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Kim DH, Lim ST, Kim HR, Kang EJ, Ahn HK, Lee YG, Sun DS, Kwon JH, Lee SC, Lee HW, Kim MK, Keam B, Park KU, Shin SH, Yun HJ. Impact of PIK3CA and cell cycle pathway genetic alterations on durvalumab efficacy in patients with head and neck squamous cell carcinoma: Post hoc analysis of TRIUMPH study. Oral Oncol 2024; 151:106739. [PMID: 38458039 DOI: 10.1016/j.oraloncology.2024.106739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/25/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES This study aimed to investigate whether genetic alterations in PI3KCA and the cell cycle pathways influence the efficacy of durvalumab, an immune checkpoint inhibitor, in patients with head and neck squamous cell carcinoma (HNSCC) who had previously failed platinum-based treatment. MATERIALS AND METHODS We obtained data from a phase II umbrella trial of patients with HNSCC who failed platinum-based treatment (TRIUMPH, NCT03292250). Patients receiving durvalumab treatment comprised those with PIK3CA alterations (Group A), those with cell cycle pathway alterations such as CDKN2A (Group B), and those with no druggable genetic alterations (Group C). We analyzed the overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) in each group and evaluated the potential predictive factors for durvalumab. RESULTS We analyzed the data of 87 patients: 18, 12, and 57 in groups A, B, and C, respectively. The ORRs were 27.8 %, 8.3 %, and 15.8 % in Groups A, B, and C, respectively (P = 0.329), and the median PFS for each group was 2.3, 1.6, and 1.7 months, respectively, with no significant differences between the groups (P = 0.24). Notably, patients with lower neutrophil-lymphocyte ratio (NLR) (≤5.8) had longer PFS (median, 2.8 vs 1.6 months, P < 0.001), while those with lower platelet-lymphocyte ratio (PLR) (≤491.2) exhibited longer PFS (median, 1.8 vs 1.2 months, P < 0.001). CONCLUSION Durvalumab's efficacy was similar, irrespective of the presence of PIK3CA or cell cycle pathway genetic alterations in patients with platinum-resistant HNSCC. The NLR and PLR may be promising predictive biomarkers.
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Affiliation(s)
- Dong Hyun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Taek Lim
- Hematology and Medical Oncology, Wonju Severance Christianity Hospital, Wonju, Republic of Korea
| | - Hye Ryun Kim
- Divison of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Seoul, Republic of Korea
| | - Eun Joo Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Kyung Ahn
- Department of Medical Oncology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Der Sheng Sun
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Hye Kwon
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sang-Cheol Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Hyun Woo Lee
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min Kyoung Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Keon-Uk Park
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Seong-Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea.
| | - Hwan Jung Yun
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
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Sheng H, He X, Chen Z, Huang K, Yang J, Wei X, Mao M. Development of a haematological indices-based nomogram for prognostic prediction and immunotherapy response assessment in primary pulmonary lymphoepithelioma-like carcinoma patients. Transl Lung Cancer Res 2024; 13:453-464. [PMID: 38601436 PMCID: PMC11002515 DOI: 10.21037/tlcr-23-813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/20/2024] [Indexed: 04/12/2024]
Abstract
Background Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a rare yet aggressive malignancy. This study aims to investigate a deep learning model based on hematological indices, referred to as haematological indices-based signature (HIBS), and propose multivariable predictive models for accurate prognosis prediction and assessment of therapeutic response to immunotherapy in PPLELC. Methods This retrospective study included 117 patients with PPLELC who received immunotherapy and were randomly divided into a training (n=82) and a validation (n=35) cohort. A total of 41 hematological features were extracted from routine laboratory tests and the least absolute shrinkage and selection operator (LASSO) algorithm were utilized to establish the HIBS. Additionally, we developed a nomogram using the HIBS and clinical characteristics through multivariate Cox regression analysis. To evaluate the nomogram's predictive performance, we used calibration curves and calculated the time-dependent area under the curve (AUC). Kaplan-Meier survival analysis was performed to estimate progression-free survival (PFS) in both cohorts. Results The proposed HIBS comprised 14 hematological features and showed that patients who experienced disease progression had significantly higher HIBS scores compared to those who did not progress (P<0.001). Five prognostic factors, including HIBS, tumor-node-metastasis (TNM) stage, presence of bone metastasis and the specific immunotherapy regimen, were found to be independent factors and were used to construct a nomogram, which effectively categorized PPLELC patients into a high-risk and a low-risk group, with patients in the high-risk patients demonstrating worse PFS (7.0 vs. 18.0 months, P<0.001) and lower overall response rates (22.2% vs. 52.7%, P<0.001). The nomogram showed satisfactory discrimination for PFS, with AUC values of 0.837 and 0.855 in the training and validation cohorts, respectively. Conclusions The HIBS-based nomogram could effectively predict the PFS and response of patients with PPLELC regarding immunotherapy and serve as a valuable tool for clinical decision making.
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Affiliation(s)
- Hui Sheng
- Department of Experimental Research, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin He
- Department of Pharmacy, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhiqiang Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kewei Huang
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jingjing Yang
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaoli Wei
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Minjie Mao
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
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Saito Y, Kobayashi K, Fukuoka O, Sakai T, Yamamura K, Ando M, Kondo K. Ultra-high combined positive score and high serum albumin are favorable prognostic biomarkers for immune checkpoint inhibitors in head and neck squamous cell carcinoma. Head Neck 2024; 46:367-377. [PMID: 38063247 DOI: 10.1002/hed.27576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Biomarkers that predict response to immune checkpoint inhibitor (ICI) in recurrent metastatic squamous cell carcinoma of the head and neck (RMHNSCC) are not well known. METHODS We prospectively measured the combined positive score (CPS) and administered ICI to patients with RMHNSCC. RESULTS Of 51 patients, 23 patients had a CPS <20 and 12 patients (23.5%) had a CPS ≥90. CPS showed a negative correlation with serum albumin. Survival analysis showed a 2-year survival rate of 24.1%. In multivariate analysis, CPS ≥90 (HR 0.3026, p = 0.02614) and albumin >3.5 (HR 0.3463, p = 0.01354) were the significant factors and plus chemotherapy (HR 0.4648, p = 0.07632) was not significant. Seven patients (14%) with CPS ≥90 and albumin >3.5 showed a 2-year survival rate of 66. 7%. CONCLUSIONS CPS ≥90 and albumin >3.5 cases are a subgroup of RMHNSCC that respond extremely well to ICI.
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Affiliation(s)
- Yuki Saito
- Departments of Otolaryngology, Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Kenya Kobayashi
- Departments of Otolaryngology, Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Osamu Fukuoka
- Departments of Otolaryngology, Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Toshihiko Sakai
- Departments of Otolaryngology, Head and Neck Surgery, University of Tokyo, Tokyo, Japan
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Yamamura
- Departments of Otolaryngology, Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Mizuo Ando
- Departments of Otolaryngology, Head and Neck Surgery, University of Tokyo, Tokyo, Japan
- Department of Otorhinolaryngology-Head and Neck Surgery, Okayama University, Graduate School of Medicine, Okayama, Japan
| | - Kenji Kondo
- Departments of Otolaryngology, Head and Neck Surgery, University of Tokyo, Tokyo, Japan
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Zhang J, Li M, Zhang L, Kuang T, Yu J, Wang W. Prognostic value of controlling nutritional status on clinical and survival outcomes in cancer patients treated with immunotherapy. Sci Rep 2023; 13:17715. [PMID: 37853186 PMCID: PMC10584918 DOI: 10.1038/s41598-023-45096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023] Open
Abstract
Cancer is a leading cause of death globally. Immunotherapy has shown promise in treating various types of cancer, but its effectiveness varies among patients. The Controlling Nutritional Status (CONUT) score has been linked to the prognosis of different cancers. However, its predictive value for immunotherapy outcomes is not well understood. Our research represents the pioneering meta-study to examine the prognostic value of the CONUT score on cancer patients treated with an immune checkpoint inhibitor (ICI). A comprehensive literature search was conducted using various databases including PubMed, the Cochrane Library, EMBASE, and Google Scholar. The study was conducted until July 28, 2023. This analysis encompassed a comprehensive evaluation of various clinical outcomes, namely overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). 663 patients from 8 studies were included in this study. It showed that cancer patients with high CONUT score had poorer OS (HR: 1.94, 95% CI, 1.52-2.47, p < 0.001) and PFS (HR: 2.22, 95% CI, 1.48-3.31, p < 0.001), as well as worse ORR (OR: 0.46, 95% CI, 0.25-0.85, p = 0.013) and DCR (HR: 0.29, 95% CI, 0.14-0.59, p = 0.001). The CONUT score can predict the prognosis of tumor patients treated with ICIs.
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Affiliation(s)
- Jiacheng Zhang
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
| | - Man Li
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
| | - Lilong Zhang
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
| | - Tianrui Kuang
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
| | - Jia Yu
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China.
| | - Weixing Wang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China.
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Miyamoto N, Takenaka Y, Sudo T, Eguchi H, Tanaka H, Fukusumi T, Takemoto N, Suzuki M, Inohara H. Prognostic significance of nutritional indices in patients with head and neck squamous cell carcinoma treated with immune checkpoint inhibitors. Acta Otolaryngol 2023; 143:925-930. [PMID: 38059478 DOI: 10.1080/00016489.2023.2288910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Although patients with head and neck squamous cell cancer (HNSCC) often show malnutrition, its effects on immune checkpoint inhibitor (ICI) treatment outcomes in these patients are unclear. OBJECTIVES To investigate the prognostic influence of nutritional indices in patients with HNSCC treated with ICIs and determine the optimal indices. METHODS This retrospective study included 106 patients with HNSCC treated with ICIs between 2017 and 2022. The prognostic influences of body mass index (BMI), geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI) on overall survival (OS) and progression-free survival (PFS) were analysed using the Kaplan-Meier method and Cox-regression models. RESULTS The 1-year PFS rates in the groups with high and low BMI, GNRI, and PNI were, respectively, 24.2% and 28.4% (p = .731), 29.7% and 14.4% (p = .024), and 30.3% and 13.9% (p = .015). PNI was an independent prognostic factor for both PFS (hazard ratio (HR) = 1.89; 95% confidence interval (CI), 1.08-3.29) and OS (HR = 3.26; 95% CI, 1.66-6.40). CONCLUSIONS PNI can predict ICI outcomes and should be assessed when ICI treatment is considered.
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Affiliation(s)
- Noriyuki Miyamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yukinori Takenaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takato Sudo
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirotaka Eguchi
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidenori Tanaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takahito Fukusumi
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Norihiko Takemoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Motoyuki Suzuki
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Sakai A, Ebisumoto K, Iijima H, Yamauchi M, Teramura T, Yamazaki A, Watanabe T, Inagi T, Maki D, Okami K. Chemotherapy following immune checkpoint inhibitors in recurrent or metastatic head and neck squamous cell carcinoma: clinical effectiveness and influence of inflammatory and nutritional factors. Discov Oncol 2023; 14:158. [PMID: 37642856 PMCID: PMC10465419 DOI: 10.1007/s12672-023-00774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the clinical effectiveness of chemotherapy following immune checkpoint inhibitors (ICI). The association between inflammatory and nutritional factors and prognosis has also been investigated. METHODS We retrospectively reviewed the medical records of recurrent or metastatic head and neck squamous cell carcinoma (RMHNSCC) patients who received chemotherapy following ICI therapy. The response rate and survival after chemotherapy, and nutritional and inflammatory factors, were examined. RESULTS The ICI before chemotherapy was nivolumab in 36 patients (70.6%) and pembrolizumab in 15 patients (29.4%). The chemotherapy regimens consisted of PTX in 32 patients (62.7%), PTX + Cmab in 9 (17.6%), and S1 in 10 (19.6%). The median overall survival (OS) was 20 months (95% CI 12-25), the estimated 12-month OS rate was 63.3%, the median progression-free survival (PFS) was 5 months (CI 4-6), and the 12-month PFS estimate was 8.9%. Univariate analysis significantly correlated Neutrophil-to-Lymphocyte Ratio (NLR), platelet-to-lymphocyte ratio (PLR), controlling nutritional status score (CONUT), and prognostic nutrition index (PNI) with OS and PFS. Additionally, these factors were significantly correlated with OS and PFS in the log-rank tests. CONCLUSIONS Chemotherapy following ICI is highly effective. There were no significant differences in the chemotherapy regimens. Inflammatory and nutritional factors may associate with patient prognosis after chemotherapy.
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Affiliation(s)
- Akihiro Sakai
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Koji Ebisumoto
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Hiroaki Iijima
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Mayu Yamauchi
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Takanobu Teramura
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Aritomo Yamazaki
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Takane Watanabe
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Toshihide Inagi
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Daisuke Maki
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Kenji Okami
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
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Arihara Y, Takada K, Murase K, Kawamura K, Kakiuchi A, Kurose M, Sasaki T, Ogi K, Yamazaki M, Miyazaki A, Kato J, Takano K. Inflammation and malnutrition as markers of poor outcomes in head and neck cancer patients treated with nivolumab. Acta Otolaryngol 2023; 143:714-720. [PMID: 37537940 DOI: 10.1080/00016489.2023.2240372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Although immune checkpoint inhibitors (ICIs) are approved for the treatment of recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC), the response to ICIs remains unclear. AIMS/OBJECTIVES To summarize the clinical outcomes of patients with HNSCC treated with nivolumab (Nivo) in our institution, and provide a basis for research on biomarkers that can predict the efficacy of ICIs. MATERIAL AND METHODS Forty-four patients with R/M HNSCC who received Nivo (2017-2022) were retrospectively analysed. RESULTS Despite the older age of this cohort (median age of 72 years), we observed favourable long-term outcomes, with an overall survival of 24.1 months, which could be attributed to our aggressive nutritional intervention. Older age, poor performance status (≥1), and higher Glasgow Prognostic Scores, reflecting the chronic inflammation and malnutrition of patients, were associated with poor prognoses, with hazard ratios for death of 2.63 (95% confidence interval [CI]; 1.07-6.46, p = .016), 3.50 (95% CI; 1.28-9.55, p = .001), and 2.69 (95% CI; 1.17-6.21, p = .029), respectively. Peripheral blood biomarker analysis revealed that systemic inflammation may negatively affect the efficacy of Nivo. CONCLUSIONS AND SIGNIFICANCE Our results suggest that nutrition and inflammation must be the focus of future studies aiming to identify novel biomarkers.
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Affiliation(s)
- Yohei Arihara
- Department of Medical Oncology, Sapporo Medical University, Sapporo, Japan
| | - Kohichi Takada
- Department of Medical Oncology, Sapporo Medical University, Sapporo, Japan
| | - Kazuyuki Murase
- Department of Medical Oncology, Sapporo Medical University, Sapporo, Japan
| | - Kentaro Kawamura
- Department of Medical Oncology, Sapporo Medical University, Sapporo, Japan
| | - Akito Kakiuchi
- Department of Otolaryngology - Head and Neck Surgery, Sapporo Medical University, Sapporo, Japan
| | - Makoto Kurose
- Department of Otolaryngology - Head and Neck Surgery, Sapporo Medical University, Sapporo, Japan
| | - Takanori Sasaki
- Department of Oral Surgery, Sapporo Medical University, Sapporo, Japan
| | - Kazuhiro Ogi
- Department of Oral Surgery, Sapporo Medical University, Sapporo, Japan
| | - Masahide Yamazaki
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Akihiro Miyazaki
- Department of Oral Surgery, Sapporo Medical University, Sapporo, Japan
| | - Junji Kato
- Department of Medical Oncology, Sapporo Medical University, Sapporo, Japan
| | - Kenichi Takano
- Department of Otolaryngology - Head and Neck Surgery, Sapporo Medical University, Sapporo, Japan
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