Phase II Clinical Study of Protection of Nail Change and Skin Toxicity by Using a Frozen Glove in Japanese Patients with Early Breast Cancer Treated by Docetaxel and Cyclophosphamide (TC) [TBCRG-03 Study]

Background: The combination docetaxel with cyclophosphamide (TC) regimen is one of standard treatment for early breast cancer patients. TC regimen has been widely used in Japan. However, a management for adverse event such as especially edema and nail/skin toxicity by docetaxel is very important due to give a completely full dosage. This multicenter phase II study was designed to evaluate the protection of nail and skin toxicity by using a frozen glove for early breast cancer patients treated by TC.Methods: Four cycles of docetaxel (75mg/m2) and cyclophosphamide (600mg/m2) administered intravenously (i.v.) every 21 days after surgery for primary breast cancer. All patients were attached frozen glove at right or left hand (protected hand) from 15 minutes before to 30 minutes after administration of docetaxel. The other hand (control hand) of same patient is not attached frozen glove between a administration of TC. Safety was assessed every cycle after the start of treatment. Primary endpoint is comparison the rates of nail and skin toxicity between protected and control hand. Secondary endpoints are feasibility of adjuvant TC regimen and adverse events by frozen glove in Japanese women.Results: Fifty two patients were enrolled from September 2007 to June 2008. The nail changes (grade 1 and 2) was occurred in 10 events (19.2%) and 19 events (36.5%) at protected and control hand, respectively. The skin toxicity was occurred in 14 events (26.9%, G1:8, G2:6) and 21 events (40.4%, G1:14, G2:7) at protected and control hand, respectively. The appearance of nail and skin toxicity was significantly decreased at protected hand than control hand (p=0.01). Overall, 41 patients (78%) completed the planned four cycles of TC without dose reductions or study discontinuation. One patient discontinued because of hematological toxicity defined as discontinuation by protocol. The dose reductions were necessary in 10(19%) patients because of hematological (febrile neutropenia) and non hematological toxicity by TC. Grade 3 and 4 adverse events (AEs) were neutropenia (G3:3.9%, G4:21.6%), febrile neutropenia (21.2%), fatigue (1.9%) and dermatitis (3.8%). Grade 1 or 2 AEs frequently observed (more than 20%) were dermatitis such as rash (45%, G1:29.4%, G2:15.7%), pigmentation, nausea, anorexia, disturbance of taste, tear dropping, fatigue, edema and peripheral sensory disturbance. However, there are no adverse events by frozen glove.Conclusion: TC is feasible regimen for early Japanese breast cancer patients after surgery. Frozen glove may be useful procedure which protected the nail and skin toxicity. Furthermore, it is necessary to protect the severe dermatitis due to completely performed planned TC treatment after surgery in Japan.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 808.

[Experimental studies on antitumor effects of endogenously induced LAK (CTL) therapy for metastatic liver tumor]

Antitumor effects of endogenously induced LAK (CTL) therapy by trans-hepatic arterial administration with OK-432 and rIL-2 for metastatic liver tumor were examined.

RESULTS

The number of metastatic nodules (NMN) showed a significant correlation with the number of inoculated tumor cells. NMN of the treated group was significantly reduced over that of the saline group in cases of 2.5 x 10(6) VX2 cells inoculation, while the survival day showed no prolongation even in the treated group. On the other hand, when 1 x 10(5) tumor cells were inoculated the survival day was slightly more prolonged in the treated group than in the saline group. The PHA-induced blastogenesis of peripheral blood was significantly increased at 10 days after the therapy in case of non-tumor bearer, while in cases of tumor bearer it was decreased at 7 days after the therapy.

[A retroperitoneal leiomyosarcoma--a case of non-concurrent double cancers with kidney cancer]

A retroperitoneal leiomyosarcoma in a 50-year-old man is reported. A laparotomy was performed on Dec. 17, 1987 and the tumor, weighing 120 g, was completely excised. The patient was followed up and has stayed healthy (1 year after operation). Although CT ultrasonography and arteriography are helpful in the diagnosis of retroperitoneal tumors, it is felt that a histological examination is indispensable for a qualitative assessment of the lesion. Surgical excision constitutes the fundamental treatment for a retroperitoneal leiomyosarcoma. However, the prognosis is usually poor and depends on successful radical surgery. This case involved non-concurrent double cancers with a retroperitoneal leiomyosarcoma and a kidney cancer.

[Case report of a second resection of rectal leiomyosarcoma due to recurrence after 10 years]

A leiomyosarcoma of the rectum is a rare disease, and cases of a recurrence are even more rare. Reported is the case of a patient who, in 1987, underwent a per sacral resection of a rectal tumor which was diagnosed as leiomyosarcoma. In 1987, after symptoms that showed that the patient's feces had become narrower, a recurrence of this tumor was diagnosed, so that the patient again underwent an abdominoperineal rectomy. The postoperative course has been good. Details of this disease still remain unclear. In Japan, there have been only 10 such cases of a recurrence reported. Of these, a liver metastasis and a localized recurrence are the most common. Long term follow-ups are considered necessary.

[A case of leiomyosarcoma of the small intestine with perforative peritonitis]

On April 15th, 1986, the patient, a 58-year-old man, felt ill because of a stomachache. On April 15, he was referred to our hospital and admitted after having been diagnosed as having pan peritonitis. During surgery, an extraintestinal growth, a small fist-size tumor, was detected in the jejunum. The tumor was partly perforated, and a partial resection of the small intestine was carried out. A histopathological examination led to the diagnosis of a leiomyosarcoma of the small intestine. On June 12, 1987, the patient again returned to our hospital, complaining of a stomachache. A reoperation was performed for perforative peritonitis due to its recurrence but only palliative treatment could be provided.

[A case of an exogastric developing-type carcinoma of the stomach and a review of thirty nine cases reported in Japan]

One personally handled case of an exogastric developing-type carcinoma of the stomach and 39 other cases reported in Japan are discussed in this study. Twenty-seven cases mainly involved an abdominal tumor. As to the developing region, it was frequently in the greater curvature of the antrum. By tissue type, many undifferentiated medullary cancers were noted. With regard to treatment, many researchers recommend the excision of the other complicated organs. Survival for more than postoperative 1 year were as few as 4 cases, including the case handled.

[Clinical evaluation of tumor markers in breast cancer patients]

During the past 4 years, the performances of various tumor markers such as CA15-3, CEA, ferritin, beta 2-microglobulin and TPA have been evaluated in 78 cases of mammary cancer. The results were categorised according to differences in stages, difference in values from patients with recurrent tumors, the incidence of abnormal values and differences in values before and after surgery. When the incidence of values higher than the cutoff value was determined for each of stage I, II and III + IV, the rates for CEA were 14.3%, 4.9% and 27.8%, respectively, whereas those for TPA were 25.0%, 22.2% and 26.7%, respectively. In addition, for CA15-3, the incidences were 0% in stage I, 5.0% in stage II and 57.1% for combined stages III + IV. The average values for patients with recurrent tumors were 3.2 ng/ml CEA, 194.5 ng/ml ferritin, 316.2 U/l TPA and 81.3 U/ml CA15-3. The rates of abnormal values were 40.0% for CEA, 40.0% for ferritin, 85.7% for TPA and 63.6% for CA15-3. Differences in the values after surgical removal of the tumor were observed with these tumor markers: the CEA value was reduced from 1.6 +/- 1.4 to 1.1 +/- 0.5 (p less than 0.01) and the CA15-3 value from 12.2 +/- 8.4 to 9.3 +/- 4.1 (p less than 0.05), respectively, whereas that for ferritin was conversely increased from 48.9 +/- 48.0 to 74.0 +/- 70.0 (p less than 0.01). However, the values for TPA, despite showing a tendency to decrease, did not show any statistically significant alteration. The fluctuations of these marker levels in patients with recurrent tumors reflects the progress of the disease, with a sudden elevation in values indicating imminent death. The diagnostic significance of these markers is not high, but they are considered to be useful in detecting the progress or condition of a recurrent tumor.