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Hirota S, Tateishi U, Nakamoto Y, Yamamoto H, Sakurai S, Kikuchi H, Kanda T, Kurokawa Y, Cho H, Nishida T, Sawaki A, Ozaka M, Komatsu Y, Naito Y, Honma Y, Takahashi F, Hashimoto H, Udo M, Araki M, Nishidate S. English version of Japanese Clinical Practice Guidelines 2022 for gastrointestinal stromal tumor (GIST) issued by the Japan Society of Clinical Oncology. Int J Clin Oncol 2024:10.1007/s10147-024-02488-1. [PMID: 38609732 DOI: 10.1007/s10147-024-02488-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/12/2024] [Indexed: 04/14/2024]
Abstract
The Japan Society of Clinical Oncology Clinical Practice Guidelines 2022 for gastrointestinal stromal tumor (GIST) have been published in accordance with the Minds Manual for Guideline Development 2014 and 2017. A specialized team independent of the working group for the revision performed a systematic review. Since GIST is a rare type of tumor, clinical evidence is not sufficient to answer several clinical and background questions. Thus, in these guidelines, we considered that consensus among the experts who manage GIST, the balance between benefits and harms, patients' wishes, medical economic perspective, etc. are important considerations in addition to the evidence. Although guidelines for the treatment of GIST have also been published by the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO), there are some differences between the treatments proposed in those guidelines and the treatments in the present guidelines because of the differences in health insurance systems among countries.
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Affiliation(s)
- Seiichi Hirota
- Department of Surgical Pathology, Hyogo Medical University School of Medicine, Nishinomiya, Japan.
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidetaka Yamamoto
- Department of Pathology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Shinji Sakurai
- Department of Diagnostic Pathology, Japan Community Healthcare Organization Gunma Central Hospital, Maebashi, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsuo Kanda
- Department of Gastroenterology, Southern TOHOKU General Hospital, Koriyama, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Haruhiko Cho
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Toshirou Nishida
- Department of Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Akira Sawaki
- Department of Medical Oncology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masato Ozaka
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshito Komatsu
- Department of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Japan
| | - Yoichi Naito
- Department of General Internal Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshitaka Honma
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Fumiaki Takahashi
- Department of Information Science, Iwate Medical University, Morioka, Japan
| | | | - Midori Udo
- Nursing Department, Osaka Police Hospital, Osaka, Japan
| | - Minako Araki
- Association of Chubu GIST Patients and Their Families, Nagoya, Japan
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Omiya M, Murata T, Sawaki A, Teshima S, Kawachi J. Cutaneous Metastasis of Transverse Colon Cancer with an Aberrant Pattern of CK7/CK20/CDX2 and High Microsatellite Instability. Intern Med 2023; 62:3625-3630. [PMID: 37164671 PMCID: PMC10781542 DOI: 10.2169/internalmedicine.1629-23] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/27/2023] [Indexed: 05/12/2023] Open
Abstract
A 79-year-old woman was diagnosed with transverse colon cancer, moderately differentiated adenocarcinoma. She underwent surgery and postoperative adjuvant chemotherapy. At 80 years old, the patient exhibited changes in skin tone at the chest and abdomen with CK7+/CK20-/CDX2- immunostaining that was later identified as poorly differentiated adenocarcinoma. The diagnosis was cancer of unknown primary origin. The patient passed away three months after the detection of the skin lesion. Autopsy revealed recurrence at the transverse colon, multiple organ metastases, a similar postmortem immunostaining pattern, and high-frequency microsatellite instability (MSI-high). We herein report this case of CK7+/CK20-/CDX2- and MSI-high transverse colon cancer showing cutaneous metastasis.
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Affiliation(s)
- Moeko Omiya
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Japan
| | - Takaaki Murata
- Department of Surgery, Shonan Kamakura General Hospital, Japan
| | - Akira Sawaki
- Department of Medical Oncology, Shonan Kamakura General Hospital, Japan
| | - Shinichi Teshima
- Department of Pathology, Shonan Kamakura General Hospital, Japan
| | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Japan
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Sawaki A, Kurokawa Y, Honma Y, Naito Y, Iwagami S, Baba H, Komatsu Y, Nishida T, Doi T. PS4-3 A phase III trial of pimitespib (TAS-116) in patients with advanced gastrointestinal stromal tumor: CHAPTER-GIST-301. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.05.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kurokawa Y, Honma Y, Sawaki A, Naito Y, Iwagami S, Komatsu Y, Takahashi T, Nishida T, Doi T. Pimitespib in patients with advanced gastrointestinal stromal tumor (CHAPTER-GIST-301): a randomized, double-blind, placebo-controlled phase 3 trial. Ann Oncol 2022; 33:959-967. [PMID: 35688358 DOI: 10.1016/j.annonc.2022.05.518] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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: 01/15/2022] [Revised: 04/06/2022] [Accepted: 05/29/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Prognosis of advanced gastrointestinal stromal tumors (GIST) refractory to tyrosine kinase inhibitors (TKIs) is poor. This randomized, placebo-controlled, phase 3 trial evaluated the efficacy and safety of pimitespib, a novel heat shock protein 90 inhibitor, in advanced GIST refractory to standard TKIs. PATIENTS AND METHODS Patients with histologically confirmed GIST refractory to imatinib, sunitinib, and regorafenib were randomized 2:1 to oral pimitespib 160 mg/day or placebo for five consecutive days per week in 21-day cycles. Following disease progression by blinded central radiological review (BCRR), crossover to open-label pimitespib was permitted. The primary endpoint was progression-free survival (PFS) by BCRR in the full analysis set. Secondary endpoints included overall survival (OS) adjusted using the rank preserving structural failure time method to reduce the expected confounding impact of crossover. RESULTS From Oct 31, 2018 to Apr 30, 2020, 86 patients were randomized to pimitespib (n=58) or placebo (n=28). Median PFS was 2.8 months (95% CI 1.6-2.9) with pimitespib versus 1.4 months (0.9-1.8) with placebo (hazard ratio [HR] 0.51 [95% CI 0.30-0.87]; one-sided p=0.006). Pimitespib showed an improvement in crossover-adjusted OS compared with placebo (HR 0.42 [0.21-0.85], one-sided p=0.007). Seventeen (60.7%) patients receiving placebo crossed-over to pimitespib; median PFS after crossover was 2.7 (95% CI 0.7-4.1) months. The most common (≥30%) treatment-related adverse events (AEs) with pimitespib were diarrhea (74.1%) and decreased appetite (31.0%); the most common (≥10%) grade ≥3 treatment-related AE was diarrhea (13.8%). Treatment-related AEs leading to pimitespib discontinuation occurred in 3 (5.2%) patients. CONCLUSION Pimitespib significantly improved PFS and crossover-adjusted OS compared with placebo and had an acceptable safety profile in patients with advanced GIST refractory to standard TKIs.
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Affiliation(s)
- Y Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan;.
| | - Y Honma
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - A Sawaki
- Department of Medical Oncology, Fujita Health University Hospital, Aichi, Japan
| | - Y Naito
- Department of General Internal Medicine/Medical Oncology/Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - S Iwagami
- Department of Gastroenterological Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Y Komatsu
- Department of Cancer Center, Hokkaido University Hospital, Sapporo, Japan
| | - T Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Nishida
- Department of Surgery, National Cancer Center Hospital, Tokyo, Japan;; Department of Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - T Doi
- Department of Experimental Therapeutics, National Cancer Center Hospital Kashiwa, Japan
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Yamaguchi Y, Katata Y, Okawaki M, Sawaki A, Yamamura M. Republication: A Prospective Observational Study of Adoptive Immunotherapy for Cancer Using Zoledronate-Activated Killer (ZAK) Cells - An Analysis for Patients With Incurable Pancreatic Cancer. Anticancer Res 2022; 42:1181-1187. [PMID: 35093924 DOI: 10.21873/anticanres.15584] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Adoptive immunotherapy (AIT) using autologous zoledronate-activated killer (ZAK) cells has been performed for developing a novel modality of cancer treatment. In this study, data series from incurable pancreatic cancer were analyzed. PATIENTS AND METHODS Patients were treated with AIT using intravenous administration of ZAK cells every 3 to 4 weeks in combination with standard chemotherapy and possible clinical benefits were examined. RESULTS Seventy-five patients were treated. A median overall survival (OS) time of 6.7 months was achieved for all patients and 13.1 months for those treated 5 times or more, that increased to 14.6 and 18.3 months, respectively, when the previous treatment period of chemotherapy alone was included in the analysis. The disease control rate was 58.5 %. Multivariate regression analysis showed a significant positive correlation between the survival and baseline value of lymphocyte percentage in white blood cell counts (p=0.031). CONCLUSION The data suggest that AIT using ZAK cells in combination with chemotherapy is safe and feasible and may be effective in prolonging survival for patients with incurable pancreatic cancer. The lymphocyte percentage at baseline may be a good biomarker for predicting the survival benefit of ZAK cell AIT.
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Affiliation(s)
- Yoshiyuki Yamaguchi
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama, Japan
| | - Yousuke Katata
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama, Japan
| | - Makoto Okawaki
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama, Japan
| | - Akira Sawaki
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama, Japan
| | - Masahiro Yamamura
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama, Japan
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Kuzuya T, Kawabe N, Hashimoto S, Miyahara R, Sawaki A, Nakano T, Nakaoka K, Tanaka H, Miyachi Y, Mii A, Kamejima S, Takahara T, Kato Y, Sugioka A, Hirooka Y. Early Changes in Alpha-Fetoprotein Are a Useful Predictor of Efficacy of Atezolizumab plus Bevacizumab Treatment in Patients with Advanced Hepatocellular Carcinoma. Oncology 2021; 100:12-21. [PMID: 34731863 DOI: 10.1159/000519448] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 08/16/2021] [Accepted: 09/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the early changes in alpha-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) levels in patients with advanced hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab and to evaluate the relationship between changes in these tumor markers and treatment efficacy. METHODS Of 58 consecutive patients who started atezolizumab plus bevacizumab at our institution, 50 patients with information on antitumor response obtained at 6 weeks after therapy were enrolled in this study and their treatment outcomes were retrospectively evaluated. RESULTS According to the Response Evaluation Criteria in Solid Tumors at 6 weeks, the objective response (OR) rate was 22.0% and the disease control (DC) rate was 78.0%. In patients who achieved OR at 6 weeks, median AFP and DCP ratios at weeks 1, 2, 3, and 6 were significantly lower than those in patients who did not achieve OR. AFP ratios in patients who did not achieve DC at 6 weeks (Non-6W-DC group) were significantly higher than in those who achieved DC at week 6 (6W-DC group). Median overall survival in the Non-6W-DC group was significantly shorter than in the 6W-DC group (156 days vs. not reached, p = 0.0008). An AFP ratio of 1.4 or higher at 3 weeks had a specificity of 88.0% and a sensitivity of 88.9% for predicting Non-6W-DC. Median progression-free survival was significantly shorter in patients with an AFP ratio of 1.4 or higher at 3 weeks than in those with an AFP ratio of <1.4 (42 days vs. 210 days, p = 0.0003). CONCLUSION Early changes in AFP might be useful for predicting the antitumor efficacy of atezolizumab plus bevacizumab in patients with advanced HCC. An AFP ratio of 1.4 or higher at 3 weeks might be an early predictor of refractoriness to atezolizumab plus bevacizumab therapy.
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Affiliation(s)
- Teiji Kuzuya
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Naoto Kawabe
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Senju Hashimoto
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Akira Sawaki
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Takuji Nakano
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Kazunori Nakaoka
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Hiroyuki Tanaka
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Yohei Miyachi
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Arisa Mii
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Sayaka Kamejima
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | | | - Yutaro Kato
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
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Honma Y, Kurokawa Y, Sawaki A, Naito Y, Iwagami S, Baba H, Komatsu Y, Nishida T, Doi T. Randomized, double-blind, placebo (PL)-controlled, phase III trial of pimitespib (TAS-116), an oral inhibitor of heat shock protein 90 (HSP90), in patients (pts) with advanced gastrointestinal stromal tumor (GIST) refractory to imatinib (IM), sunitinib (SU) and regorafenib (REG). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11524] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11524 Background: Pimitespib (PIM) is a novel class of orally active selective HSP90 inhibitors. KIT and PDGFRA are clients of HSP90 for their functional stability; therefore, HSP90 is a rational therapeutic target on GIST in pts with acquired resistance, such as secondary mutation in KIT, to approved tyrosine kinase inhibitors. A phase II trial showed clinical activity of PIM in pts with advanced GIST refractory to standard treatments whose medical need remains unmet. This phase III trial evaluated the efficacy and safety of PIM for this unmet clinical need. Methods: Eligible pts had histologically confirmed advanced GIST refractory to IM, SU, and REG, ≥1 measurable lesion, and ECOG performance status 0 or 1. Pts were randomized 2:1 to receive either PIM 160 mg once daily on a 5-days-on/ 2-days-off schedule or PL. Pts eligible for unblinding at the time of progressive disease were allowed to crossover to open-label PIM. The primary endpoint was progression-free survival (PFS) by blinded central radiological review based on modified RECIST 1.1. Secondary endpoints included overall survival (OS), PFS in the pts crossed over to PIM (secondary PFS), and safety. Crossover-adjusted OS was derived using the rank preserving structural failure time (RPSFT) model. Exploratory endpoints included pharmacogenomics (PGx). Results: From Oct 2018 to Apr 2020, 86 pts were randomized to receive either PIM (n = 58) or PL (n = 28). Baseline characteristics were well balanced between the two arms. Median PFS was 2.8 months (mo) (95% CI: 1.6–2.9) for PIM vs. 1.4 mo (95% CI: 0.9–1.8) for PL. The hazard ratio (HR) for PFS was 0.51 (95% CI: 0.30–0.87) ( p = 0.006, stratified log-rank test). Median OS was 13.8 mo (95% CI: 9.2–not reached) for PIM vs. 9.6 mo (95% CI: 5.5–not reached) for PL (HR for OS 0.63; p = 0.081), with 60.7 % of PL pts crossed over to PIM; secondary PFS was 2.7 mo (95% CI: 0.7–4.1). The RPSFT-adjusted median OS of PL was 7.6 mo (adjusted HR for OS 0.42; p = 0.007). Furthermore, the results of PGx analysis suggested that PIM was also effective in pts with secondary KIT mutation detected from blood samples. The most common ( > 5%) grade 3 or higher adverse events (AEs) in PIM/PL were diarrhea (13.8%/0%), anemia (6.9%/10.7%), decreased appetite (6.9%/0%), and tumor hemorrhage (5.2%/0%). AEs leading to PIM/PL study discontinuation were observed in 4/2 pts (6.9%/7.1%), respectively. Conclusions: This randomized trial demonstrated that PIM significantly improved PFS with OS prolongation in pts with advanced GIST refractory to IM, SU, and REG, as a HSP90 inhibitor for the first time. PIM was tolerated and AEs were manageable. With a mechanism of action different from that of standard therapies, PIM has the potential to be a new standard treatment in GIST. Clinical trial information: JapicCTI-184094.
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Affiliation(s)
| | | | | | - Yoichi Naito
- National Cancer Center Hospital East, Chiba, Japan
| | | | - Hideo Baba
- Kumamoto University Hospital, Kumamoto, Japan
| | | | - Toshirou Nishida
- Japan Community Health care Organization Osaka Hospital, National Cancer Center Hospital, Osaka, Tokyo, Japan
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Matsuoka H, Hayashi T, Takigami K, Imaizumi K, Shiroki R, Ohmiya N, Sugiura K, Kawada K, Sawaki A, Maeda K, Ando Y, Uyama I. Correlation between immune-related adverse events and prognosis in patients with various cancers treated with anti PD-1 antibody. BMC Cancer 2020; 20:656. [PMID: 32664888 PMCID: PMC7362440 DOI: 10.1186/s12885-020-07142-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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: 03/09/2020] [Accepted: 07/06/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1) are used for the treatment of various cancer types. However, immune-related adverse events (irAEs) occur in patients treated with ICIs. Several small-scale studies have reported the onset of irAEs and therapeutic effects of ICIs. Here we report a large-scale retrospective study covering a wide range of cancers. We evaluated irAEs and the therapeutic effects of ICIs and determined whether irAEs could be predicted. METHODS This study included patients treated with the anti-PD-1 antibodies nivolumab or pembrolizumab at Fujita Health University Hospital between December 2015 and March 2019. We retrospectively reviewed the electronic medical records for age, cancer type, pre-treatment blood test data, presence or absence of irAE onset, type and severity of irAEs, outcome of irAE treatment, response rate, progression-free survival and overall survival. RESULTS Two hundred-eighty patients received ICIs. The overall incidence of irAEs was 41.1% (115 patients), and the incidence of severe irAEs of grade 3 and higher was 2.8% (eight patients). The most common irAEs were skin disorders, thyroid disorders and interstitial pneumonitis. Patients with irAEs were significantly older than those without irAEs (69.7 versus 66.0 years, P = 0.02). The objective response rate (ORR) in patients with irAEs was 30.4%, which was significantly higher than in patients without irAEs (12.7%; P < 0.01). Both the median overall and progression-free survival were significantly longer in patients with irAEs (P < 0.01, p < 0.01). Based on the blood test data obtained before ICI therapy, hypothyroidism, thyroid-stimulating hormone levels and thyroglobulin antibody levels were associated with the onset of irAEs. In many patients with irAEs of Common Terminology Criteria for Adverse Events Grade 3 or higher, re-administration of ICIs was difficult, and their outcomes were poor. In contrast, many patients with irAEs of a lower grade were able to resume ICI therapy. CONCLUSION Although the onset of irAEs was difficult to be predicted based on pre-treatment tests. It appeared that the continuation of ICI therapy, along with early detection and adequate control of irAEs, might contribute to the improved prognosis of patients.
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Affiliation(s)
- Hiroshi Matsuoka
- Department of Surgery Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake City, Aichi, Japan.
| | - Takahiro Hayashi
- College of Pharmacy, Kinjo Gakuin University, 2-1723 Oomori Moriyama, Nagoya City, Aichi, 463-8521, Japan
| | - Karen Takigami
- College of Pharmacy, Kinjo Gakuin University, 2-1723 Oomori Moriyama, Nagoya City, Aichi, 463-8521, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake City, Aichi, Japan
| | - Ryoichi Shiroki
- Department of Urology Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake City, Aichi, Japan
| | - Naoki Ohmiya
- Department of Gastroenterology Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake City, Aichi, Japan
| | - Kazumitsu Sugiura
- Department of Dermatology Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake City, Aichi, Japan
| | - Kenji Kawada
- Department of Clinical Oncology Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake City, Aichi, Japan
| | - Akira Sawaki
- Department of Clinical Oncology Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake City, Aichi, Japan
| | - Koutaro Maeda
- Fujita Health University International Medical Center, Dengakugakubo 1-98, Kutsukake-cho, Toyoake City, Aichi, Japan
| | - Yousuke Ando
- Department of Pharmacy Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake City, Aichi, Japan
| | - Ichiro Uyama
- Department of Surgery Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake City, Aichi, Japan
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Nagasaka T, Inada R, Ojima H, Noura S, Tanioka H, Munemoto Y, Shimada Y, Ishibashi K, Shindo Y, Kagawa Y, Tomibayashi A, Okamoto K, Tsuji A, Tsuji Y, Yamaguchi S, Sawaki A, Mishima H, Shimokawa M, Okajima M, Yamaguchi Y. Randomized phase III study of sequential treatment with capecitabine or 5-fluorouracil (FP) plus bevacizumab (BEV) followed by the addition with oxaliplatin (OX) versus initial combination with OX+FP+ BEV in the first-line chemotherapy for metastatic colorectal cancer: The C-cubed study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Doi T, Kurokawa Y, Sawaki A, Komatsu Y, Ozaka M, Takahashi T, Naito Y, Ohkubo S, Nishida T. Efficacy and safety of TAS-116, an oral inhibitor of heat shock protein 90, in patients with metastatic or unresectable gastrointestinal stromal tumour refractory to imatinib, sunitinib and regorafenib: a phase II, single-arm trial. Eur J Cancer 2019; 121:29-39. [PMID: 31536852 DOI: 10.1016/j.ejca.2019.08.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 05/15/2019] [Revised: 08/08/2019] [Accepted: 08/14/2019] [Indexed: 12/31/2022]
Abstract
AIM We evaluated the efficacy and safety of TAS-116, a novel class of an orally active selective inhibitor of heat shock protein 90, in patients with advanced gastrointestinal stromal tumour (GIST) after failure of three or more lines of standard treatment with imatinib, sunitinib and regorafenib. METHODS In this single-arm phase II study, patients received 160 mg/day oral TAS-116 for five consecutive days, followed by a 2-day rest. The primary end-point was centrally assessed progression-free survival (PFS). The secondary end-points were objective response rate, disease control rate, overall survival (OS), metabolic response rate, safety, pharmacokinetics and pharmacogenomics. RESULTS Forty-one patients were enrolled in Japan, and 40 patients underwent efficacy and safety evaluation. At the cut-off date, the median PFS was 4.4 months (95% confidence interval [CI], 2.8-6.0) and 12-week progression-free rate was 73.4% (95% CI, 58.1-88.7). Thirty-four patients (85.0%) had stable disease for ≥ 6 weeks. The median OS was 11.5 months (95% CI, 7.0-not reached). All patients experienced at least one treatment-related adverse event (AE), including diarrhoea (80.0%), decreased appetite (45.0%) and increase in blood creatinine level (42.5%). Grade ≥3 AEs and treatment-related grade ≥3 AEs occurred in 23 (57.5%) and 21 (52.5%) patients, respectively. All AEs resolved after dose modification, and no TAS-116-related AEs led to treatment discontinuation. CONCLUSION TAS-116 showed significant activity in advanced GIST refractory to standard treatment. Further development of TAS-116 is warranted. TRIAL REGISTRATION JapicCTI-163182.
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Affiliation(s)
| | | | - Akira Sawaki
- Fujita Health University Hospital, Nagoya, Japan
| | | | - Masato Ozaka
- The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Yoichi Naito
- National Cancer Center Hospital East, Chiba, Japan
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Miyazaki K, Takeuchi T, Yamaguchi M, Asano N, Sawaki A, Imai H, Ono R, Nosaka T, Kobayashi K, Tanaka K, Katayama N. GENE MUTATIONS AND SITES OF INVOLVEMENT IN DUODENAL-TYPE FOLLICULAR LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.2_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- K. Miyazaki
- Department of Hematology and Oncology; Mie University Graduate School of Medicine; Tsu Japan
| | - T. Takeuchi
- Department of Hematology and Oncology; Mie University Graduate School of Medicine; Tsu Japan
| | - M. Yamaguchi
- Department of Hematology and Oncology; Mie University Graduate School of Medicine; Tsu Japan
| | - N. Asano
- Department of Molecular Diagnostics; Shinshu Medical Center; Suzaka Japan
| | - A. Sawaki
- Department of Hematology and Oncology; Mie University Graduate School of Medicine; Tsu Japan
| | - H. Imai
- Pathology Division; Mie University Hospital; Tsu Japan
| | - R. Ono
- Department of Microbiology and Molecular Genetics; Mie University Graduate School of Medicine; Tsu Japan
| | - T. Nosaka
- Department of Microbiology and Molecular Genetics; Mie University Graduate School of Medicine; Tsu Japan
| | - K. Kobayashi
- Gastroenterology; Matsusaka Chuo General Hospital; Matsusaka Japan
| | - K. Tanaka
- Department of Endoscopy; Mie University Hospital; Tsu Japan
| | - N. Katayama
- Department of Hematology and Oncology; Mie University Graduate School of Medicine; Tsu Japan
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12
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Ito T, Tori M, Hashigaki S, Kimura N, Sato K, Ohki E, Sawaki A, Okusaka T. Efficacy and safety of sunitinib in Japanese patients with progressive, advanced/metastatic, well-differentiated, unresectable pancreatic neuroendocrine tumors: final analyses from a Phase II study. Jpn J Clin Oncol 2019; 49:354-360. [PMID: 30834940 PMCID: PMC6452620 DOI: 10.1093/jjco/hyz009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/15/2018] [Revised: 10/18/2018] [Accepted: 02/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background In an interim analysis of a Phase II trial in Japanese patients with pancreatic neuroendocrine tumors (panNETs), sunitinib demonstrated antitumor activity with an objective response rate (ORR) of 50% (95% confidence interval [CI], 21–79) and a median progression-free survival (PFS) of 16.8 months (95% CI, 9.3–26.2). Here, we report the final analyses of efficacy and safety, as well as additional analyses, from this Phase II study. Methods This was a multicenter, open-label, Phase II trial (NCT01121562) of sunitinib in Japanese patients with panNETs. Patients received oral sunitinib 37.5 mg/day on a continuous daily dosing schedule. Dose modifications were permitted. The primary endpoint was clinical benefit rate (CBR). Secondary endpoints included ORR, PFS, overall survival (OS), safety and pharmacokinetics. Results Of 12 patients enrolled and treated, all discontinued treatment—the majority (n = 8) owing to disease progression. Most patients were male (n = 8), <65 years of age (n = 11) and had a non-functional tumor (n = 10). The median (range) number of days on drug was 323.5 (22–727). The CBR (95% CI) was 75.0% (42.8–94.5). ORR (95% CI) was 50.0% (21.1–78.9). Median (95% CI) PFS was 16.8 (9.3–26.2) months; however, median (95% CI) OS was not reached (22.0–not estimable). Most common adverse events (AEs; all-causality) were diarrhea (n = 10; 83.3%), hand-foot syndrome (n = 8; 66.7%) and hypertension (n = 8; 66.7%). Conclusions These results support the efficacy and safety of sunitinib in Japanese patients with panNETs. Appropriate AE management through dose reduction and interruption may prolong sunitinib treatment and maximize its efficacy.
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Affiliation(s)
- Tetsuhide Ito
- Department of Hepato-Biliary-Pancreatic Medicine, Fukuoka Sanno Hospital, International University of Health and Welfare, Tokyo 814-0001, Japan
| | - Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital, Osaka 543-0035, Japan
| | | | | | | | | | - Akira Sawaki
- Department of Medical Oncology, Fujita Health University, Aichi 470-1192, Japan
| | - Takuji Okusaka
- Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
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13
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Ito T, Okusaka T, Nishida T, Yamao K, Igarashi H, Morizane C, Kondo S, Mizuno N, Hara K, Sawaki A, Hashigaki S, Kimura N, Murakami M, Ohki E, Chao RC, Imamura M. Correction to: Phase II study of sunitinib in Japanese patients with unresectable or metastatic, well-differentiated pancreatic neuroendocrine tumor. Invest New Drugs 2019; 37:591. [PMID: 30903344 DOI: 10.1007/s10637-019-00757-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the original publication of this article, the license subtype should be CC BY and not CC BY-NC.
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Affiliation(s)
- Tetsuhide Ito
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, Japan.
| | - Takuji Okusaka
- Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hisato Igarashi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, Japan
| | - Chigusa Morizane
- Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shunsuke Kondo
- Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akira Sawaki
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.,Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | | | | | - Mami Murakami
- Pfizer Japan Inc., Tokyo, Japan.,Drug Delivery and Formulation Group, Medicinal Chemistry Platform, Ontario Institute for Cancer Research, Toronto, ON, Canada
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14
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Ishibashi K, Nagasaka T, Sawaki A, Mishima H, Tsuji A, Tsuji Y, Munemoto Y, Yamaguchi S, Shimokawa M, Shibata M, Sugiyama Y, Suzuki H, Okajima M, Yamaguchi Y. A phase III trial of Cape/5-FU+Bmab followed by CapeOX/mFOLFOX6+Bmab vs. CapeOX/mFOLFOX6+Bmab in mCRC: C-Cubed(C3) study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy375.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Ojima H, Mishima H, Sawaki A, Nagasaka T, Shimokawa M, Inukai M, Shinozaki K, Tanioka H, Nasu J, Nishina T, Hazama S, Okajima M, Tsuji A, Tsuji Y, Munemoto Y, Yamaguchi S, Yamaguchi Y. A randomized phase III clinical trial of sequential capecitabine or 5-FU plus bevacizumab (Cape/5-FU+Bmab) followed by Cape/5-FU plus oxaliplatin plus Bmab (CapeOX/mFOLFOX6+Bmab) versus combination CapeOX/mFOLFOX6+Bmab in advanced colorectal cancer: The C-cubed (C 3) study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.tps872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS872 Background: Less intensive regimens, focusing on survival and disease control, may be better first-line treatments in unresectable metastatic colorectal cancer (mCRC). Several randomized trials suggested that sequential cytotoxic agents in mCRC may improve overall survival compared with combination chemotherapy. This study investigated whether sequential treatment with Bmab-based first-line therapy with oxaliplatin has superior efficacy to combination treatment for unresectable mCRC. Methods: This study is a two-arm, multicenter, open-label, randomized phase III trial in Japan, comparing the efficacy and safety of sequential Cape/5-FU+Bmab with escalation to CapeOX/mFOLFOX6+Bmab versus combination CapeOX/mFOLFOX6+Bmab as the first-line treatment of mCRC. The primary endpoint is Time to failure of strategy (TFS). In the sequential arm (Arm A: oxaliplatin ‘wait-and-go’), treatment escalation from Cape/5-FU+Bmab to CapeOX/mFOLFOX6+Bmab is recommended for progressive disease. In the combination arm (Arm B: oxaliplatin ‘stop-and-go’), de-escalation from CapeOX/mFOLFOX6+Bmab to Cape/5-FU+Bmab is possible after 12 weeks of treatment. Re-escalation to CapeOX/mFOLFOX6+Bmab after progressive disease is considered only for patients who received de-escalation of oxaliplatin, not caused by oxaliplatin-associated toxicity, after 12 weeks of treatment. A target sample size of 304 evaluable patients is considered sufficient to detect a hazard ratio of 0.69 for the TFS of the sequential ‘wait-and-go’ approach compared with the combination ‘stop-and go’ approach with 80% power and a 2-sided significance level of 5%. From December 2014 to September 2016, 311 patients were enrolled across 81 centers in Japan. The follow-up period is until March 2018, and results are expected in 2019, and results are expected in 2019. Clinical trial information: 000015405.
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Affiliation(s)
| | | | | | - Takeshi Nagasaka
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | | | | | | | | | | | | | - Shoichi Hazama
- Yamaguchi University Graduate School of Medicine, Ube, Japan
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16
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Sawaki A, Yamada Y, Yamaguchi K, Nishina T, Doi T, Satoh T, Chin K, Boku N, Omuro Y, Komatsu Y, Hamamoto Y, Koizumi W, Saji S, Shah MA, Van Cutsem E, Kang YK, Iwasaki J, Kuriki H, Ohtsuka W, Ohtsu A. Regional differences in advanced gastric cancer: exploratory analyses of the AVAGAST placebo arm. Gastric Cancer 2018; 21:429-438. [PMID: 29058097 PMCID: PMC5906488 DOI: 10.1007/s10120-017-0773-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 07/11/2017] [Accepted: 10/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AVAGAST was an international, randomized, placebo-controlled phase III study of chemotherapy with or without bevacizumab as first-line therapy for patients with advanced gastric cancer. We performed exploratory analyses to evaluate regional differences observed in the trial. METHODS Analyses were performed in the placebo plus chemotherapy arm (intention-to-treat population). Chemotherapy was cisplatin 80 mg/m2 for six cycles plus capecitabine (1000 mg/m2 orally bid days 1-14) or 5-fluorouracil (800 mg/m2/day continuous IV infusion days 1-5) every 3 weeks until disease progression or unacceptable toxicity. RESULTS Overall, 387 patients were assigned to placebo plus chemotherapy (eastern Europe/South America, n = 118; USA/western Europe, n = 81; Korea/other Asia, n = 94; Japan, n = 94). At baseline, poor performance status, liver metastases, and larger tumors were most frequent in eastern Europe/South America and least frequent in Japan. Patients received subsequent chemotherapy after disease progression as follows: eastern Europe/South America (14%); USA/western Europe (37%); Korea/other Asia (61%); and Japan (77%). Hazard ratios for overall survival versus USA/western Europe were 1.47 (95% CI, 1.09-1.99) for eastern Europe/South America, 0.91 (95% CI, 0.67-1.25) for Korea/other Asia, and 0.87 (95% CI, 0.64-1.19) for Japan. CONCLUSIONS Regional differences in the healthcare environment may have contributed to the differences in overall survival observed in the AVAGAST study.
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Affiliation(s)
- Akira Sawaki
- Aichi Cancer Center Hospital, Aichi, Japan.
- Department of Medical Oncology, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan.
| | | | - Kensei Yamaguchi
- Saitama Cancer Center Hospital, Saitama, Japan
- Cancer Institute Hospital of JFCR, Tokyo, Japan
| | | | - Toshihiko Doi
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Taroh Satoh
- Faculty of Medicine, Kinki University Hospital, Osaka, Japan
- Osaka University Hospital, Osaka, Japan
| | - Keisho Chin
- Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Narikazu Boku
- National Cancer Center Hospital, Tokyo, Japan
- Shizuoka Cancer Center, Shizuoka, Japan
| | - Yasushi Omuro
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | | | | | - Wasaburo Koizumi
- Kitasato University East Hospital, Kanagawa, Japan
- Kitasato University Hospital, Tokyo, Japan
| | - Shigehira Saji
- International Medical Center, Saitama Medical University, Saitama, Japan
- Fukushima Medical University, Fukushima, Japan
| | - Manish A Shah
- Weill Cornell Medical College/New York Hospital, New York, USA
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg, Leuven and KULeuven, Louvain, Belgium
| | - Yoon-Koo Kang
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | | | | | | | - Atsushi Ohtsu
- National Cancer Center Hospital East, Kashiwa, Japan
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Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms that arise in the gastrointestinal tract and rarely elsewhere in the abdomen. GISTs that develop outside the digestive tract are called extra-GISTs (EGISTs). The incidence of EGISTs is reported to be approximately 10% of all GISTs, and the median age is younger than that of conventional GISTs. EGISTs have similar histology and immunohistochemical features as conventional GISTs, with the majority of them in the omentum and mesentery. Most GISTs harbor a kinase-activating mutation in either KIT or PDGFRA. For EGISTs, the incidence of this type of mutation is 40-50%, which is somewhat lower than for conventional GISTs. EGISTs may have a worse prognosis compared with conventional GISTs with high mitotic indices, large size, and distant metastasis including lymph node involvement. In large abdominal tumors, the visceral origin is almost impossible to discern.
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Affiliation(s)
- Akira Sawaki
- Department of Medical Oncology, Fujita Health University, Toyoake, Japan
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18
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Kurokawa Y, Doi T, Sawaki A, Komatsu Y, Ozaka M, Takahashi T, Naito Y, Okubo S, Nishida T. Phase II study of TAS-116, an oral inhibitor of heat shock protein 90 (HSP90), in metastatic or unresectable gastrointestinal stromal tumor refractory to imatinib, sunitinib and regorafenib. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx387.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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Koo DH, Ryu MH, Kim KM, Yang HK, Sawaki A, Hirota S, Zheng J, Zhang B, Tzen CY, Yeh CN, Nishida T, Shen L, Chen LT, Kang YK. Asian Consensus Guidelines for the Diagnosis and Management of Gastrointestinal Stromal Tumor. Cancer Res Treat 2016; 48:1155-1166. [PMID: 27384163 PMCID: PMC5080813 DOI: 10.4143/crt.2016.187] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [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: 04/22/2016] [Accepted: 06/03/2016] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors originating in the gastrointestinal tract. With the introduction of molecular-targeted therapy for GISTs which has yielded remarkable outcomes, these tumors have become a model of multidisciplinary oncological treatment. Although Western clinical guidelines are available for GISTs, such as those published by the National Comprehensive Cancer Network (NCCN) and the European Society of Medical Oncology (ESMO), the clinical situations in Asian countries are different from those in Western countries in terms of diagnostic methods, surgical approach, and availability of new targeted agents. Accordingly, we have reviewed current versions of several GIST guidelines published by Asian countries (Japan, Korea, China, and Taiwan) and the NCCN and ESMO and discussed the areas of dissensus. We here present the first version of the Asian GIST consensus guidelines that were prepared through a series of meetings involving multidisciplinary experts in the four countries. These guidelines provide an optimal approach to the diagnosis and management of GIST patients in Asian countries.
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Affiliation(s)
- Dong-Hoe Koo
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.,Korean GIST Study Group, Seoul, Korea
| | - Min-Hee Ryu
- Korean GIST Study Group, Seoul, Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung-Mee Kim
- Korean GIST Study Group, Seoul, Korea.,Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han-Kwang Yang
- Korean GIST Study Group, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Akira Sawaki
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.,Japanese GIST Subcommittee, Nishinomiya, Japan
| | - Seiichi Hirota
- Japanese GIST Subcommittee, Nishinomiya, Japan.,Department of Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Jie Zheng
- Department of Pathology, Peking University Third Hospital, Beijing, China.,Chinese Expert Committee on GIST, Sichuan, China
| | - Bo Zhang
- Chinese Expert Committee on GIST, Sichuan, China.,Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Chin-Yuan Tzen
- Department of Pathology and Laboratory Medicine, Cathay General Hospital, Taipei, Taiwan
| | - Chun-Nan Yeh
- Department of Surgery, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Toshirou Nishida
- Japanese GIST Subcommittee, Nishinomiya, Japan.,Department of Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Lin Shen
- Chinese Expert Committee on GIST, Sichuan, China.,Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.,Department of Internal Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yoon-Koo Kang
- Korean GIST Study Group, Seoul, Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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20
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Nagasaka T, Mishima H, Sawaki A, Shimokawa M, Inukai M, Shinozaki K, Tanioka H, Nasu J, Nishina T, Hazama S, Okajima M, Yamaguchi Y. Protocol of a randomised phase III clinical trial of sequential capecitabine or 5-fluorouracil plus bevacizumab (Cape/5-FU-Bmab) to capecitabine or 5-fluorouracil plus oxaliplatin plus bevacizumab (CapeOX/mFOLFOX6-Bmab) versus combination CapeOX/mFOLFOX6-Bmab in advanced colorectal cancer: the C-cubed (C3) study. BMJ Open 2016; 6:e011454. [PMID: 27256093 PMCID: PMC4893850 DOI: 10.1136/bmjopen-2016-011454] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Results from several randomised trials suggest that the sequential use of cytotoxic agents in patients with metastatic colorectal cancer (mCRC) has the potential to improve overall survival compared with combination chemotherapy. This study is designed to investigate whether sequential treatment with bevacizumab-based first-line treatment with oxaliplatin is superior to combination treatment of mCRC. METHODS AND ANALYSIS The C-cubed (C(3)) study is a two-arm, multicentre, open-label, randomised phase III trial in Japan comparing the efficacy and safety of sequential capecitabine or 5-fluorouracil plus bevacizumab (Cape/5-FU-Bmab) with escalation to capecitabine or 5-fluorouracil plus oxaliplatin plus bevacizumab (CapeOX/mFOLFOX6-Bmab) versus combination CapeOX/mFOLFOX6-Bmab as the first-line treatment of mCRC. In the sequential arm (Arm A: oxaliplatin 'wait-and-go'), treatment escalation from Cape/5-FU-Bmab to CapeOX/mFOLFOX6-Bmab is recommended in the case of progressive disease. In the combination arm (Arm B: oxaliplatin 'stop-and-go'), de-escalation from CapeOX/mFOLFOX6-Bmab to Cape/5-FU-Bmab is possible after 12 weeks of treatment. Re-escalation to CapeOX/mFOLFOX6-Bmab after progressive disease is considered only for patients who received de-escalation of oxaliplatin after 12 weeks of treatment not caused by oxaliplatin-associated toxicity. A target sample size of 304 evaluable patients is considered sufficient to validate an expected HR for time to failure of strategy of the sequential approach 'wait-and-go' compared to the combination approach 'stop-and go' with 80% power and 2-sided 5% α in case of a true HR<0.69. ETHICS AND DISSEMINATION This study is conducted according to the standards of Good Clinical Practice and in compliance with the Declaration of Helsinki 2013 and local regulations, and has been submitted and approved by the Ethical Committee of the Non-Profit Organization MINS Institutional Review Board. The protocol and the trial results, even inconclusive, will be presented at international oncology congresses and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER UMIN000015405, Pre-results.
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Affiliation(s)
- Takeshi Nagasaka
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Akira Sawaki
- Department of Clinical Oncology, Kawasaki Medical School, Okayama, Japan
| | - Mototsugu Shimokawa
- Cancer Biostatistics Lab, Clinical Research Institute, National Hospital Organization Kyusyu Cancer Center, Fukuoka, Japan
| | - Michio Inukai
- Department of Integrated Medicine, Kagawa University Hospital, Kagawa, Japan
| | - Katsunori Shinozaki
- Division of Clinical Oncology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hiroaki Tanioka
- Department of Medical Oncology, Okayama Rosai Hospital, Okayama, Japan
| | - Junichiro Nasu
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Tomohiro Nishina
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama City, Japan
| | - Shoichi Hazama
- Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masazumi Okajima
- Department of Surgery, Hiroshima City Hospital, Hiroshima City, Japan
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21
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Nishida T, Takagi M, Ozaka M, Kitagawa Y, Kurokawa Y, Komatsu Y, Ishioka C, Doi T, Cho H, Kanda T, Sugiyama T, Sawaki A, Kakeji Y, Hirai T, Hato S, Baba H, Shirao K, Hirota S, Kagimura T, Masuzawa T. The adjuvant therapy for high risk GIST patients after complete resection in the clinical practice. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e22516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Masato Ozaka
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshito Komatsu
- Department of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Japan, Sapporo, Japan
| | | | | | | | | | - Toshiro Sugiyama
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Shinji Hato
- National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kuniaki Shirao
- Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, Oita, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan
| | - Tatsuo Kagimura
- Foundation for Biomedical Research and Innovation, Translational Research Informatics Center, Kobe, Japan
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22
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Yamaguchi Y, Katata Y, Okawaki M, Sawaki A, Yamamura M. A Prospective Observational Study of Adoptive Immunotherapy for Cancer Using Zoledronate-Activated Killer (ZAK) Cells - An Analysis for Patients with Incurable Pancreatic Cancer. Anticancer Res 2016; 36:2307-2313. [PMID: 27127137] [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] [Received: 03/10/2016] [Accepted: 04/12/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND/AIM Adoptive immunotherapy (AIT) using autologous zoledronate-activated killer (ZAK) cells has been performed for developing a novel modality of cancer treatment. In this study, data series from incurable pancreatic cancer were analyzed. PATIENTS AND METHODS Patients were treated with AIT using intravenous administration of ZAK cells every 3 to 4 weeks in combination with standard chemotherapy and possible clinical benefits were examined. RESULTS Seventy-five patients were treated. A median overall survival (OS) time of 6.7 months was achieved for all patients and 13.1 months for those treated 5 times or more, that increased to 14.6 and 18.3 months, respectively, when the previous treatment period of chemotherapy alone was included in the analysis. The disease control rate was 58.5 %. Multivariate regression analysis showed a significant positive correlation between the survival and baseline value of lymphocyte percentage in white blood cell counts (p=0.031). CONCLUSION The data suggest that AIT using ZAK cells in combination with chemotherapy is safe and feasible and may be effective in prolonging survival for patients with incurable pancreatic cancer. The lymphocyte percentage at baseline may be a good biomarker for predicting the survival benefit of ZAK cell AIT.
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Affiliation(s)
- Yoshiyuki Yamaguchi
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama, Japan
| | - Yousuke Katata
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama, Japan
| | - Makoto Okawaki
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama, Japan
| | - Akira Sawaki
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama, Japan
| | - Masahiro Yamamura
- Department of Clinical Oncology, Kawasaki Medical School and Hospital, Kurashiki, Okayama, Japan
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Nishida T, Kondo M, Ozaka M, Cho H, Komatsu Y, Doi T, Baba H, Kitagawa Y, Kurokawa Y, Kanda T, Sugiyama T, Sawaki A, Kakeji Y, Hirai T, Hato S, Shirao K, Ishioka C, Hirota S, Kagimura T, Takagi M. Clinicopathological features of ruptured GIST in the ReGISTry study of high risk GIST patients after complete resection in Japan. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.96] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
96 Background: Ruptured GIST, either preoperatively or intraoperatively, has ominous prognosis and is classified as high risk GIST in the modified Fletcher risk stratification. Although patients (pts) with these GISTs are recommended for 3-year imatinib adjuvant therapy, their clinicopathological features and compliance of guidelines are unknown. Methods: Between Dec. 2012 and Aug. 2015, 474 pts with high-risk GISTs locally diagnosed were prospectively registered. Among them, 453 pts with GISTs histologically confirmed by central review were analyzed. There were 243 males and 210 females with median age of 65 yrs. In the central review, H&E, immunohistochemistry, and genotyping were tested. Results: Disease was located in the stomach (n = 279), small intestine (n = 137), large intestine (n = 25), or others (n = 12). Median tumor size was 7.7 cm and median mitosis (local pathology) was 10/50HPF. Tumor rupture was seen in 54 pts (12%) who had preoperative rupture (28 pts) or intraoperative rupture (25 pts). After surgery, adjuvant therapy was administered for 342 pts (75%) and withheld for 89 pts (20%). Tumor rupture was frequently observed in small intestinal GIST (23.6%) other than the duodenum and in epithelioid and/or mixed features (24%). Mitosis of ruptured GIST (median = 5.0/50 HPF) was significantly lower than that of non-ruptured (11/50 HPF). Age, gender, tumor size and genotype are not related with rupture. There was no difference in postoperative complications and adhibition of adjuvant therapy in pts who have ruptures vs pts who don’t. Preoperative rupture was associated with small intestinal GIST and R1 surgery. Mitosis was significantly lower in GIST with preoperative rupture (5/50 HPF) than that without rupture (11/50 HPF). GIST with intraoperative rupture (11.8 cm) was larger than that without rupture (7.5 cm) although there was no difference in mitosis, location and genotype. Frequency of intraoperative rupture was not different between laparoscopic surgery (4.8%) and open one (6.3%). Conclusions: Tumor rupture was not infrequent in high risk GIST and half of rupture was occurred during surgery, which may be related to large tumor size but not with laparoscopic surgery. Clinical trial information: UMIN000009531.
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Affiliation(s)
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masato Ozaka
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | | | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | | | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Toshiro Sugiyama
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Shinji Hato
- National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Kuniaki Shirao
- Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, Oita, Japan
| | | | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan
| | - Tatsuo Kagimura
- Foundation for Biomedical Research and Innovation, Translational Research Informatics Center, Kobe, Japan
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Sawaki A, Yamamura M, Katata Y, Okawaki M, Yamaguchi Y, Hirai T. 364P Imatinib plasma levels and clinical features of successful long-term treatment of metastatic gastrointestinal stromal tumors. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv530.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ito T, Okusaka T, Tori M, Hashigaki S, Kimura N, Ohki E, Sawaki A, Nishida T, Yamao K, Imamura M. Final phase II results for sunitinib (SU) in Japanese pts with well-differentiated pancreatic neuroendocrine tumor (NET). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv466.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yamaguchi Y, Katata Y, Okawaki M, Yamamura M, Sawaki A. [Current Cancer Immunotherapy Using Activated Lymphocytes - Do Lymphocytes Actually Recognize Cancer Cells ?]. Gan To Kagaku Ryoho 2015; 42:1031-1035. [PMID: 26469157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Molecular cloning of interleukin-2(IL-2)has enabled adoptive cell therapy(ACT)to be established by using autologous activated lymphocytes. The low of regenerative medicine will promote the active development of ACT for public use, and ACTs that utilize tumor-infiltrating lymphocytes(TIL), in vitro tumor-sensitized lymphocytes, natural killer T cells, and gammadelta T cells are being evaluated as advanced medical treatments in Japan. In addition, chimeric antigen receptor genemodified T(CAR-T)cells and T cell receptor gene-modified T(TCR-T)cells are available for investigational clinical use. CART and TCR-T cells have been associated with serious adverse events as well as drastic clinical efficacies, indicating the importance of choosing the antigens to be targeted. Presently, it is accurate to state that lymphocytes do recognize cancer cells. Clinical ACT research focusing on TIL and mutated cancer antigens will be initiated for the development of personalized immunotherapy for cancer in the future.
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Yamamura M, Nohno T, Yamauchi A, Katase N, Okawaki M, Sawaki A, Matsumoto H, Hirai T, Yamaguchi Y. Abstract 1757: The new molecular target therapy of Hsp90 inhibition in esophageal squamous cell carcinoma. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Heat shock protein 90 (HSP90) has numerous cellular functions, including promotion of proper protein folding, and stabilizes a number of oncogenic proteins, many of which are overexpressed in cancers. The objective of this study is to evaluate an antitumor effect of HSP90 inhibitor, AUY922, in esophageal squamous cell carcinoma(ESCC) cell lines. ESCC cell lines were treated with AUY922 to examine the effect on proliferation assay, apoptosis assay, Western blotting, and chemotaxis assay. AUY922 inhibited cell proliferation in ESCC cells in a dose- and time-dependent manner. Growth inhibitory effect of AUY922 for ESCC cells was higher than CDDP. With flowcytometry and immunostaining, we showed that AUY922 induced apoptosis in ESCC cells and inhibited chemotaxis of ESCC cells. These antitumor effects of AUY922 were due to inhibition of cell proliferation through suppression of phosphorylation of the client proteins. The HSP90 inhibitor is useful as an antitumor drug in ESCC by inhibiting proliferation of ESCC cells through novel mechanism.
Citation Format: Masahiro Yamamura, Tsutomu Nohno, Akira Yamauchi, Naoki Katase, Makoto Okawaki, Akira Sawaki, Hideo Matsumoto, Toshihiro Hirai, Yoshiyuki Yamaguchi. The new molecular target therapy of Hsp90 inhibition in esophageal squamous cell carcinoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1757. doi:10.1158/1538-7445.AM2015-1757
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Nishida T, Kitagawa Y, Kurokawa Y, Komatsu Y, Ishioka C, Doi T, Yamada Y, Ozaka M, Cho H, Kanda T, Sugiyama T, Sawaki A, Kakeji Y, Hirai T, Hato S, Baba H, Shirao K, Hirota S, Kagimura T. ReGISTry Study of High Risk GIST Patients After Complete Resection:The adjuvant therapy and pathological diagnosis in Japan. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.10533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshito Komatsu
- Division of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Japan
| | | | | | - Yasuhide Yamada
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masato Ozaka
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Toshiro Sugiyama
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | | | - Shinji Hato
- National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kuniaki Shirao
- Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, Oita, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan
| | - Tatsuo Kagimura
- Foundation for Biomedical Research and Innovation, Translational Research Informatics Center, Kobe, Japan
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Ioka T, Okusaka T, Ohkawa S, Boku N, Sawaki A, Fujii Y, Kamei Y, Takahashi S, Namazu K, Umeyama Y, Bycott P, Furuse J. Efficacy and safety of axitinib in combination with gemcitabine in advanced pancreatic cancer: subgroup analyses by region, including Japan, from the global randomized Phase III trial. Jpn J Clin Oncol 2015; 45:439-48. [PMID: 25647781 PMCID: PMC4412139 DOI: 10.1093/jjco/hyv011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/12/2015] [Indexed: 02/07/2023] Open
Abstract
Objective Axitinib is a potent and selective inhibitor of vascular endothelial growth factor receptors 1–3. This analysis compared efficacy and safety of axitinib plus gemcitabine in patients with advanced pancreatic cancer from Japan, North America and the European Union, enrolled in a randomized Phase III study. Methods Patients (n = 632), stratified by disease extent, were randomly assigned (1:1) to receive axitinib/gemcitabine or placebo/gemcitabine. Axitinib was administered at a starting dose of 5 mg orally twice daily and gemcitabine at 1000 mg/m2 once weekly for 3 weeks in 4 week cycles. Primary endpoint was overall survival. Results Among Japanese patients, median overall survival was not estimable (95% confidence interval, 7.4 months—not estimable) with axitinib/gemcitabine (n = 58) and 9.9 months (95% confidence interval, 7.4–10.5) with placebo/gemcitabine (n = 56) (hazard ratio 1.093 [95% confidence interval, 0.525–2.274]). Median survival follow-up (range) was 5.1 months (0.02–12.3) with axitinib/gemcitabine vs. 5.4 months (1.8–10.5) with placebo/gemcitabine. Similarly, no difference was detected in overall survival between axitinib/gemcitabine and placebo/gemcitabine in patients from North America or the European Union. Common adverse events with axitinib/gemcitabine in Japanese patients were fatigue, anorexia, dysphonia, nausea and decreased platelet count. Axitinib safety profile was generally similar in patients from the three regions, although there were differences in incidence of some adverse events. An exploratory analysis did not show any correlation between axitinib/gemcitabine-related hypertension and overall survival. Conclusions Axitinib/gemcitabine, while tolerated, did not provide survival benefit over gemcitabine alone in patients with advanced pancreatic cancer from Japan or other regions.
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Affiliation(s)
- Tatsuya Ioka
- Department of Hepatobiliary and Pancreatic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - Takuji Okusaka
- Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, Tokyo
| | - Shinichi Ohkawa
- Department of Gastroenterology, Kanagawa Cancer Center, Kanagawa
| | - Narikazu Boku
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka
| | - Akira Sawaki
- Department of Clinical Oncology, Kawasaki Medical School, Okayama
| | | | | | | | | | | | | | - Junji Furuse
- Department of Medical Oncology, Kyorin University School of Medicine, Tokyo, Japan
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Sawaki A, Inaba K, Nomura S, Kanie H, Yamada T, Hayashi K, Okawaki M, Yamamura M, Yamaguchi Y, Hirai T, Orito E. Imatinib plasma levels during successful long-term treatment of metastatic-gastrointestinal stromal tumors. Hepatogastroenterology 2014; 61:1984-1989. [PMID: 25713899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS To investigate whether imatinib dosage correlated with effective plasma levels and clinical characteristics for Japanese patients undergoing long-term (≥2 years) imatinib therapy for GISTs. METHODOLOGY Twenty-five patients who received imatinib for a metastatic pathologically diagnosed GISTs at our hospital were enrolled. Imatinib response was assessed according to Choi’s criteria. Blood samples were collected 22–26 h after the previous imatinib dose before the next scheduled dose. Results: Fourteen patients were male and the median age was 65 years. The median duration of imatinib therapy was 3.8 years (range, 2.0–11.5 years). The median plasma level of imatinib was 1098 ng/ml and the minimal plasma level after ≥5 years of therapy was 789 ng/ml. Imatinib dosage was significantly correlated with history of gastrectomy. The minimum body surface area of patients who received 400-mg/day imatinib dosage was 1.560 m2. CONCLUSIONS The minimum level in all patients showing response for ≥5 years of treatment was 789 ng/ml, suggesting an effective plasma imatinib level of ≥800 ng/ml. Our results suggest that imatinib dosage of 400 mg/day is recommended for a patient with a large BSA (≥1.56 m2) and that of 300 mg/day might be sufficient for patients who have undergone a gastrectomy.
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Sawaki A, Kanda T, Komatsu Y, Nishida T. Impact of rechallenge with imatinib in patients with advanced gastrointestinal stromal tumor after failure of imatinib and sunitinib. Gastroenterol Res Pract 2014; 2014:342986. [PMID: 24587795 PMCID: PMC3920623 DOI: 10.1155/2014/342986] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 12/27/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. This retrospective, nonrandomized study investigated the effect of imatinib rechallenge plus best supportive care (BSC) on overall survival after imatinib and sunitinib treatment for patients with locally advanced or metastatic gastrointestinal stromal tumor (GIST). Methods. Twenty-six patients who had previously been exposed to both imatinib and sunitinib were enrolled in this study. The treatment regimen was BSC with or without imatinib, based on the patient's choice after discussion with his or her physician. The primary endpoint was overall survival, and secondary endpoints were time to treatment failure, clinical response rate assessed by Choi criteria, and safety. Results. Fourteen patients were treated with imatinib plus BSC and 12 received BSC alone. Median overall survival was greatly improved for the imatinib group, although differences were not significant (22 months for imatinib plus BSC versus 4 months for BSC; P = 0.058). Three patients (21%) had a clinical response in the imatinib group, and one had a clinical response in the BSC alone group. Imatinib was well tolerated. Conclusions. Rechallenge with imatinib may be associated with improvement in overall survival without deteriorating performance status in patients who failed imatinib and sunitinib. A prospective study should be considered to confirm the efficacy of rechallenge with imatinib.
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Affiliation(s)
- Akira Sawaki
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya-shi, Aichi 464-8681, Japan
| | - Tatsuo Kanda
- Digestive and General Surgery 2 Division, Niigata University Hospital, 754 Ichibancho, Asahimachidori, Chuo-ku, Niigata-shi, Niigata 951-8510, Japan
| | - Yoshito Komatsu
- Department of Cancer Chemotherapy, Hokkaido University Hospital, Cancer Center, Kita 14-jo Nishi 5-chome, Kita-ku, Sapporo-shi, Hokkaido 060-8648, Japan
| | - Toshirou Nishida
- Department of Surgery, Osaka University, School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
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Igarashi H, Okusaka T, Ito T, Nishida T, Hashigaki S, Kimura N, Ohki E, Sawaki A, Yamao K, Imamura M. Phase II Study of Sunitinib (SU) in Japanese Patients with Well-Differentiated Pancreatic Neuroendocrine Tumor (NET). Ann Oncol 2013. [DOI: 10.1093/annonc/mdt460.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sawaki A, Inaba K, Hayashi K, Kanie H, Owaki T, Kimata T, Suzuki M, Kawachi A, Orito E. Imatinib plasma concentrations during long-term effective treatment of metastatic gastrointestinal stromal tumor. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.10543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10543 Background: Imatinib concentrations at one month after the start of imatinib have shown an association with clinical benefit in pts with gastrointestinal stromal tumors (GISTs) and a significant decrease of 30% within twelve months. This retrospective study investigated imatinib plasma concentrations in pts with metastatic GISTs in a long-term (≥2 years) effective treatment. Methods: 31 metastatic GIST pts, who had been treated with imatinib for two or more years in our hospital, were enrolled in this study. 11 pts were excluded because of adjuvant setting (n=5) and rejection to concentration testing (n=6). 20 pts were included in this study. GISTs were immunohistochemically diagnosed, and radiologically assessed as effective GIST by Choi’s criteria without relapse. Results: 10 pts were male, median age was 63 years (range, 31-84), and median imatinib exposure time was 3.5 year (range, 2-12). The median plasma concentration was 1093 ng/ml (range, 417-2091) and minimal level after at least five years was 789 ng/ml. imatinib concentration has no significant correlation with age, gender, gastrectomy, leukocyte count, platelet count, serum albumin, serum creatinine, cholesterol, and duration of imatinib exposure. Body surface area (BSA) isn’t directly associated with imatinib dose; median BSA of pts taking 300mg imatinib was 1.560 m2 and that of 400mg 1.595 m2, but minimal BSA of 400mg imatinib was 1.560 m2, which is higher than the minimum of 300mg. Conclusions: Plasma concentrations of long-term (≥2 years) response pts was scattered, but one of longer-term (≥5 years) response pts were more than 789 ng/ml. Effective imatinib plasma level might be more than 789 ng/ml and 400mg imatinib may be recommended for a pt with BSA(≥1.56 m2).
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Affiliation(s)
| | | | | | | | | | | | | | - Aya Kawachi
- Nagoya Daini Red Cross Hospital, Nagoya, Japan
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Lordick F, Kang YK, Salman P, Oh SC, Bodoky G, Kurteva GP, Volovat CD, Moiseyenko V, Sawaki A, Park JO, Gorbunova VA, Goette H, Melezinkova H, Stroh C, Moehler M. Clinical outcome according to tumor HER2 status and EGFR expression in advanced gastric cancer patients from the EXPAND study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4021 Background: In the EXPAND study adding cetuximab to first-line capecitabine and cisplatin chemotherapy (CT) failed to improve clinical outcome in patients (pts) with advanced gastric or gastroesophageal junction cancer. This analysis assessed treatment outcome according to tumor HER2 status (a pre-defined subgroup) and EGFR expression in EXPAND study pts. Methods: Tumor HER2 status was determined primarily by immunohistochemistry (IHC), HER2 +ve tumors were IHC 3+ or IHC 2+ and fluorescence in situ hybridization (FISH) +ve. EGFR expression was assessed by IHC. A continuous scoring system (scale of 0–300) was used to determine the level of EGFR expression. Biomarker status was correlated with clinical outcome. Results: In both treatment arms, pts with HER2 +ve tumors (n=144) vs HER2 -ve tumors (n=535) had a longer median overall survival (OS): 13.3 (95% CI 10.9–15.5) vs 9.2 (95% CI 8.1–10.5) months in the CT + cetuximab arm and 14.0 (95% CI 11.3–17.1) vs 9.7 (95% CI 8.6–11.0) months in the CT arm, and a better overall response rate, 51.4 (95% CI 39.3–63.3) vs 27.0 (95% CI 21.9–32.6) % and 37.5 (95% CI 26.4–49.7) vs 26.4 (95% CI 21.1–32.3) % respectively. In stepwise multivariable models, pts with HER2 -ve vs HER2 +ve tumors showed an increased risk of death (adjusted hazards ratio 1.552, 95% CI 1.244–1.936) and reduced odds of response (adjusted odds ratio 0.477, 95% CI 0.316–0.720). EGFR tumor expression was evaluable in 774 pts from the intent to treat population (n=904). The EGFR IHC score was low (median 0, range 0–300). No discriminating threshold for the IHC score was identified. However in pt subgroups defined by a series of cut-off points from an IHC score of 10 upwards (rising incrementally by 10), there was a tendency for improved OS, progression-free survival, and tumor response when adding cetuximab to CT in pts with high tumor EGFR IHC scores. Conclusions: In this analysis of EXPAND study pts, those with HER2 +ve tumors were associated with better outcome irrespective of the treatment arm compared with pts with HER2 -ve tumors. Tumor EGFR expression was generally low. Adding cetuximab to CT failed to improve outcome overall, but may benefit a small proportion of pts with high EGFR tumor expression. Clinical trial information: 2007-004219-75.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Joon Oh Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | - Markus Moehler
- Department of Gastroenterology & Hepatology, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
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Lordick F, Kang YK, Chung HC, Salman P, Oh SC, Bodoky G, Kurteva G, Volovat C, Moiseyenko VM, Gorbunova V, Park JO, Sawaki A, Celik I, Götte H, Melezínková H, Moehler M. Capecitabine and cisplatin with or without cetuximab for patients with previously untreated advanced gastric cancer (EXPAND): a randomised, open-label phase 3 trial. Lancet Oncol 2013; 14:490-9. [PMID: 23594786 DOI: 10.1016/s1470-2045(13)70102-5] [Citation(s) in RCA: 640] [Impact Index Per Article: 58.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with advanced gastric cancer have a poor prognosis and few efficacious treatment options. We aimed to assess the addition of cetuximab to capecitabine-cisplatin chemotherapy in patients with advanced gastric or gastro-oesophageal junction cancer. METHODS In our open-label, randomised phase 3 trial (EXPAND), we enrolled adults aged 18 years or older with histologically confirmed locally advanced unresectable (M0) or metastatic (M1) adenocarcinoma of the stomach or gastro-oesophageal junction. We enrolled patients at 164 sites (teaching hospitals and clinics) in 25 countries, and randomly assigned eligible participants (1:1) to receive first-line chemotherapy with or without cetuximab. Randomisation was done with a permuted block randomisation procedure (variable block size), stratified by disease stage (M0 vs M1), previous oesophagectomy or gastrectomy (yes vs no), and previous (neo)adjuvant (radio)chemotherapy (yes vs no). Treatment consisted of 3-week cycles of twice-daily capecitabine 1000 mg/m(2) (on days 1-14) and intravenous cisplatin 80 mg/m(2) (on day 1), with or without weekly cetuximab (400 mg/m(2) initial infusion on day 1 followed by 250 mg/m(2) per week thereafter). The primary endpoint was progression-free survival (PFS), assessed by a masked independent review committee in the intention-to-treat population. We assessed safety in all patients who received at least one dose of study drug. This study is registered at EudraCT, number 2007-004219-75. FINDINGS Between June 30, 2008, and Dec 15, 2010, we enrolled 904 patients. Median PFS for 455 patients allocated capecitabine-cisplatin plus cetuximab was 4.4 months (95% CI 4.2-5.5) compared with 5.6 months (5.1-5.7) for 449 patients who were allocated to receive capecitabine-cisplatin alone (hazard ratio 1.09, 95% CI 0.92-1.29; p=0.32). 369 (83%) of 446 patients in the chemotherapy plus cetuximab group and 337 (77%) of 436 patients in the chemotherapy group had grade 3-4 adverse events, including grade 3-4 diarrhoea, hypokalaemia, hypomagnesaemia, rash, and hand-foot syndrome. Grade 3-4 neutropenia was more common in controls than in patients who received cetuximab. Incidence of grade 3-4 skin reactions and acne-like rash was substantially higher in the cetuximab-containing regimen than in the control regimen. 239 (54%) of 446 in the cetuximab group and 194 (44%) of 436 in the control group had any grade of serious adverse event. INTERPRETATION Addition of cetuximab to capecitabine-cisplatin provided no additional benefit to chemotherapy alone in the first-line treatment of advanced gastric cancer in our trial. FUNDING Merck KGaA.
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Affiliation(s)
- Florian Lordick
- University Cancer Center Leipzig, University of Leipzig, Leipzig, Germany.
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Yamaguchi K, Sawaki A, Doi T, Satoh T, Yamada Y, Omuro Y, Nishina T, Boku N, Chin K, Hamamoto Y, Takiuchi H, Komatsu Y, Saji S, Koizumi W, Miyata Y, Sato A, Baba E, Tamura T, Abe T, Ohtsu A. Efficacy and safety of capecitabine plus cisplatin in Japanese patients with advanced or metastatic gastric cancer: subset analyses of the AVAGAST study and the ToGA study. Gastric Cancer 2013; 16:175-82. [PMID: 22782463 PMCID: PMC3627028 DOI: 10.1007/s10120-012-0167-0] [Citation(s) in RCA: 20] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 05/11/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Capecitabine plus cisplatin (XP) is recognized as one of the global standard first-line chemotherapy regimens for patients with metastatic gastric cancer (mGC). Recent multinational phase III trials in mGC have been conducted with XP as the control arm, although no data on XP in Japanese patients with mGC have been published to date. The AVAGAST (XP ± bevacizumab in mGC) and ToGA (XP ± trastuzumab in human epidermal growth factor receptor 2 [HER2]-positive mGC) studies were the first two global studies including Japanese mGC patients. The aim of this analysis was to investigate the efficacy and safety of XP in Japanese mGC patients, using AVAGAST and ToGA subgroup data. METHODS Efficacy and safety analyses were carried out in Japanese patients with mGC receiving XP alone, based on results from the AVAGAST and ToGA studies. There were differences in the target populations between the two studies; for example, the ToGA study limited patients to those with HER2-positive tumors; therefore, efficacy was evaluated separately. RESULTS Ninety-four Japanese patients in the AVAGAST study and 50 in the ToGA study received XP alone. Median overall and progression-free survivals were 14.2 and 5.7 months, respectively, in the AVAGAST study, and 17.7 and 5.6 months, respectively, in the ToGA study. Overall response rates were 49.2 % in the AVAGAST and 58.5 % in the ToGA study. Adverse events were generally mild; the most common grade 3/4 events were neutropenia, anemia, anorexia, and nausea. CONCLUSIONS XP is effective and well tolerated in Japanese patients with mGC, and could be one of the standard regimens for the first-line treatment in this cohort.
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Affiliation(s)
- Kensei Yamaguchi
- Department of Gastroenterology, Saitama Cancer Center Hospital, 818 Komuro, Ina-machi, Kitaadachi-gun, Saitama, 362-0806, Japan.
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Ito T, Okusaka T, Nishida T, Yamao K, Igarashi H, Morizane C, Kondo S, Mizuno N, Hara K, Sawaki A, Hashigaki S, Kimura N, Murakami M, Ohki E, Chao RC, Imamura M. Phase II study of sunitinib in Japanese patients with unresectable or metastatic, well-differentiated pancreatic neuroendocrine tumor. Invest New Drugs 2012; 31:1265-74. [PMID: 23269537 PMCID: PMC3771378 DOI: 10.1007/s10637-012-9910-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 12/03/2012] [Indexed: 11/30/2022]
Abstract
Background. Pancreatic neuroendocrine tumors (NETs) are rare but are frequently diagnosed at advanced stages and require systemic therapy. Patients and methods. This multicenter, open-label, phase II study evaluated sunitinib in Japanese patients with well-differentiated pancreatic NET. Patients received sunitinib 37.5 mg/day on a continuous daily dosing (CDD) schedule. The primary endpoint was clinical benefit rate (CBR; percentage of complete responses [CRs] plus partial responses [PRs] plus stable disease [SD] ≥24 weeks). Secondary endpoints included objective response rate (ORR), tumor shrinkage, progression-free survival (PFS) probability, safety, pharmacokinetics, and biomarkers. Results. Twelve patients received treatment. The CBR was 75 % (95 % confidence interval [CI], 43–94) and included 6 patients with a PR and 3 with SD. The ORR was 50 % (95 % CI, 21–79). PFS probability was 91 % (95 % CI, 54–99) at 6 months and 71 % (95 % CI, 34–90) at 12 months. Commonly reported treatment-emergent (all-causality), any-grade adverse events included diarrhea (n = 10), hand–foot syndrome and hypertension (both n = 8), fatigue and headache (both n = 7), and neutropenia (n = 6). No deaths on study were reported; one death due to disease progression occurred >28 days after end of treatment. Sunitinib on a CDD schedule resulted in sustained drug concentrations without accumulation across cycles. Tumor responses in all 12 patients did not appear to correlate with decreases in chromogranin A levels. Conclusions. Sunitinib 37.5 mg/day on a CDD schedule demonstrated antitumor activity in Japanese patients with unresectable, well-differentiated pancreatic NET. Commonly reported adverse events were consistent with the known safety profile of sunitinib.
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Affiliation(s)
- Tetsuhide Ito
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, Japan,
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Kondoh C, Takahari D, Shitara K, Mizota A, Nomura M, Yokota T, Ura T, Ito S, Kawai H, Sawaki A, Muro K. Efficacy of docetaxel in patients with paclitaxel-resistant advanced gastric cancer. Gan To Kagaku Ryoho 2012; 39:1511-1515. [PMID: 23064062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Although there appears to be incomplete cross-resistance between docetaxel and paclitaxel in several types of malignancies, to our best knowledge there have been no available data on this for advanced gastric cancer. METHODS We retrospectively evaluated the efficacy and safety of docetaxel in patients with paclitaxel-resistant advanced gastric cancer. Docetaxel was administered at 50-60 mg/m2 every 3 weeks. RESULTS Twenty-one patients were evaluated. All patients had received 2 or more previous chemotherapy regimens. Among the 12 patients with measurable lesions, apparent tumor shrinkage was seen in 1 patient for an overall response rate of 8. 3% and a disease control rate of 33. 3%. Median progression free survival and overall survival of all patients were 2. 6 months and 6. 7 months, respectively. There were no correlations between the progression free survival of docetaxel and the progression free survival of previous paclitaxel and between the progression free survival of docetaxel and taxane-free interval(Spearman's correlation coefficients of ρ=-0. 14 and ρ=-0. 02, respectively). Grade 3/4 neutropenia developed in 8 patients(38%)and Grade 3 febrile neutropenia in 1 patient(4. 8%). CONCLUSIONS Docetaxel showed modest activity in paclitaxel-resistant advanced gastric cancer patients, and no correlations between previous efficacy of paclitaxel or taxane-free interval were seen.
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Affiliation(s)
- Chihiro Kondoh
- Dept.of Clinical Oncology, Aichi Cancer Center Hospital, Aichi, Japan
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Tajika M, Niwa Y, Bhatia V, Kawai H, Kondo S, Sawaki A, Mizuno N, Hara K, Hijioka S, Matsumoto K, Kobayashi Y, Saeki A, Akabane A, Komori K, Yamao K. Efficacy of mosapride citrate with polyethylene glycol solution for colonoscopy preparation. World J Gastroenterol 2012; 18:2517-25. [PMID: 22654449 PMCID: PMC3360450 DOI: 10.3748/wjg.v18.i20.2517] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [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: 07/08/2011] [Revised: 09/22/2011] [Accepted: 02/27/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy and safety of adjunctive mosapride citrate for bowel preparation before colonoscopy.
METHODS: We conducted a randomized, double-blind, placebo-controlled study with mosapride in addition to polyethylene glycol (PEG)-electrolyte solution. Of 250 patients undergoing colonoscopy, 124 were randomized to receive 2 L PEG plus 15 mg of mosapride citrate (mosapride group), and 126 received 2 L PEG plus placebo (placebo group). Patients completed a questionnaire reporting the acceptability and tolerability of the bowel preparation process. The efficacy of bowel preparation was assessed by colonoscopists using a 5-point scale based on Aronchick’s criteria. The primary end point was optimal bowel preparation rates (scores of excellent/good/fair vs poor/inadequate).
RESULTS: A total of 249 patients were included in the analysis. In the mosapride group, optimal bowel preparation rates were significantly higher in the left colon compared with the placebo group (78.2% vs 65.6%, P < 0.05), but not in the right colon (76.5% vs 66.4%, P = 0.08). After excluding patients with severe constipation, there was a significant difference in bowel preparation in both the left and right colon (82.4% vs 66.7%, 80.8% vs 67.5%, P < 0.05, P < 0.01). The incidence of adverse events was similar in both groups. Among the subgroup who had previous colonoscopy experience, a significantly higher number of patients in the mosapride group felt that the current preparation was easier compared with patients in the placebo group (34/72 patients vs 24/74 patients, P < 0.05).
CONCLUSION: Mosapride citrate may be an effective and safe adjunct to PEG-electrolyte solution that leads to improved quality of bowel preparation, especially in patients without severe constipation.
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Shitara K, Sawaki A, Matsuo K, Kondo C, Takahari D, Ura T, Tajika M, Niwa Y, Muro K. A retrospective comparison of S-1 plus cisplatin and capecitabine plus cisplatin for patients with advanced or recurrent gastric cancer. Int J Clin Oncol 2012; 18:539-46. [PMID: 22552360 DOI: 10.1007/s10147-012-0416-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 04/16/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND Based on the results of the SPIRITS trial, combination chemotherapy of S-1 plus cisplatin (SP) is now considered the standard treatment for patients with advanced gastric cancer (AGC) in Japan. On the other hand, several non-Japanese studies have shown the efficacy of capecitabine plus cisplatin (XP), which has been used as the reference arm in recent global studies of AGC. METHODS We retrospectively compared the efficacy and safety of SP and XP in first-line treatment for patients with AGC. RESULTS From August 2006 to November 2008, 26 AGC patients received XP in the context of 2 global trials (AVAGAST and ToGA), and 50 patients received SP during the same period. The objective response rate was 43.2 % in the SP group and 50 % in the XP group, with no significant difference (p = 0.62). There were also no significant differences in progression-free survival (median 5.8 vs. 5.2 months; p = 0.91) and overall survival (median 13.8 vs. 13.5 months; p = 0.97) between the SP and XP groups. The frequencies of hematological toxicities of grade 3 or more and non-hematological toxicities were not significantly different between the 2 groups. Although grade 1 or 2 hand-foot syndrome was more common in the XP group, no patients experienced grade 3 or more. CONCLUSIONS Although the retrospective nature of this study and the small number of patients is a major limitation, SP and XP were associated with similar efficacy and safety in patients with AGC.
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Affiliation(s)
- Kohei Shitara
- Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
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Ogura T, Yamao K, Sawaki A, Mizuno N, Hara K, Hijioka S, Niwa Y, Tajika M, Kondo S, Shimizu Y, Bhatia V, Higuchi K, Hosoda W, Yatabe Y. Clinical impact of K-ras mutation analysis in EUS-guided FNA specimens from pancreatic masses. Gastrointest Endosc 2012; 75:769-74. [PMID: 22284089 DOI: 10.1016/j.gie.2011.11.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 11/11/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND EUS-guided FNA (EUS-FNA) is considered optimal for differentially diagnosing pancreatic masses. However, the sensitivity of EUS-FNA ranges from 65% to 95%, respectively, which requires improvement. OBJECTIVE To evaluate clinical impact of K-ras mutation analysis in EUS-FNA specimens from pancreatic masses. DESIGN Prospective registration, single-center study. SETTING Tertiary referral center. PATIENTS This study involved 394 consecutive patients with pancreatic masses (307 pancreatic ductal adenocarcinomas [PDACs], 47 pancreatic inflammatory lesions, and 40 other types of tumors) who underwent EUS-FNA and analysis of K-ras mutations. INTERVENTION EUS-FNA, Cycleave polymerase chain reaction. MAIN OUTCOME MEASUREMENTS Improvement of the diagnostic accuracy by K-ras mutation analysis; absence of K-ras mutations in non-PDAC masses. RESULTS K-ras mutations were detected in 266 of 307 PDAC aspirates (87%) and in 3 of 87 non-PDAC masses (3%). K-ras mutations were detected in 18 of 39 patients (46%) who remained cytohistopathologically undiagnosed. The sensitivity, specificity, positive and negative predictive values, and accuracy of cytohistopathological and K-ras mutation analyses alone were 87%, 100%, 100%, 54%, and 89%, respectively, and, when combined, were 93%, 100%, 100%, 68%, and 94%, respectively. Adding K-ras mutation analysis to standard cytohistopathological assessment increased the sensitivity and accuracy of EUS-FNA by 6% (P < .001) and 5% (P < .001), respectively. LIMITATIONS Single-center study. CONCLUSIONS K-ras mutation analysis may be helpful in patients with suspected PDAC yet inconclusive EUS-FNA findings. K-ras mutations were extremely rare in pancreatic inflammation and other pancreatic tumors.
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Affiliation(s)
- Takeshi Ogura
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
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Okamoto Y, Sawaki A, Ito S, Nishida T, Takahashi T, Toyota M, Suzuki H, Shinomura Y, Takeuchi I, Shinjo K, An B, Ito H, Yamao K, Fujii M, Murakami H, Osada H, Kataoka H, Joh T, Sekido Y, Kondo Y. Aberrant DNA methylation associated with aggressiveness of gastrointestinal stromal tumour. Gut 2012; 61:392-401. [PMID: 21708825 DOI: 10.1136/gut.2011.241034] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIMS The majority of gastrointestinal stromal tumors (GISTs) have KIT mutations; however, epigenetic abnormalities that could conceivably potentiate the aggressiveness of GISTs are largely unidentified. Our aim was to establish epigenetic profiles associated with the malignant transformation of GISTs. METHODS Methylation of four tumor suppressor genes, RASSF1A, p16, CDH1, and MGMT was analyzed in GISTs. Additionally, genome-wide DNA methylation profiles were compared between small, malignant-prone, and malignant GISTs using methylated GpG island amplification microarrays (MCAM) in a training set (n=40). Relationships between the methylation status of genes identified by MCAM and clinical features of the disease were tested in a validation set (n=75). RESULTS Methylation of RASSF1A progressively increased from small to malignant GISTs. p16 was specifically methylated in malignant-prone and malignant GISTs. MCAM analysis showed that more genes were methylated in advanced than in small GISTs (average of 473 genes vs 360 genes, respectively, P=0.012). Interestingly, the methylation profile of malignant GISTs was prominently affected by their location. Two genes, REC8 and PAX3, which were newly-identified via MCAM analysis, were differentially methylated in small and malignant GISTs in the training and validation sets. Patients with methylation of at least REC8, PAX3, or p16 had a significantly poorer prognosis (P=0.034). CONCLUSION Our results suggest that GIST is not, in epigenetic terms, a uniform disease and that DNA methylation in a set of genes is associated with aggressive clinical behavior and unfavorable prognosis. The genes identified may potentially serve as biomarkers for predicting aggressive GISTs with poor survivability.
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Affiliation(s)
- Yasuyuki Okamoto
- Division of Molecular Oncology, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
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Nishina T, Sawaki A, Yamaguchi K, Doi T, Yamada Y, Chin K, Satoh T, Boku N, Omuro Y, Komatsu Y, Takiuchi H, Hamamoto Y, Koizumi W, Saji S, Shah MA, Van Cutsem E, Kang YK, Ohtsu A. Regional differences in patient (pt) characteristics of AVAGAST: An exploratory comparison in chemotherapy plus placebo (PL) arm between Japanese (JPN) and the rest of the world (ROW) pts. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
100 Background: AVAGAST study showed regional differences in efficacy, including notable differences in progression free survival (PFS) and overall survival in the PL arm. In Japan, there is a certain number of pts with minimal peritoneal metastasis (PM) diagnosed only by laparoscopy or open surgery, which seems unusual in Western as well as in other Asian countries, and it might have led the differences. Therefore, an exploratory analysis was conducted among the PL arm to examine pt characteristics including PM associated with differences in outcome between JPN and ROW. Methods: We compared PFS of PL arm between pts enrolled from JPN and those from ROW. Hazard ratio (HR) and its 95% confidence interval (95%CI) between JPN and ROW were calculated using Cox’s proportional hazard model for each major covariates (disease status, performance status, prior gastrectomy, prior (neo)adjuvant chemotherapy, age, sex, primary site, liver metastasis (mets), number of metastatic sites, disease measurability, histologic type, maximum of tumor size, sum of tumor size, bone mets, PM and only PM) Results: 188 pts from 14 sites were enrolled from JPN, of which 94 pts were randomized to PL arm. Compared with 293 pts from ROW in PL arm, PFS tend to be favorable in JPN. Subgroups of JPN without liver mets, with diffuse or mixed type gastric cancer (GC), with PM and with only PM were clearly favorable than that of ROW. The difference in subgroup with PM was especially large with lower confidence limit of 1.21. When the pts with only PM were excluded, the difference of PFS in PL arm between JPN and ROW became smaller ( Table ). Conclusions: In this exploratory analysis, pts with PM in JPN had a better prognosis than ROW pts. Understanding this unique pt population may provide insight to the regional differences in outcome noted on this study. [Table: see text]
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Affiliation(s)
- Tomohira Nishina
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Akira Sawaki
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Kensei Yamaguchi
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Toshihiko Doi
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Yasuhide Yamada
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Keisho Chin
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Taroh Satoh
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Narikazu Boku
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Yasushi Omuro
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Yoshito Komatsu
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Hiroya Takiuchi
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Yasuo Hamamoto
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Wasaburo Koizumi
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Shigehira Saji
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Manish A. Shah
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Eric Van Cutsem
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Yoon-Koo Kang
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
| | - Atsushi Ohtsu
- National Hospital Organization, Shikoku Cancer Center, Ehime, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Kashiwa, Japan; National Cancer Center Hospital, Tokyo, Japan; Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Osaka University Graduate School of Medicine, Osaka, Japan; Saint Marianna University School of Medicine, Kanagawa, Japan; Tokyo Metropolitan Cancer and Infectious
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Okusaka T, Ito T, Nishida T, Igarashi H, Mizuno N, Hara K, Morizane C, Kondo S, Hashigaki S, Kimura N, Okano K, Tanuma J, Murakami M, Sawaki A, Yamao K, Imamura M. Phase II study of sunitinib (SU) in Japanese patients with unresectable or metastatic, well-differentiated pancreatic neuroendocrine tumor (NET). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
381 Background: SU is an oral, multitargeted, antiangiogenic, tyrosine kinase inhibitor effective in patients (pts) with unresectable, well-differentiated pancreatic NET. This open-label, phase II study examined whether SU is also effective in Japanese pts with this disease. Methods: Japanese pts received SU 37.5 mg/day on a continuous daily dosing (CDD) schedule (28-day cycle). The primary endpoint was clinical benefit rate (CBR; complete response [CR] + partial response [PR] + stable disease [SD] ≥24 weeks). Secondary endpoints included: objective response rate (ORR; CR + PR), 6-mos progression-free survival (PFS) probability, safety and pharmacokinetics. Tumor assessments were performed at baseline and 8-wk intervals by CT or MRI (RECIST). Results: Twelve patients were enrolled and received treatment (tx; median age 54 yrs, range 34–79); 9 were ongoing at data cut-off (July 1, 2011). CBR was 75.0% (95% CI 42.8, 94.5), comprising 5 PRs and 4 pts with SD ≥24 weeks. ORR was 41.7% (95% CI 15.2, 72.3). 6-mos PFS probability was 91.7% (95% CI 53.9, 98.8). One PR occurred in a pt with gastrinoma, in whom gastrin levels decreased by 93% and tumor bulk decreased by 45%. All-causality, any-grade (G) AEs included diarrhea (n=9, 75%), HFS and hypertension (both n=8, 67%). Neutropenia was the most common G3 AE (n=5, 42%, all tx-related). Three pts (25%) experienced G4 AEs (herpes encephalitis, convulsion, loss of consciousness [n=1] and lipase increased [n=2], all tx-related).Two pts (17%) experienced serious AEs: convulsion and loss of consciousness (n=1, tx-related), and acute cholecystitis (n=1, unrelated to tx). There were no deaths on study; one death due to disease progression occurred 3 mos after study withdrawal. On day 15 (cycle 1), mean trough plasma concentrations (n=10) for SU, its metabolite, and SU + metabolite were 53.9, 23.7 and 77.5 ng/mL, respectively. SU on a CDD schedule resulted in sustained drug concentrations without accumulation across cycles. Conclusions: SU 37.5 mg/day on a CDD schedule demonstrated antitumor activity in Japanese pts with unresectable, well-differentiated pancreatic NET. Common AEs were consistent with the known safety profile of SU.
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Affiliation(s)
- Takuji Okusaka
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Tetsuhide Ito
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Toshirou Nishida
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Hisato Igarashi
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Nobumasa Mizuno
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Kazuo Hara
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Chigusa Morizane
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Shunsuke Kondo
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Satoshi Hashigaki
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Nobuyuki Kimura
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Kyoko Okano
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Junichi Tanuma
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Mami Murakami
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Akira Sawaki
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Kenji Yamao
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
| | - Masayuki Imamura
- National Cancer Center Hospital, Tokyo, Japan; Kyushu University, Fukuoka, Japan; Osaka Police Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Pfizer Japan Inc, Tokyo, Japan; Nagoya Daini Red Cross Hospital, Nagoya, Japan; Kansai Electric Power Company Hospital, Osaka, Japan
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Sawaki A, Ohashi Y, Omuro Y, Satoh T, Hamamoto Y, Boku N, Miyata Y, Takiuchi H, Yamaguchi K, Sasaki Y, Nishina T, Satoh A, Baba E, Tamura T, Abe T, Hatake K, Ohtsu A. Efficacy of trastuzumab in Japanese patients with HER2-positive advanced gastric or gastroesophageal junction cancer: a subgroup analysis of the Trastuzumab for Gastric Cancer (ToGA) study. Gastric Cancer 2012; 15:313-22. [PMID: 22179434 PMCID: PMC3390686 DOI: 10.1007/s10120-011-0118-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [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: 08/06/2011] [Accepted: 10/31/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Trastuzumab for Gastric Cancer (ToGA) study is the first international trial to include Japanese patients with human epidermal growth factor 2 (HER2) positive advanced/metastatic gastric or gastroesophageal junction cancer. ToGA showed that trastuzumab plus chemotherapy (capecitabine/cisplatin or 5-fluorouracil/cisplatin) improved overall survival in the overall population (hazard ratio 0.74). Regional differences in outcome in favor of Japanese populations were observed in other studies; therefore, subgroup analyses of ToGA may contribute to the evaluation of the potential benefits of this regimen in Japanese patients. METHODS We performed subgroup analyses on 101 Japanese patients enrolled into ToGA (trastuzumab plus chemotherapy, n = 51; chemotherapy, n = 50). RESULTS Median overall survival in the Japanese subgroup was 15.9 months (95% confidence interval 12-25) for trastuzumab plus chemotherapy and 17.7 months (95% confidence interval 12-24) for chemotherapy (hazard ratio 1.00; 95% confidence interval 0.59-1.69). After adjusting for prespecified covariates, the estimated hazard ratio for overall survival was 0.68 (95% confidence interval 0.36-1.27). Further post hoc and exploratory examinations supported the robustness of the adjusted hazard ratios. CONCLUSIONS After adjusting for imbalanced patient backgrounds between arms, overall survival of Japanese patients with human epidermal growth factor 2 positive advanced/metastatic gastric or gastroesophageal junction cancer who received trastuzumab plus chemotherapy was improved compared with patients who received chemotherapy alone.
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Affiliation(s)
- Akira Sawaki
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan.
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Kanda T, Nishida T, Wada N, Kobayashi O, Yamamoto M, Sawaki A, Boku N, Koseki M, Doi T, Toh Y, Kakeji Y, Sugiyama T, Komatsu Y, Kikuchi S, Ogoshi K, Katai H, Miyachi K, Hirota S, Ohtsu A. Adjuvant therapy with imatinib mesylate after resection of primary high-risk gastrointestinal stromal tumors in Japanese patients. Int J Clin Oncol 2011; 18:38-45. [DOI: 10.1007/s10147-011-0339-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 10/05/2011] [Indexed: 10/15/2022]
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Ohtsu A, Shah MA, Van Cutsem E, Rha SY, Sawaki A, Park SR, Lim HY, Yamada Y, Wu J, Langer B, Starnawski M, Kang YK. Bevacizumab in Combination With Chemotherapy As First-Line Therapy in Advanced Gastric Cancer: A Randomized, Double-Blind, Placebo-Controlled Phase III Study. J Clin Oncol 2011; 29:3968-76. [DOI: 10.1200/jco.2011.36.2236] [Citation(s) in RCA: 887] [Impact Index Per Article: 68.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The Avastin in Gastric Cancer (AVAGAST) trial was a multinational, randomized, placebo-controlled trial designed to evaluate the efficacy of adding bevacizumab to capecitabine-cisplatin in the first-line treatment of advanced gastric cancer. Patients and Methods Patients received bevacizumab 7.5 mg/kg or placebo followed by cisplatin 80 mg/m2 on day 1 plus capecitabine 1,000 mg/m2 twice daily for 14 days every 3 weeks. Fluorouracil was permitted in patients unable to take oral medications. Cisplatin was given for six cycles; capecitabine and bevacizumab were administered until disease progression or unacceptable toxicity. The primary end point was overall survival (OS). Log-rank test was used to test the OS difference. Results In all, 774 patients were enrolled; 387 were assigned to each treatment group (intention-to-treat population), and 517 deaths were observed. Median OS was 12.1 months with bevacizumab plus fluoropyrimidine-cisplatin and 10.1 months with placebo plus fluoropyrimidine-cisplatin (hazard ratio 0.87; 95% CI, 0.73 to 1.03; P = .1002). Both median progression-free survival (6.7 v 5.3 months; hazard ratio, 0.80; 95% CI, 0.68 to 0.93; P = .0037) and overall response rate (46.0% v 37.4%; P = .0315) were significantly improved with bevacizumab versus placebo. Preplanned subgroup analyses revealed regional differences in efficacy outcomes. The most common grade 3 to 5 adverse events were neutropenia (35%, bevacizumab plus fluoropyrimidine-cisplatin; 37%, placebo plus fluoropyrimidine-cisplatin), anemia (10% v 14%), and decreased appetite (8% v 11%). No new bevacizumab-related safety signals were identified. Conclusion Although AVAGAST did not reach its primary objective, adding bevacizumab to chemotherapy was associated with significant increases in progression-free survival and overall response rate in the first-line treatment of advanced gastric cancer.
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Affiliation(s)
- Atsushi Ohtsu
- Atsushi Ohtsu, National Cancer Center Hospital East, Kashiwa, Chiba; Akira Sawaki, Aichi Cancer Center Hospital, Nagoya; Yasuhide Yamada, National Cancer Center Hospital, Tokyo, Japan; Manish A. Shah, Memorial Sloan-Kettering Cancer Center, New York, NY; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Sun Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine; Ho Yeong Lim, Samsung Medical Center; Yoon-Koo Kang, Asan Medical Center, University of Ulsan College of
| | - Manish A. Shah
- Atsushi Ohtsu, National Cancer Center Hospital East, Kashiwa, Chiba; Akira Sawaki, Aichi Cancer Center Hospital, Nagoya; Yasuhide Yamada, National Cancer Center Hospital, Tokyo, Japan; Manish A. Shah, Memorial Sloan-Kettering Cancer Center, New York, NY; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Sun Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine; Ho Yeong Lim, Samsung Medical Center; Yoon-Koo Kang, Asan Medical Center, University of Ulsan College of
| | - Eric Van Cutsem
- Atsushi Ohtsu, National Cancer Center Hospital East, Kashiwa, Chiba; Akira Sawaki, Aichi Cancer Center Hospital, Nagoya; Yasuhide Yamada, National Cancer Center Hospital, Tokyo, Japan; Manish A. Shah, Memorial Sloan-Kettering Cancer Center, New York, NY; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Sun Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine; Ho Yeong Lim, Samsung Medical Center; Yoon-Koo Kang, Asan Medical Center, University of Ulsan College of
| | - Sun Young Rha
- Atsushi Ohtsu, National Cancer Center Hospital East, Kashiwa, Chiba; Akira Sawaki, Aichi Cancer Center Hospital, Nagoya; Yasuhide Yamada, National Cancer Center Hospital, Tokyo, Japan; Manish A. Shah, Memorial Sloan-Kettering Cancer Center, New York, NY; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Sun Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine; Ho Yeong Lim, Samsung Medical Center; Yoon-Koo Kang, Asan Medical Center, University of Ulsan College of
| | - Akira Sawaki
- Atsushi Ohtsu, National Cancer Center Hospital East, Kashiwa, Chiba; Akira Sawaki, Aichi Cancer Center Hospital, Nagoya; Yasuhide Yamada, National Cancer Center Hospital, Tokyo, Japan; Manish A. Shah, Memorial Sloan-Kettering Cancer Center, New York, NY; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Sun Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine; Ho Yeong Lim, Samsung Medical Center; Yoon-Koo Kang, Asan Medical Center, University of Ulsan College of
| | - Sook Ryun Park
- Atsushi Ohtsu, National Cancer Center Hospital East, Kashiwa, Chiba; Akira Sawaki, Aichi Cancer Center Hospital, Nagoya; Yasuhide Yamada, National Cancer Center Hospital, Tokyo, Japan; Manish A. Shah, Memorial Sloan-Kettering Cancer Center, New York, NY; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Sun Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine; Ho Yeong Lim, Samsung Medical Center; Yoon-Koo Kang, Asan Medical Center, University of Ulsan College of
| | - Ho Yeong Lim
- Atsushi Ohtsu, National Cancer Center Hospital East, Kashiwa, Chiba; Akira Sawaki, Aichi Cancer Center Hospital, Nagoya; Yasuhide Yamada, National Cancer Center Hospital, Tokyo, Japan; Manish A. Shah, Memorial Sloan-Kettering Cancer Center, New York, NY; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Sun Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine; Ho Yeong Lim, Samsung Medical Center; Yoon-Koo Kang, Asan Medical Center, University of Ulsan College of
| | - Yasuhide Yamada
- Atsushi Ohtsu, National Cancer Center Hospital East, Kashiwa, Chiba; Akira Sawaki, Aichi Cancer Center Hospital, Nagoya; Yasuhide Yamada, National Cancer Center Hospital, Tokyo, Japan; Manish A. Shah, Memorial Sloan-Kettering Cancer Center, New York, NY; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Sun Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine; Ho Yeong Lim, Samsung Medical Center; Yoon-Koo Kang, Asan Medical Center, University of Ulsan College of
| | - Jian Wu
- Atsushi Ohtsu, National Cancer Center Hospital East, Kashiwa, Chiba; Akira Sawaki, Aichi Cancer Center Hospital, Nagoya; Yasuhide Yamada, National Cancer Center Hospital, Tokyo, Japan; Manish A. Shah, Memorial Sloan-Kettering Cancer Center, New York, NY; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Sun Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine; Ho Yeong Lim, Samsung Medical Center; Yoon-Koo Kang, Asan Medical Center, University of Ulsan College of
| | - Bernd Langer
- Atsushi Ohtsu, National Cancer Center Hospital East, Kashiwa, Chiba; Akira Sawaki, Aichi Cancer Center Hospital, Nagoya; Yasuhide Yamada, National Cancer Center Hospital, Tokyo, Japan; Manish A. Shah, Memorial Sloan-Kettering Cancer Center, New York, NY; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Sun Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine; Ho Yeong Lim, Samsung Medical Center; Yoon-Koo Kang, Asan Medical Center, University of Ulsan College of
| | - Michal Starnawski
- Atsushi Ohtsu, National Cancer Center Hospital East, Kashiwa, Chiba; Akira Sawaki, Aichi Cancer Center Hospital, Nagoya; Yasuhide Yamada, National Cancer Center Hospital, Tokyo, Japan; Manish A. Shah, Memorial Sloan-Kettering Cancer Center, New York, NY; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Sun Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine; Ho Yeong Lim, Samsung Medical Center; Yoon-Koo Kang, Asan Medical Center, University of Ulsan College of
| | - Yoon-Koo Kang
- Atsushi Ohtsu, National Cancer Center Hospital East, Kashiwa, Chiba; Akira Sawaki, Aichi Cancer Center Hospital, Nagoya; Yasuhide Yamada, National Cancer Center Hospital, Tokyo, Japan; Manish A. Shah, Memorial Sloan-Kettering Cancer Center, New York, NY; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven, Belgium; Sun Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine; Ho Yeong Lim, Samsung Medical Center; Yoon-Koo Kang, Asan Medical Center, University of Ulsan College of
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Ogura T, Tajika M, Niwa Y, Kawai H, Kondo S, Sawaki A, Mizuno N, Hara K, Hijioka S, Nakamura M, Higuchi K, Goto H, Yamao K. [Recurrent autoimmune hemolytic anemia induced by XELOX chemotherapy for colon cancer]. Nihon Shokakibyo Gakkai Zasshi 2011; 108:1712-1719. [PMID: 21971145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We describe a 54-year old woman with oxaliplatin-induced autoimmune hemolytic anemia and review the clinical features of similar published cases. The present patient had metastatic colon cancer and was admitted to our hospital with a floating sensation and general malaise on day 4 after undergoing the last of 4 cycles of a 7th round of chemotherapy with XELOX. Laboratory data revealed 4.6g/dl hemoglobin and 8.77 mg/dl creatinine. Direct and indirect Coombs tests of a blood sample for blood transfusion were both positive. We diagnosed immune hemolysis with acute renal failure based on the clinical course and blood samples showing haptoglobin <10mg/dl. We treated her with hemodialysis, plasmapheresis and immune suppression with prednisolone, which improved the anemia and renal failure.
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Affiliation(s)
- Takeshi Ogura
- Department of Gastroenterology, Aichi Cancer Center Hospital
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Ennishi D, Shitara K, Ito H, Hosono S, Watanabe M, Ito S, Sawaki A, Yatabe Y, Yamao K, Tajima K, Tanimoto M, Tanaka H, Hamajima N, Matsuo K. Association between insulin-like growth factor-1 polymorphisms and stomach cancer risk in a Japanese population. Cancer Sci 2011; 102:2231-5. [PMID: 21854509 DOI: 10.1111/j.1349-7006.2011.02062.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The insulin-like growth factor (IGF) signaling system plays a central role in cellular growth, differentiation and proliferation. Although the association between IGF1 gene polymorphisms and cancer risk has been evaluated for several carcinomas, this association has not yet been examined for stomach cancer. We investigated the association between IGF1 polymorphisms and the risk of stomach cancer in a Japanese population. A total of 703 patients with stomach cancer and 1462 non-cancer control subjects were enrolled in this case-control study. Associations between polymorphisms of 10 IGF1 loci and the risk of stomach cancer were evaluated using odds ratios (OR) and 95% confidence intervals (CI) in multiple logistic regression models. We observed that the C allele in rs1520220 and the G allele in rs4764887 were significantly associated with stomach cancer risk in the per-allele model after adjusting for other risk factors (OR: 1.14 [95% CI: 1.00-1.30] and OR: 1.18 [95% CI: 1.02-1.36], respectively). We also observed a positive and dose-dependent association between the number of risk alleles and stomach cancer risk (P-trend: 0.019) when examining the two loci in the same model. These associations were still seen after adjusting for potential confounders, including sex, age, smoking status, history of diabetes and family history of stomach cancer. We did not find any significant interaction between these factors and the number of risk alleles. In conclusion, we observed a significant association between IGF1 polymorphisms and stomach cancer risk among a Japanese population. Examination of the biological significance of IGF1 is warranted.
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Affiliation(s)
- Daisuke Ennishi
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
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Shen L, Kang Y, Lichinitser M, Chung H, Ohtsu A, Bang Y, Van Cutsem E, Al-Sakaff N, Hill J, Sawaki A. 3032 POSTER Health-related Quality of Life in Patients With HER2-positive Advanced Gastric or Gastroesophageal Junction Cancer With High HER2 Expression Levels – Exploratory Analysis of the Phase III ToGA Study. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71105-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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