized to once-daily treatment with fasiglifam 25 mg (n = 63) or 50 mg (n = 62) or placebo (n = 67) for 24 weeks. The primary efficacy endpoint was the change from baseline in glycated haemoglobin (HbA1c) at week 24. RESULTS At week 24, both fasiglifam groups had significantly reduced HbA1c levels compared with the placebo group (p < 0.0001). The least squares mean change from baseline in HbA1c was 0.16% with placebo, -0.57% with fasiglifam 25 mg and -0.83% with fasiglifam 50 mg. The percentage of patients who achieved an HbA1c target of <6.9% at week 24 was also significantly higher (p < 0.05) for fasiglifam 25 mg (30.2%) and 50 mg (54.8%) compared with placebo (13.8%). Fasiglifam significantly reduced fasting plasma glucose levels at all assessment points, starting from week 2. The incidence and types of treatment-emergent adverse events in each fasiglifam group were similar to those in the placebo group, and hypoglycaemia was reported in 1 patient receiving fasiglifam 50 mg. There were no clinically meaningful changes in body weight in any treatment group. CONCLUSIONS Fasiglifam significantly improved glycaemic control and was well tolerated, with a low risk of hypoglycaemia in Japanese patients with type 2 diabetes inadequately controlled by diet and exercise; however, in a recent review of data from overall fasiglifam global clinical trials, concerns about liver safety arose and the clinical development of fasiglifam was terminated after this trial was completed.
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Affiliation(s)
- K Kaku
- Department of Medicine, Kawasaki Medical School, Okayama, Japan
| | - K Enya
- Pharmaceutical Development Division, Takeda Pharmaceutical Company Limited, Osaka, Japan
| | - R Nakaya
- Pharmaceutical Development Division, Takeda Pharmaceutical Company Limited, Osaka, Japan
| | - T Ohira
- Pharmaceutical Development Division, Takeda Pharmaceutical Company Limited, Osaka, Japan
| | - R Matsuno
- Pharmaceutical Development Division, Takeda Pharmaceutical Company Limited, Osaka, Japan
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Yoshino T, Yamazaki K, Gotoh M, Nasroulah F, Gao L, Yoshizuka N, Ohtsu A. Safety and Pharmacokinetics of Second-line Ramucirumab plus FOLFIRI in Japanese Patients with Metastatic Colorectal Carcinoma. Anticancer Res 2015; 35:4003-7. [PMID: 26124348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND This phase Ib study evaluated the pharmacokinetic profile and safety of ramucirumab, a recombinant human IgG1 neutralizing monoclonal antibody specific for vascular endothelial growth factor receptor 2, in combination with irinotecan, levofolinate and 5-fluorouracil (FOLFIRI) in Japanese patients with metastatic colorectal carcinoma (mCRC). PATIENTS AND METHODS Eligible patients had Eastern Cooperative Oncology Group performance status 0-1, and disease progression during or within 6 months following first-line therapy with bevacizumab, oxaliplatin and a fluoropyrimidine. Six enrolled patients received 8 mg/kg ramucirumab plus FOLFIRI every 2 weeks. RESULTS One out of six patients experienced a dose-limiting toxicity (grade 2 proteinuria and grade 4 neutropenia, resulting in a dose delay >2 weeks). All patients experienced at least one grade 3 or higher adverse event: neutropenia (five patients, 83%), proteinuria (two patients; 33%) and anemia, thrombocytopenia and hypertension (one patient each, 17%). There were no serious adverse events or deaths. CONCLUSION Ramucirumab plus FOLFIRI was well-tolerated in Japanese patients with mCRC, warranting further investigation of this combination therapy.
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Affiliation(s)
| | | | | | | | - Ling Gao
- Eli Lilly and Company, Bridgewater, NJ, U.S.A
| | | | - Atsushi Ohtsu
- National Cancer Center Hospital East, Kashiwa, Japan
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Matsubara N, Uemura H, Fukui I, Niwakawa M, Yamaguchi A, Iizuka K, Akaza H. Phase-1 study of abiraterone acetate in chemotherapy-naïve Japanese patients with castration-resistant prostate cancer. Cancer Sci 2014; 105:1313-20. [PMID: 25117615 PMCID: PMC4462344 DOI: 10.1111/cas.12496] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/25/2014] [Accepted: 07/29/2014] [Indexed: 12/19/2022] Open
Abstract
Persistent androgen synthesis under castration status in adrenal gland, testes and tumor cells is thought to be one of the major causes of development and progression of castration-resistant prostate cancer (CRPC). Abiraterone acetate (AA), the prodrug of abiraterone, which is an inhibitor of androgen synthesis enzymes, was evaluated for pharmacokinetics, pharmacodynamics, preliminary efficacy and safety in Japanese patients with CRPC in a phase-1, open-label and dose-escalation study. Chemotherapy-naïve Japanese CRPC patients (N = 27) received one of four AA daily doses (250 mg [n = 9], 500 mg [n = 6], 1000 [1 h premeal] mg [n = 6] and 1000 [2 h postmeal] mg [n = 6]) continuously through 28-day treatment cycles. In the first cycle, AA monotherapy was given on days 1–7 for pharmacokinetics, and AA plus prednisone (5 mg twice daily) from days 8 to 28. Of 27 patients, 9 continued treatment with AA until the data cut-off date (18 July 2013). Over the evaluated dose range, plasma abiraterone concentrations increased with dose, with median tmax 2–3 h. At each dose level, mean serum corticosterone concentrations increased, while testosterone and dehydroepiandrosterone sulfate concentrations rapidly decreased following a single AA dose and were further reduced to near the quantification limit on day 8 regardless of the dose. At least 3 patients from each dose-group experienced ≥50% prostate-specific antigen reduction, suggesting clinical benefit from AA in Japanese CRPC patients. AA was generally well-tolerated, and, therefore, the recommended AA dosage regimen in Japanese CRPC patients is 1000 mg oral dose under modified fasting conditions (at least 1 h premeal or 2 h postmeal). This study is registered at ClinicalTrials.gov: NCT01186484.
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Affiliation(s)
- Nobuaki Matsubara
- Division of Oncology and Hematology, National Cancer Center Hospital East, Chiba, Japan
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Sarashina A, Ueki K, Sasaki T, Tanaka Y, Koiwai K, Sakamoto W, Woerle HJ, Salsali A, Broedl UC, Macha S. Effect of renal impairment on the pharmacokinetics, pharmacodynamics, and safety of empagliflozin, a sodium glucose cotransporter 2 inhibitor, in Japanese patients with type 2 diabetes mellitus. Clin Ther 2014; 36:1606-15. [PMID: 25199997 DOI: 10.1016/j.clinthera.2014.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/11/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to assess the effect of renal impairment on the pharmacokinetic, pharmacodynamic, and safety profiles of empagliflozin, a sodium glucose cotransporter 2 (SGLT2) inhibitor, in Japanese patients with type 2 diabetes mellitus (T2DM). METHODS In an open-label, parallel-group study, 32 Japanese patients with T2DM and different degrees of renal function (n = 8 per renal function category: normal renal function, estimated glomerular filtration rate [eGFR; Japanese equation] ≥90 mL/min/1.73 m(2); mild renal impairment, eGFR of 60-<90 mL/min/1.73 m(2); moderate renal impairment, eGFR of 30-<60 mL/min/1.73 m(2); and severe renal impairment, eGFR of 15-<30 mL/min/1.73 m(2)) received a single 25 mg dose of empagliflozin. FINDINGS Empagliflozin exposure increased with increasing renal impairment. Maximum empagliflozin plasma concentrations were similar among all renal function groups. Adjusted geometric mean ratios for extent of exposure (AUC0-∞) to empagliflozin versus normal renal function were 128.8% (95% CI, 106.0-156.6%), 143.8% (95% CI, 118.3-174.8%), and 152.3% (95% CI, 125.3-185.2%) for patients with mild, moderate, and severe renal impairment, respectively. Decreases in renal clearance of empagliflozin correlated with eGFR. Urinary glucose excretion decreased with increasing renal impairment and correlated with eGFR (adjusted mean [SE] change from baseline: 75.0 [4.84] g, 62.6 [5.75] g, 57.9 [4.86] g, and 23.7 [5.24] g for patients with normal renal function and mild, moderate, and severe renal impairment, respectively). Only 2 patients (6%) had adverse events; both were mild. IMPLICATIONS Pharmacokinetic data suggest that no dose adjustment of empagliflozin is necessary in Japanese patients with T2DM and renal impairment because increases in exposure were <2-fold. Urinary glucose excretion decreased with increasing renal impairment. ClinicalTrials.gov identifier: NCT01581658.
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Affiliation(s)
| | - Kohjiro Ueki
- Department of Molecular Sciences on Diabetes, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Molecular Diabetic Medicine, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Yuko Tanaka
- Nippon Boehringer Ingelheim Co Ltd, Tokyo, Japan
| | | | | | - Hans J Woerle
- Boehringer Ingelheim GmbH & Co KG, Ingelheim, Germany
| | | | - Uli C Broedl
- Boehringer Ingelheim GmbH & Co KG, Ingelheim, Germany
| | - Sreeraj Macha
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut
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Asami K, Kawahara M, Hirashima T, Suzuki H, Okishio K, Omachi N, Tamiya M, Tamiya A, Hirooka A, Nakao K, Tsuji T, Atagi S. Prospective phase II study of cisplatin plus pemetrexed with maintenance of pemetrexed for advanced non-squamous cell non-small cell lung cancer in Japan. Thorac Cancer 2014; 5:289-96. [PMID: 26767015 DOI: 10.1111/1759-7714.12091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/06/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND A previous study showed a survival benefit with maintenance therapy with pemetrexed in patients with advanced non-small cell lung cancer (NSCLC). However, it remains unclear whether continuation maintenance therapy with pemetrexed is beneficial in Japanese patients. Here, we present our phase II study that assessed the efficacy and safety of cisplatin plus pemetrexed as induction chemotherapy, followed by maintenance therapy with pemetrexed in advanced NSCLC patients in Japan. METHODS Chemotherapy-naïve patients received 500 mg/m(2) pemetrexed and 75 mg/m(2) cisplatin on day one every three weeks for four cycles. In patients who responded to therapy or achieved stable disease, pemetrexed was continued until disease progression. The primary endpoint of this study was the progression-free survival rate at six months (PFS-6). RESULTS Of the 35 patients initially enrolled in the study, 18 (51%) received maintenance chemotherapy with pemetrexed. The median PFS was 6.7 months, and the PFS-6 was 60% (95% confidence interval [CI], 42-76%). Median overall survival (OS) was 15.5 months (95% CI, 8.3-22.7 months). The median PFS and OS in patients who received maintenance chemotherapy with pemetrexed were 9.5 months and 25.3 months, respectively. The most frequently noted severe toxicity during induction chemotherapy was neutropenia, which occurred in seven patients. Two patients discontinued maintenance therapy owing to prolonged grade 2 edema in one patient and grade 3 neutropenia in another. CONCLUSION Continuation maintenance chemotherapy with pemetrexed is associated with a survival benefit in patients who have completed induction chemotherapy for non-squamous NSCLC.
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Affiliation(s)
- Kazuhiro Asami
- Department of Clinical Oncology, National Hospital Organization Kinki-chuo Chest Medical Center Sakai, Japan
| | - Masaaki Kawahara
- Department of Clinical Oncology, Federation of National Public Service Personnel Mutual Aid Associations, Otemae Hospital Osaka, Japan
| | - Tomonori Hirashima
- Department of Clinical Oncology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases Habikino, Japan
| | - Hidekazu Suzuki
- Department of Clinical Oncology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases Habikino, Japan
| | - Kyoichi Okishio
- Department of Clinical Oncology, National Hospital Organization Kinki-chuo Chest Medical Center Sakai, Japan
| | - Naoki Omachi
- Department of Clinical Oncology, National Hospital Organization Kinki-chuo Chest Medical Center Sakai, Japan
| | - Motohiro Tamiya
- Department of Clinical Oncology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases Habikino, Japan
| | - Akihiro Tamiya
- Department of Clinical Oncology, National Hospital Organization Kinki-chuo Chest Medical Center Sakai, Japan
| | - Aya Hirooka
- Department of Clinical Oncology, National Hospital Organization Kinki-chuo Chest Medical Center Sakai, Japan
| | - Keiko Nakao
- Department of Clinical Oncology, National Hospital Organization Kinki-chuo Chest Medical Center Sakai, Japan
| | - Taisuke Tsuji
- Department of Clinical Oncology, National Hospital Organization Kinki-chuo Chest Medical Center Sakai, Japan
| | - Shinji Atagi
- Department of Clinical Oncology, National Hospital Organization Kinki-chuo Chest Medical Center Sakai, Japan
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Ogura M, Tobinai K, Hatake K, Ishizawa K, Uike N, Uchida T, Suzuki T, Aoki T, Watanabe T, Maruyama D, Yokoyama M, Takubo T, Kagehara H, Matsushima T. Phase I / II study of brentuximab vedotin in Japanese patients with relapsed or refractory CD30-positive Hodgkin's lymphoma or systemic anaplastic large-cell lymphoma. Cancer Sci 2014; 105:840-6. [PMID: 24814862 PMCID: PMC4317919 DOI: 10.1111/cas.12435] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/17/2014] [Accepted: 04/30/2014] [Indexed: 12/11/2022] Open
Abstract
Brentuximab vedotin is an antibody–drug conjugate that selectively delivers the antimicrotubule agent monomethyl auristatin E into CD30-expressing cells. To assess its safety, pharmacokinetics, and efficacy in Japanese patients with refractory or relapsed CD30-positive Hodgkin's lymphoma or systemic anaplastic large-cell lymphoma, we carried out a phase I/II study. Brentuximab vedotin was given i.v. on day 1 of each 21-day cycle up to 16 cycles. In the phase I part of a dose-escalation design, three patients per cohort were treated at doses of 1.2 and 1.8 mg/kg. In the phase II part, a dose of 1.8 mg/kg was given to 14 patients (nine with Hodgkin's lymphoma and five with systemic anaplastic large-cell lymphoma). The median number of treatment cycles was 16 (range, 4–16). In the phase I part, no dose-limiting toxicity event was observed. In the total population, common adverse events included lymphopenia (80%), neutropenia (65%), leukopenia (65%), and peripheral sensory neuropathy (60%). Grade 3/4 adverse events in more than two patients were lymphopenia (50%) and neutropenia (15%). The pharmacokinetic profile was similar to that observed in the previous studies in the USA. In the phase II part, six patients (67%) with Hodgkin's lymphoma achieved an objective response with 56% of complete response rate, and five patients (100%) with systemic anaplastic large-cell lymphoma achieved an objective response with 80% of complete response rate. These results show that brentuximab vedotin has an acceptable safety profile and promising antitumor activity in the Japanese population. This trial was registered in JAPIC Clinical Trials Information (JapicCTI-111650). This phase I/II study was to investigate the tolerability, safety and efficacy of brentuximab vedotin. This study indicates that 1.8 mg/kg brentuximab vedotin given every 3 weeks has a manageable safety profile and has high overall tumor response rate in Japanese patients with relapsed or refractory Hodgkin lymphoma or systemic anaplastic large-cell lymphoma.
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Affiliation(s)
- Michinori Ogura
- Department of Hematology and Oncology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
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Sasaki Y, Hamaguchi T, Arai T, Goto A, Ura T, Muro K, Yamada Y, Shirao K, Shimada Y. Phase I study of combination therapy with irinotecan, leucovorin, and bolus and continuous-infusion 5-fluorouracil (FOLFIRI) for advanced colorectal cancer in Japanese patients. Anticancer Res 2014; 34:2029-2034. [PMID: 24692743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Irinotecan, leucovorin, and bolus and continuous-infusion 5-fluorouracil administered every two weeks (FOLFIRI regimen) is active in patients with metastatic colorectal cancer. However, the efficacy and toxicity of this regimen in Japanese patients with metastatic colorectal cancer remain unknown. PATIENTS AND METHODS We investigated the maximum tolerated dose, dose-limiting toxicity, and recommended dose at Step 1. Twenty-one patients with metastatic colorectal cancer were enrolled in Step 1. At the five dose levels, fixed doses of bolus 5-fluorouracil (400 mg/m(2)) and leucovorin (200 mg/m(2)) were administered in combination with escalating doses of irinotecan from 120-180 mg/m(2) with 46-h continuous infusion of 5-fluorouracil 2000-3000 mg/m(2) every two weeks. In Step 2, an additional 24 patients received the recommended doses determined in Step 1, and safety and antitumor efficacy were evaluated in terms of tumor response. RESULTS No dose-limiting toxicities were observed at dose levels 1-4. Four out of eight patients experienced a dose-limiting toxicity at level 5; therefore, this level was considered the maximum tolerated dose. Consequently, the recommended doses were determined to be 180 mg/m(2) of irinotecan and 2,400 mg/m(2) of 5-fluorouracil in continuous i.v. infusion. At this level (FOLFIRI-180), National Cancer Institute common terminology criteria grade 3-4 neutropenia, leukopenia, and vomiting were common but manageable. Other hematological and non-hematological toxicities were mild. Seven out of 23 response-assessable patients achieved an objective response (response rate=30%). CONCLUSION This FOLFIRI-180 regimen is manageable and effective in Japanese patients with metastatic colorectal cancer.
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Affiliation(s)
- Yusuke Sasaki
- Gastrointestinal Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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Ikeda M, Ohkawa S, Okusaka T, Mitsunaga S, Kobayashi S, Morizane C, Suzuki I, Yamamoto S, Furuse J. Japanese phase I study of GC33, a humanized antibody against glypican-3 for advanced hepatocellular carcinoma. Cancer Sci 2014; 105:455-62. [PMID: 24521523 PMCID: PMC4317809 DOI: 10.1111/cas.12368] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/27/2014] [Accepted: 02/05/2014] [Indexed: 12/15/2022] Open
Abstract
GC33 is a humanized mAb against human glypican-3 (GPC3). In the first-in-human study carried out in the USA, GC33 was well tolerated and showed preliminary antitumor activity in patients with advanced hepatocellular carcinoma. This study aimed to assess the safety, tolerability, and pharmacokinetic characteristics of GC33 in Japanese patients with advanced hepatocellular carcinoma. The study design was a conventional 3 + 3 dose-escalation design to determine the maximum tolerated dose of GC33 given i.v. at 5, 10, or 20 mg/kg weekly. Immunohistochemistry was carried out on tumor biopsies to evaluate GPC3 expression. Thirteen patients were enrolled across the three dose levels, and no patients observed any dose-limiting toxicity up to the highest planned dose of 20 mg/kg. The most common adverse events were decreased lymphocyte count, decreased natural killer cell count, increased C-reactive protein, and pyrexia. Grade 3 adverse events (increased blood pressure, decreased lymphocyte count, and decreased platelet count) were observed in two or more patients. The AUCinf showed a dose-proportional increase from the 5 mg/kg dose group to the 20 mg/kg dose group. The trough concentrations of GC33 appeared to reach a steady state after the fourth to the sixth dose. Seven of the 13 patients showed stable disease, the other six showed progressive disease. Furthermore, three patients showed long-term stable disease of more than 5 months. In conclusion, GC33 given at up to 20 mg/kg weekly was well tolerated in Japanese patients with advanced hepatocellular carcinoma.
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Affiliation(s)
- Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan
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Ando Y, Inada-Inoue M, Mitsuma A, Yoshino T, Ohtsu A, Suenaga N, Sato M, Kakizume T, Robson M, Quadt C, Doi T. Phase I dose-escalation study of buparlisib (BKM120), an oral pan-class I PI3K inhibitor, in Japanese patients with advanced solid tumors. Cancer Sci 2014; 105:347-53. [PMID: 24405565 PMCID: PMC4317947 DOI: 10.1111/cas.12350] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/19/2013] [Accepted: 12/28/2013] [Indexed: 12/27/2022] Open
Abstract
Buparlisib (BKM120) is an oral pan-phosphatidylinositol 3-kinase inhibitor, targeting all four isoforms of class I PI3K (α, β, γ and δ). This open-label Phase I dose-escalation study was conducted to determine the maximum tolerated dose of continuous daily buparlisib in Japanese patients with advanced solid tumors. Secondary objectives included safety and tolerability, pharmacokinetics, antitumor activity and pharmacodynamic marker changes. Fifteen patients were treated at 25 mg/day (n = 3), 50 mg/day (n = 3) and 100 mg/day (n = 9) dose levels. One dose-limiting toxicity of Grade 4 abnormal liver function occurred at 100 mg/day. Considering the safety profile and the maximum tolerated dose in the first-in-man study of buparlisib in non-Japanese patients, further dose escalation was stopped and 100 mg/day was declared the recommended dose. The most common treatment-related adverse events were rash, abnormal hepatic function (including increased transaminase levels), increased blood insulin levels and increased eosinophil count. Hyperglycemia was experienced by two patients, one Grade 1 and one Grade 4, and mood alterations were experienced by three patients, two Grade 1 and one Grade 2. Pharmacokinetic results showed that buparlisib was rapidly absorbed in a dose-proportional manner. Best overall response was stable disease for six patients, including one unconfirmed partial response. In these Japanese patients with advanced solid tumors, buparlisib had a manageable safety profile, with similar pharmacokinetics to non-Japanese patients. The recommended dose of 100 mg/day will be used in future studies of buparlisib in Japanese patients.
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140
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Yamanaka H, Ishiguro N, Takeuchi T, Miyasaka N, Mukai M, Matsubara T, Uchida S, Akama H, Kupper H, Arora V, Tanaka Y. Recovery of clinical but not radiographic outcomes by the delayed addition of adalimumab to methotrexate-treated Japanese patients with early rheumatoid arthritis: 52-week results of the HOPEFUL-1 trial. Rheumatology (Oxford) 2014; 53:904-13. [PMID: 24441150 PMCID: PMC3988871 DOI: 10.1093/rheumatology/ket465] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objective. The aim of this study was to compare efficacy outcomes of initial treatment with adalimumab + MTX vs adalimumab addition following 26 weeks of MTX monotherapy in Japanese early RA patients naive to MTX with high disease activity. Methods. Patients completing the 26-week, randomized, placebo-controlled trial of adalimumab + MTX were eligible to receive 26 weeks of open-label adalimumab + MTX. Patients were assessed for mean change from baseline in the 28-joint DAS with ESR (DAS28-ESR) and modified total Sharp score (mTSS), and for the proportions of patients achieving clinical, functional or radiographic remission. Results. Of 333 patients assessed, 278 (137 from the initial adalimumab + MTX and 141 from the initial placebo + MTX groups) completed the 52-week study. Significant differences in clinical and functional parameters observed during the 26-week blinded period were not apparent following the addition of open-label adalimumab to MTX. Open-label adalimumab + MTX slowed radiographic progression through week 52 in both groups, but patients who received adalimumab + MTX throughout the study exhibited less radiographic progression than those who received placebo + MTX during the first 26 weeks (mean ΔmTSS at week 52 = 2.56 vs 3.30, P < 0.001). Conclusion. Delayed addition of adalimumab in Japanese MTX-naive early RA patients did not impact clinical and functional outcomes at week 52 compared with the earlier addition of adalimumab. However, the accrual of significant structural damage during blinded placebo + MTX therapy contributed to the persistence of differences between the treatment strategies, suggesting that Japanese patients at risk for aggressive disease should benefit from the early inclusion of adalimumab + MTX combination therapy. Trial registration. ClinicalTrials.gov (http://clinicaltrials.gov/), NCT00870467.
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Affiliation(s)
- Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawado-cho, Shinjuko-ku, Tokyo 162-0054, Japan.
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Shiochi H, Ohkura T, Fujioka Y, Sumi K, Yamamoto N, Nakanishi R, Matsuzawa K, Izawa S, Ohkura H, Inoue K, Ueta E, Kato M, Taniguchi SI, Yamamoto K. Bezafibrate improves insulin resistance evaluated using the glucose clamp technique in patients with type 2 diabetes mellitus: a small-scale clinical study. Diabetol Metab Syndr 2014; 6:113. [PMID: 25360162 PMCID: PMC4213459 DOI: 10.1186/1758-5996-6-113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/09/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Bezafibrate is mainly used to treat hypertriglyceridemia. Studies have reported that bezafibrate also improves type 2 diabetes mellitus, but the mechanism has not been fully elucidated. We performed euglycemic hyperinsulinemic clamps (glucose clamp) and meal tolerance tests (MTT) to examine the effects of bezafibrate on insulin resistance in patients with type 2 diabetes mellitus. METHODS Twelve Japanese patients with type 2 diabetes mellitus and dyslipidemia (mean age: 59.5 years; fasting plasma glucose: 7.95 mmol/L; hemoglobin A1c [HbA1c]: 7.3%; body mass index: 26.5 kg/m(2)) underwent a glucose clamp and MTT before and after 12 weeks of treatment with 400 mg/day bezafibrate. The glucose infusion rate was measured during the glucose clamp. The patients took a test meal (460 kcal) in the MTT. Plasma glucose and immunoreactive insulin levels were measured at 0 (fasting), 30, 60, 120, and 180 min. Serum C-peptide immunoreactivity, serum lipids, and liver function markers were also measured during the MTT. RESULTS Bezafibrate significantly increased the mean glucose infusion rate from 5.78 ± 1.94 to 6.78 ± 2.52 mg/kg/min (p < 0.05). HbA1c improved from 7.30 ± 0.55% to 7.02 ± 0.52% (p < 0.05). In the MTT, fasting plasma glucose decreased from 7.95 ± 1.15 to 6.98 ± 1.07 mmol/L (p < 0.05). The area under the plasma glucose curve from 0 to 180 min decreased significantly from 29.48 ± 5.07 to 27.12 ± 3.98 mmol/h/L (p < 0.05), whereas immunoreactive insulin was unchanged. Furthermore, bezafibrate also significantly improved serum lipids, with decreases in triglyceride levels from 1.84 ± 0.88 to 1.14 ± 0.41 mmol/L (p < 0.05), low-density lipoprotein cholesterol levels from 3.56 ± 0.83 to 2.92 ± 0.55 mmol/L (p < 0.05), and remnant-like particle cholesterol levels decreased from 0.25 ± 0.16 to 0.14 ± 0.06 mmol/L (p < 0.05), and increases in high-density lipoprotein cholesterol levels from 1.50 ± 0.24 to 1.66 ± 0.29 mmol/L (p < 0.05). CONCLUSIONS Bezafibrate improved glucose intolerance and peripheral insulin resistance in these Japanese patients with type 2 diabetes mellitus and dyslipidemia. Therefore, bezafibrate could be used to treat insulin resistance in patients with type 2 diabetes mellitus and dyslipidemia. TRIAL REGISTRATION University Hospital Medical Information Network (UMIN) Clinical Trials Registry, UMIN000012462.
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Affiliation(s)
- Hideki Shiochi
- />Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine, Nishi-chou 36-1, Yonago, Tottori, 683-8504 Japan
| | - Tsuyoshi Ohkura
- />Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine, Nishi-chou 36-1, Yonago, Tottori, 683-8504 Japan
| | - Yohei Fujioka
- />Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine, Nishi-chou 36-1, Yonago, Tottori, 683-8504 Japan
| | - Keisuke Sumi
- />Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine, Nishi-chou 36-1, Yonago, Tottori, 683-8504 Japan
| | - Naoya Yamamoto
- />Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine, Nishi-chou 36-1, Yonago, Tottori, 683-8504 Japan
| | - Risa Nakanishi
- />Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine, Nishi-chou 36-1, Yonago, Tottori, 683-8504 Japan
| | - Kazuhiko Matsuzawa
- />Department of Regional Medicine, Tottori University Faculty of Medicine, Yonago, Tottori, 683-8504 Japan
| | - Schoichiro Izawa
- />Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine, Nishi-chou 36-1, Yonago, Tottori, 683-8504 Japan
| | - Hiroko Ohkura
- />Department of Regional Medicine, Tottori University Faculty of Medicine, Yonago, Tottori, 683-8504 Japan
| | - Kazuoki Inoue
- />Department of Regional Medicine, Tottori University Faculty of Medicine, Yonago, Tottori, 683-8504 Japan
| | - Etsuko Ueta
- />School of Health Science, Tottori University Faculty of Medicine, Yonago, Tottori, 683-8504 Japan
| | - Masahiko Kato
- />Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine, Nishi-chou 36-1, Yonago, Tottori, 683-8504 Japan
| | - Shin-ichi Taniguchi
- />Department of Regional Medicine, Tottori University Faculty of Medicine, Yonago, Tottori, 683-8504 Japan
| | - Kazuhiro Yamamoto
- />Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine, Nishi-chou 36-1, Yonago, Tottori, 683-8504 Japan
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Kimura T, Kido M, Miki K, Yamamoto T, Sasaki H, Kuruma H, Hayashi N, Takahashi H, Aoki M, Egawa S. Mid-term outcome of permanent prostate iodine-125 brachytherapy in Japanese patients. Int J Urol 2013; 21:473-8. [PMID: 24256329 DOI: 10.1111/iju.12347] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyze mid-term oncological outcomes of low-dose rate brachytherapy in Japanese patients. METHODS Between 2003 and 2010, 604 consecutive patients with clinically localized prostate cancer were treated with low-dose rate brachytherapy at Jikei University Hospital in Tokyo, Japan. Median follow up was 48 months. Of these patients, 260 (43%) were treated with neoadjuvant therapy, 45 (7.5%) with adjuvant hormonal therapy and 75 (12.4%) with supplemental external beam radiation therapy. Biochemical recurrence was defined as the prostate-specific antigen nadir plus 2 ng/mL. RESULTS Of the 604 patients, 219 (36.2%) were low risk, 361 (59.8%) were intermediate risk and 24 (4.0%) had high-risk disease. The median biologically effective dose was 174.4 Gy2. At 8 years, biochemical recurrence-free survival, cancer-specific survival, and overall survival were 82.2%, 100% and 95.6%, respectively. Biochemical recurrence-free survival at 8 years was 89.9%, 79.4% and 52.5%, for the low-, intermediate-, and high-risk groups, respectively. Biochemical recurrence-free survival for the high-risk group was significantly lower than the low- and intermediate-risk groups (P < 0.001). Biochemical recurrence-free survival did not differ significantly by biologically effective dose stratification. In multivariate analysis, younger age (P = 0.045), higher prostate-specific antigen (P = 0.004), higher Gleason score (P = 0.006) and higher clinical T stage (P = 0.008) were significant covariates associated with biochemical recurrence. The addition of hormonal therapy or external beam radiation therapy was associated with significantly better outcomes than low-dose rate brachytherapy monotherapy (P = 0.0021 and 0.010). Just four patients experienced G3 genitourinary or gastrointestinal toxicity. CONCLUSIONS Low-dose rate brachytherapy results in excellent mid-term oncological outcomes and acceptable toxicity in Japanese patients. In our experience, biologically effective dose does not represent a significant predictor for biochemical recurrence.
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Affiliation(s)
- Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
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143
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Goto K, Nishio M, Yamamoto N, Chikamori K, Hida T, Maemondo M, Katakami N, Kozuki T, Yoshioka H, Seto T, Fukuyama T, Tamura T. A prospective, phase II, open-label study (JO22903) of first-line erlotinib in Japanese patients with epidermal growth factor receptor (EGFR) mutation-positive advanced non-small-cell lung cancer (NSCLC). Lung Cancer 2013; 82:109-14. [PMID: 23910906 DOI: 10.1016/j.lungcan.2013.07.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/24/2013] [Accepted: 07/07/2013] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor erlotinib is associated with survival benefits in patients with EGFR mutation-positive non-small-cell lung cancer (NSCLC). This phase II, single-arm study examined the efficacy and safety of first-line erlotinib in Japanese patients with EGFR mutation-positive NSCLC. METHODS Eligible patients received erlotinib 150 mg/day until disease progression or unacceptable toxicity. The primary endpoints were progression-free survival (PFS) and safety. RESULTS A high degree of concordance was observed between different mutation testing methodologies, suggesting feasibility of early, rapid detection of EGFR mutations. Median PFS was 11.8 months (95% confidence interval [CI]: 9.7-15.3) at data cut-off (1 June 2012) (n = 102). Exon 19 deletions seemed to be associated with longer PFS compared with L858R mutations; T790M mutations were tentatively linked with shorter PFS. The safety profile was as expected: rash (any grade; 83%) and diarrhea (any grade; 81%) were most common. Six interstitial lung disease (ILD)-like cases were reported, and 5 were confirmed as ILD-like events by the extramural committee. Two patients died of treatment-related pneumonitis (JAPIC Clinical Trials Information number: Japic CTI-101085). CONCLUSION Erlotinib should be considered for first-line treatment in this subset of Japanese patients, with close monitoring for ILD-like events.
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Affiliation(s)
- Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
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Imai K. Lead extraction using excimer laser sheath--in full swing even in Japan. J Cardiol 2013; 62:201-2. [PMID: 23849825 DOI: 10.1016/j.jjcc.2013.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 06/01/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Katsuhiko Imai
- Department of Cardiovascular Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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Hirai T, Nishizawa Y, Nakazono H, Asai M, Yamashita H, Sasaki A, Yamashita T, Yamashita K, Shigemoto K, Harada S, Mizuiri S. Hemoglobin maintenance and dosing strategies using intravenous continuous erythropoietin receptor activator in Japanese hemodialysis patients. Ther Apher Dial 2013; 17:498-503. [PMID: 24107278 DOI: 10.1111/1744-9987.12013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Methoxy polyethylene glycol-epoetin beta, a continuous erythropoietin receptor activator (CERA), is reported to be effective in managing renal anemia but there is little data about CERA in Japan. This study aimed to ascertain the effects of CERA in Japanese hemodialysis patients and the appropriate starting dose of CERA when switching from other erythropoiesis-stimulating agents. We switched 61 stable hemodialysis patients to 4-weekly intravenous CERA, from either epoetin beta (rHuEPO) or darbepoetin alpha (DA). When determining the initial dose of CERA, we used guidelines recommended by the Japanese supplier for switching from rHuEPO, but for DA we based the CERA dose on European reports, because no Japanese guidelines exist. Fifty-two patients completed the 28-week study. Hemoglobin was maintained within the target range (10.0-12.0 g/dL). The required CERA dose decreased over the 28 weeks. The hemoglobin level and CERA dose stabilized faster when switching from DA. CERA showed similar efficacy in diabetic and non-diabetic patients. The effect of CERA is similar regardless of whether patients switch from low- or high-dose erythropoiesis-stimulating agents. In conclusion, CERA is effective for Japanese hemodialysis patients at a lower dose than expected.
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Affiliation(s)
- Takayuki Hirai
- Department of Internal Medicine, Harada Hospital, Hiroshima, Japan
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Francesco VD, Zullo A, Hassan C. Is concomitant quadruple therapy for Helicobacter pylori eradication really needed for Japanese patients? World J Gastrointest Pharmacol Ther 2012; 3:103-4. [PMID: 23494655 PMCID: PMC3596515 DOI: 10.4292/wjgpt.v3.i6.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/20/2012] [Accepted: 11/20/2012] [Indexed: 02/06/2023] Open
Abstract
The study found that the 7 d of concomitant therapy (lansoprazole, amoxicillin, clarithromycin and metronidazole) achieved significantly higher eradication rates compared to 7 d of triple therapy (lansoprazole, amoxicillin, clarithromycin), the intention to treat (ITT) cure rates being 94.9% and 68.3%, respectively. According to our opinion, this study is clinically relevant for Japanese physicians for at least 2 reasons: (1) the standard triple therapy (clarithromycin plus amoxicillin) achieved disappointing cure rates in Japan - in agreement with what was observed in several countries; and (2) the concomitant quadruple therapy is an effective therapeutic alternative.
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Affiliation(s)
- Vincenzo De Francesco
- Vincenzo De Francesco, Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Ospedali Riuniti, 71100 Foggia, Italy
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