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Tokunaga M, Machida N, Mizusawa J, Ito S, Yabusaki H, Hirao M, Watanabe M, Imamura H, Kinoshita T, Yasuda T, Hihara J, Fukuda H, Yoshikawa T, Boku N, Terashima M. Early endpoints of a randomized phase II trial of preoperative chemotherapy with S-1/CDDP with or without trastuzumab followed by surgery for HER2-positive resectable gastric or esophagogastric junction adenocarcinoma with extensive lymph node metastasis: Japan Clinical Oncology Group study JCOG1301C (Trigger Study). Gastric Cancer 2024; 27:580-589. [PMID: 38243037 DOI: 10.1007/s10120-024-01467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND This randomized phase II study explored the superiority of trastuzumab plus S-1 plus cisplatin (SP) over SP alone as neoadjuvant chemotherapy (NAC) for HER2-positive resectable gastric cancer with extensive lymph node metastasis. METHODS Eligible patients with HER2-positive gastric or esophagogastric junction cancer and extensive lymph node metastasis were randomized to receive three or four courses of preoperative chemotherapy with SP (arm A) or SP plus trastuzumab (arm B). Following gastrectomy, adjuvant chemotherapy with S-1 was administered for 1 year in both arms. The primary endpoint was overall survival, and the sample size was 130 patients in total. The trial is registered with the Japan Registry of Clinical Trials, jRCTs031180006. RESULTS This report elucidates the early endpoints, including pathological findings and safety. The study was terminated early due to slow patient accruals. In total, 46 patients were allocated to arm A (n = 22) and arm B (n = 24). NAC was completed in 20 patients (91%) in arm A and 23 patients (96%) in arm B, with similar incidences of grade 3-4 hematological and non-hematological adverse events. Objective response rates were 50% in arm A and 84% in arm B (p = 0·065). %R0 resection rates were 91% and 92%, and pathological response rates (≥ grade 1b in Japanese classification) were 23% and 50% (p = 0·072) in resected patients, respectively. CONCLUSIONS Trastuzumab can be safely added to platinum-containing doublet chemotherapy as NAC, and it has the potential to contribute to higher antitumor activity against locally advanced, HER2-positive gastric or esophagogastric junction cancer with extensive nodal metastasis.
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Affiliation(s)
- Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, Japan.
| | - Nozomu Machida
- Department of Gastroenterology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroshi Yabusaki
- Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masaya Watanabe
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Takahiro Kinoshita
- Department of Gastric Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Takushi Yasuda
- Department of Surgery, Kinki University Faculty of Medicine, Osaka, Japan
| | - Jun Hihara
- Department of Gastrointestinal Surgery, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Takaki Yoshikawa
- Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Narikazu Boku
- Department of Oncology and General Medicine, IMSUT Hospital, Institute of Medical Science, University of Tokyo, Tokyo, Japan
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Homma A, Mikami M, Matsuura K, Onimaru R, Yoshida D, Shinomiya H, Ohkoshi A, Hayashi R, Saito Y, Tachibana H, Shiga K, Ueda T, Uemura H, Nakamura K, Fukuda H. Dose-Finding and Efficacy Confirmation Trial of the Superselective Intra-arterial Infusion of Cisplatin and Concomitant Radiation Therapy for Locally Advanced Maxillary Sinus Cancer (JCOG1212): Results of the Efficacy Confirmation Phase in Patients with T4aN0M0. Int J Radiat Oncol Biol Phys 2024; 118:1271-1281. [PMID: 38008195 DOI: 10.1016/j.ijrobp.2023.11.031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Locally advanced maxillary sinus cancers require radical surgery as a standard treatment, but this often results in significant disfigurement and impairment of function. JCOG1212 seeks to evaluate the safety and efficacy of the superselective intra-arterial infusion of cisplatin and concomitant radiation therapy (RADPLAT) for T4aN0M0 and T4bN0M0 maxillary sinus squamous cell carcinomas. We herein report the results of the efficacy confirmation phase in the T4a cohort. METHODS AND MATERIALS Patients received 100 mg/m2 cisplatin intra-arterially weekly for 7 weeks with concomitant radiation therapy (total 70 Gy) as determined by the results of the preceding dose-finding phase. The trial aimed to evaluate the primary endpoint of 3-year overall survival (OS), comparing RADPLAT with the historical control for 3-year OS in surgery (80%). RESULTS From April 2014 to August 2018, 65 patients were registered in the T4a cohort from 18 institutions, consisting of 54 men and 11 women with a median age of 64 years (range, 40-78 years) and Eastern Cooperative Oncology Group performance status 0/1 (58/7). After excluding 1 ineligible patient, 64 patients were included in the primary analysis of efficacy and safety. The median follow-up was 4.5 years in all eligible patients, and the primary endpoint for 3-year OS was 82.8% (90% CI, 73.4%-89.2%). With regard to acute adverse events, mucositis (grade ≥3), neutropenia (grade ≥3), increased creatinine (grade ≥2), hearing impairment (grade ≥2), and stroke (grade ≥2) were observed in 20.3%, 14.1%, 3.1%, 3.1%, and 1.6% of patients, respectively. One treatment-related death due to a thromboembolic event was reported. CONCLUSIONS We demonstrated that RADPLAT showed favorable results for patients with T4aN0M0 maxillary sinus squamous cell carcinomas compared with the historical control for 3-year OS in surgery, which was from an earlier period, and showed some specific toxicities. Therefore, RADPLAT, as well as surgery, can be regarded as a possible treatment option for these patients.
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Affiliation(s)
- Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Hospital, Sapporo, Japan.
| | - Masashi Mikami
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Rikiya Onimaru
- Department of Radiation Oncology, Tonan Hospital, Sapporo, Japan
| | - Daisuke Yoshida
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yuki Saito
- Department of Otolaryngology, Head and Neck Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kiyoto Shiga
- Department of Head & Neck Surgery, Iwate Medical University, Shiwa, Japan
| | - Tsutomu Ueda
- Department of Otorhinolaryngology, Head and Neck Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirokazu Uemura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Kenichi Nakamura
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
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Kawabata J, Fukuda H, Morikane K. Effect of participation in a surgical site infection surveillance programme on hospital performance in Japan: a retrospective study. J Hosp Infect 2024; 146:183-191. [PMID: 37142058 DOI: 10.1016/j.jhin.2023.02.018] [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: 11/04/2022] [Revised: 02/12/2023] [Accepted: 02/18/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The effect of hospital participation in the Japan Nosocomial Infection Surveillance (JANIS) programme on surgical site infection (SSI) prevention is unknown. AIM To determine if participation in the JANIS programme improved hospital performance in SSI prevention. METHODS This retrospective before-after study analysed Japanese acute care hospitals that joined the SSI component of the JANIS programme in 2013 or 2014. The study participants comprised patients who had undergone surgeries targeted for SSI surveillance at JANIS hospitals between 2012 and 2017. Exposure was defined as the receipt of an annual feedback report 1 year after participation in the JANIS programme. The changes in standardized infection ratio (SIR) from 1 year before to 3 years after exposure were calculated for 12 operative procedures: appendectomy, liver resection, cardiac surgery, cholecystectomy, colon surgery, caesarean section, spinal fusion, open reduction of long bone fracture, distal gastrectomy, total gastrectomy, rectal surgery, and small bowel surgery. Logistic regression models were used to analyse the association of each post-exposure year with the occurrence of SSI. FINDINGS In total, 157,343 surgeries at 319 hospitals were analysed. SIR values declined after participation in the JANIS programme for procedures such as liver resection and cardiac surgery. Participation in the JANIS programme was significantly associated with reduced SIR for several procedures, especially after 3 years. The odds ratios in the third post-exposure year (reference: pre-exposure year) were 0.86 [95% confidence interval (CI) 0.79-0.84] for colon surgery, 0.72 (95% CI 0.56-0.92) for distal gastrectomy, and 0.77 (95% CI 0.59-0.99) for total gastrectomy. CONCLUSION Participation in the JANIS programme was associated with improved SSI prevention performance in several procedures in Japanese hospitals after 3 years.
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Affiliation(s)
- J Kawabata
- Advanced Emergency Medical Service Centre, Kurume University Hospital, Kurume, Japan
| | - H Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
| | - K Morikane
- Division of Clinical Laboratory and Division of Infection Control, Yamagata University Hospital, Yamagata, Japan
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Sugita S, Tanaka K, Oda Y, Nojima T, Konishi N, Machida R, Kita R, Fukuda H, Ozaki T, Hasegawa T. Prognostic evaluation of the Ki-67 labeling system in histological grading of non-small round cell sarcoma: a supplementary analysis of a randomized controlled trial, JCOG1306. Jpn J Clin Oncol 2024:hyae020. [PMID: 38391203 DOI: 10.1093/jjco/hyae020] [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: 10/07/2023] [Accepted: 01/27/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Soft tissue sarcoma (STS) has various histological types and is rare, making it difficult to evaluate the malignancy of each histological type. Thus, comprehensive histological grading is most important in the pathological examination of STS. The Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grading system is most commonly used in daily pathological analysis of STS. Among the FNCLCC grading system parameters, mitotic count is a key morphological parameter reflecting the proliferative activity of tumor cells, although its reproducibility may be lacking. Here, we compared the prognostic utility of the conventional and modified FNCLCC grading systems in JCOG1306. METHODS We analyzed 140 patients with non-small round cell sarcoma. We performed Ki-67 immunostaining using open biopsy specimens before preoperative chemotherapy in all patients. We assessed histological grade in individual cases by conventional FNCLCC grading (tumor differentiation, mitotic count, and necrosis) and modified FNCLCC grading using the Ki-67 labeling index instead of mitotic count. We conducted univariable and multivariable Cox regression analyses to investigate the influence of grade on overall survival. RESULTS In univariable analysis, prognosis was worse for patients with conventional FNCLCC Grade 3 tumors compared with Grade 1 or 2 tumors (hazard ratio [HR] 4.21, 95% confidence interval [CI] 1.47-12.05, P = 0.008). Moreover, prognosis was worse in patients with modified FNCLCC Grade 3 tumors compared with Grade 1 or 2 tumors (HR 4.90, 95% CI 1.64-14.65, P = 0.004). In multivariable analysis including both conventional and modified FNCLCC grading, the modified grading more strongly affected overall survival (HR 6.70, 95% CI 1.58-28.40, P = 0.010). CONCLUSIONS The modified FNCLCC grading system was superior to the conventional system in predicting the prognosis of patients with non-small round cell sarcoma according to this supplementary analysis of data from the randomized controlled trial JCOG1306.
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Affiliation(s)
- Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, Chuo-ku, Sapporo
| | - Kazuhiro Tanaka
- Department of Advanced Medical Sciences, Oita University, Yufu, Oita
| | - Yoshinao Oda
- Department of Anatomic Pathology, Kyushu University, Fukuoka
| | - Takayuki Nojima
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Kahoku, Ishikawa
| | - Naomi Konishi
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo
| | - Ryunosuke Machida
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo
| | - Ryosuke Kita
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine, Chuo-ku, Sapporo
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Ikenaga N, Hashimoto T, Mizusawa J, Kitabayashi R, Sano Y, Fukuda H, Nakata K, Shibuya K, Kitahata Y, Takada M, Kamei K, Kurahara H, Ban D, Kobayashi S, Nagano H, Imamura H, Unno M, Takahashi A, Yagi S, Wada H, Shirakawa H, Yamamoto N, Hirono S, Gotohda N, Hatano E, Nakamura M, Ueno M. A multi-institutional randomized phase III study comparing minimally invasive distal pancreatectomy versus open distal pancreatectomy for pancreatic cancer; Japan Clinical Oncology Group study JCOG2202 (LAPAN study). BMC Cancer 2024; 24:231. [PMID: 38373949 PMCID: PMC10875854 DOI: 10.1186/s12885-024-11957-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Minimally invasive distal pancreatectomy (MIDP), including laparoscopic and robotic distal pancreatectomy, has gained widespread acceptance over the last decade owing to its favorable short-term outcomes. However, evidence regarding its oncologic safety is insufficient. In March 2023, a randomized phase III study was launched in Japan to confirm the non-inferiority of overall survival in patients with resectable pancreatic cancer undergoing MIDP compared with that of patients undergoing open distal pancreatectomy (ODP). METHODS This is a multi-institutional, randomized, phase III study. A total of 370 patients will be enrolled from 40 institutions within 4 years. The primary endpoint of this study is overall survival, and the secondary endpoints include relapse-free survival, proportion of patients undergoing radical resection, proportion of patients undergoing complete laparoscopic surgery, incidence of adverse surgical events, and length of postoperative hospital stay. Only a credentialed surgeon is eligible to perform both ODP and MIDP. All ODP and MIDP procedures will undergo centralized review using intraoperative photographs. The non-inferiority of MIDP to ODP in terms of overall survival will be statistically analyzed. Only if non-inferiority is confirmed will the analysis assess the superiority of MIDP over ODP. DISCUSSION If our study demonstrates the non-inferiority of MIDP in terms of overall survival, it would validate its short-term advantages and establish its long-term clinical efficacy. TRIAL REGISTRATION This trial is registered with the Japan Registry of Clinical Trials as jRCT 1,031,220,705 [ https://jrct.niph.go.jp/en-latest-detail/jRCT1031220705 ].
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Affiliation(s)
- Naoki Ikenaga
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582, Fukuoka, Japan
| | - Tadayoshi Hashimoto
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
- Translational Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Ryo Kitabayashi
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Sano
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582, Fukuoka, Japan
| | - Kazuto Shibuya
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Yuji Kitahata
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Minoru Takada
- Department of Surgery, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Kagoshima University, Kagoshima, Japan
| | - Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hajime Imamura
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Amane Takahashi
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | - Shintaro Yagi
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Ishikawa, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hirofumi Shirakawa
- Department of HepatoBiliary-Pancreatic Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Naoto Yamamoto
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Seiko Hirono
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Gastroenterological Surgery, Hyogo Medical University, Hyogo, Japan
| | - Naoto Gotohda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582, Fukuoka, Japan.
| | - Makoto Ueno
- Department of Gastroenterology, Kanagawa Cancer Center, Kanagawa, Japan
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Kita R, Yanagimoto Y, Imazeki H, Booka E, Tsushima T, Mizusawa J, Sasaki K, Fukuda H, Kurokawa Y, Takeuchi H, Kato K, Kitagawa Y, Boku N, Yoshikawa T, Terashima M. Protocol digest of a randomized controlled adaptive Phase II/III trial of neoadjuvant chemotherapy for Japanese patients with oesophagogastric junction adenocarcinoma: Japan Clinical Oncology Group Study JCOG2203 (NEO-JPEG). Jpn J Clin Oncol 2024; 54:206-211. [PMID: 37952093 DOI: 10.1093/jjco/hyad149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Treatment strategies for oesophagogastric junction adenocarcinoma have not been standardized despite its poor prognosis due to differences in the incidence rates between Western countries and Asia. This randomized Phase II/III trial was initiated in June 2023 to determine which neoadjuvant chemotherapy regimen, docetaxel, oxaliplatin and S-1 or fluorouracil, oxaliplatin and docetaxel, is a more promising treatment in Phase II and confirm the superiority of neoadjuvant chemotherapy with docetaxel, oxaliplatin and S-1 or fluorouracil, oxaliplatin and docetaxel followed by surgery and postoperative chemotherapy over upfront surgery and postoperative chemotherapy in terms of overall survival in patients with Clinical Stage III or IVA oesophagogastric junction adenocarcinoma in Phase III. A total of 460 patients, including 150 patients in Phase II and 310 patients in Phase III, are planned to be enrolled from 85 hospitals in Japan over 5 years. This trial has been registered in the Japan Registry of Clinical Trials as jRCTs031230182 (https://jrct.niph.go.jp/latest-detail/jRCTs031230182).
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Affiliation(s)
- Ryosuke Kita
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | | | - Hiroshi Imazeki
- Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan
| | - Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Takahiro Tsushima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Keita Sasaki
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University, Osaka, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narikazu Boku
- Department of Oncology and General Medicine, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Takaki Yoshikawa
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
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Hattori A, Suzuki K, Takamochi K, Wakabayashi M, Sekino Y, Tsutani Y, Nakajima R, Aokage K, Saji H, Tsuboi M, Okada M, Asamura H, Nakamura K, Fukuda H, Watanabe SI. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer with radiologically pure-solid appearance in Japan (JCOG0802/WJOG4607L): a post-hoc supplemental analysis of a multicentre, open-label, phase 3 trial. Lancet Respir Med 2024; 12:105-116. [PMID: 38184010 DOI: 10.1016/s2213-2600(23)00382-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/01/2023] [Accepted: 10/11/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Although segmentectomy was better than lobectomy in terms of overall survival for patients with non-small-cell lung cancer (NSCLC) with a pure-solid tumour appearance on thin-section CT in the open-label, multicentre, randomised, controlled, phase 3 JCOG0802/WJOG4607L trial, the reasons why segmentectomy was associated with better overall survival were unclear. We aimed to compare the survival, cause of death, and recurrence patterns after segmentectomy versus lobectomy in trial participants with NSCLC with a pure-solid appearance METHODS: We conducted a post-hoc supplemental analysis of the JCO0802/WJOG4607L randomised, controlled, non-inferiority trial for the patients (aged 20-85 years) with small-sized NSCLC with radiologically pure-solid appearance on thin-section CT (≤2 cm, consolidation tumour ratio 1·0). The primary aim was to compare the overall and relapse-free survival, cause of death, and recurrence patterns associated with segmentectomy and lobectomy for patients with radiologically pure-solid NSCLC to determine why the overall survival of segmentectomy was superior to that of lobectomy, even for oncologically invasive lung cancers. JCO0802/WJOG4607L is registered with the UMIN Clinical Trials Registry, UMIN000002317, and is complete. FINDINGS Between Aug 10, 2009, and Oct 21, 2014, 1106 patients were randomly assigned to undergo either lobectomy or segmentectomy. Of these participants, 553 (50%) had radiologically pure-solid NSCLC and were eligible for this post-hoc supplemental analysis. Of these 553 participants, 274 (50%) patients underwent lobectomy and 279 (50%) underwent segmentectomy. Median patient age was 67 years (IQR 61-73), 347 (63%) of 553 patients were male and 206 (37%) were female, and data on race and ethnicity were not collected. As of data cutoff (June 13, 2020), after a median follow-up of 7·3 years (IQR 6·0-8·5), the 5-year overall survival rate was significantly higher after segmentectomy than after lobectomy (86·1% [95% CI 81·4-89·7] in the lobectomy group, with 55 deaths vs 92·4% [88·6-95·0] in the segmentectomy group, with 38 deaths; hazard ratio (HR) 0·64 [95% CI 0·41-0·97]; log-rank test p=0·033), whereas the 5-year relapse-free survival was similar between the groups (81·7% [95% CI 76·5-85·8], with 34 events vs 82·0% [76·9-86·0], with 52 events; HR 1·01 [95% CI 0·72-1·42]; p=0·94). Deaths after a median follow-up of 7·3 years due to lung cancer occurred in 20 (7%) of 274 patients after lobectomy and 19 (7%) of 279 after segmentectomy, and deaths due to other causes occurred in 35 (13%) patients after lobectomy compared with 19 (7%) after segmentectomy (lung cancer death vs other cause of death, p=0·19). The locoregional recurrence was higher after segmentectomy (21 [8%] vs 45 [16%]; p=0·0021). In subgroup analyses, better 5-year overall survival after segmentectomy than after lobectomy was observed in the subgroup of patients aged 70 years or older (77·1% [95% CI 68·2-83·8] with lobectomy vs 85·6% [77·5-90·9] with segmentectomy; p=0·013) and in male patients (80·5% [73·7-85·7] vs 92·1% [87·0-95·2]; p=0·0085). By contrast, better 5-year relapse-free survival after lobectomy than after segmentectomy was observed in the subgroup younger than 70 years (87·4% [95% CI 81·2-91·7] with lobectomy vs 84·4% [77·9-89·1] with segmentectomy; p=0·049) and in female patients (94·2% [87·6-97·4] vs 82·2% [73·2-88·4]; p=0·047). INTERPRETATION This post-hoc analysis showed improved overall survival after segmentectomy in patients with pure-solid NSCLC compared with lobectomy. However, survival outcomes of segmentectomy depend on the patient's age and sex. Given the results of this exploratory analysis, further research is necessary to determine clinically relevant indications for segmentectomy in radiologically pure-solid NSCLC. FUNDING Japanese National Cancer Center Research and Development Fund and Practical Research for Innovative Cancer Control Fund, and a Grant-in-Aid for Scientific Research from the Ministry of Health, Labor, and Welfare of Japan.
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Affiliation(s)
- Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masashi Wakabayashi
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yuta Sekino
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Tsutani
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Ryu Nakajima
- Department of General Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Hisashi Saji
- Department of Chest Surgery, St Marianna University School of Medicine, Kawasaki, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kenichi Nakamura
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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8
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Sasaki K, Nomura M, Kato K, Sakanaka K, Ito Y, Kadota T, Machida R, Kataoka T, Minashi K, Tsubosa Y, Kajiwara T, Fukuda H, Takeuchi H, Mizowaki T, Nishimura Y, Kitagawa Y. A phase III randomized controlled trial comparing local field with additional prophylactic irradiation in chemoradiotherapy for clinical-T1bN0M0 esophageal cancer: ARMADILLO trial (JCOG1904). Jpn J Clin Oncol 2024; 54:103-107. [PMID: 37801434 DOI: 10.1093/jjco/hyad137] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023] Open
Abstract
Chemoradiotherapy has been considered as one of the standard treatment options for clinical T1bN0M0 esophageal squamous cell carcinoma with organ preservation. However, 20% of patients develop locoregional recurrence after chemoradiotherapy, which requires salvage treatment including salvage surgery and endoscopic resection. Salvage surgery can cause complications and treatment-related death. Interestingly, chemoradiotherapy with elective nodal irradiation has been reported to reduce the locoregional recurrence of advanced esophageal squamous cell carcinoma. Hence, we are conducting a clinical trial to confirm whether modified chemoradiotherapy with elective nodal irradiation was superiority to that without elective nodal irradiation for the patients with cT1bN0M0 esophageal squamous cell carcinoma. The primary endpoint is major progression-free survival, defined as the time from randomization to the date of death or disease progression, excluding successful curative resection through salvage endoscopic resection. We plan to enroll 280 patients from 54 institutions over 4 years. This trial has been registered in the Japan Registry of Clinical Trials (jRCTs031200067).
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Affiliation(s)
- Keita Sasaki
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Motoo Nomura
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Katsuyuki Sakanaka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Tomohiro Kadota
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ryunosuke Machida
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Kataoka
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Keiko Minashi
- Clinical Trial Promotion Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan
| | - Yasuhiro Tsubosa
- Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Takeshi Kajiwara
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Takashi Mizowaki
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Hospital, Osaka, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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9
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Yoshikawa T, Terashima M, Mizusawa J, Nunobe S, Nishida Y, Yamada T, Kaji M, Nomura T, Hato S, Choda Y, Yabusaki H, Yoshida K, Misawa K, Masuzawa T, Tsuda M, Kawachi Y, Katayama H, Fukuda H, Kurokawa Y, Boku N, Sano T, Sasako M. 5-year follow-up results of a JCOG1104 (OPAS-1) phase III non-inferiority trial to compare 4 courses and 8 courses of S-1 adjuvant chemotherapy for pathological stage II gastric cancer. Gastric Cancer 2024; 27:155-163. [PMID: 37989806 DOI: 10.1007/s10120-023-01447-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Postoperative adjuvant chemotherapy with S-1 for 1 year (corresponding to eight courses) is the standard treatment for pathological stage II gastric cancer. The phase III trial (JCOG1104) investigating the non-inferiority of four courses of S-1 to eight courses was terminated due to futility at the first interim analysis. To confirm the primary results, we reported the results after a 5-years follow-up in JCOG1104. METHODS Patients histologically diagnosed with stage II gastric cancer after radical gastrectomy were randomly assigned to receive S-1 for eight or four courses. In detail, 80 mg/m2/day S-1 was administered for 4 weeks followed by a 2-week rest as a single course. RESULTS Between February 16, 2012, and March 19, 2017, 590 patients were enrolled and randomly assigned to 8-course (295 patients) and 4-course (295 patients) regimens. After a 5-years follow-up, the relapse-free survival at 3 years was 92.2% for the 8-course arm and 90.1% for the 4-course arm, and that at 5 years was 87.7% for the 8-course arm and 85.6% for the 4-course arm (hazard ratio 1.265, 95% CI 0.846-1.892). The overall survival at 3 years was 94.9% for the 8-course arm, 93.2% for the 4-course arm, and that at 5 years was 89.7% for the 8-course arm, and 88.6% for the 4-course arm (HR 1.121, 95% CI 0.719-1.749). CONCLUSIONS The survival of the four-course arm was slightly but consistently inferior to that of the eight-course arm. Eight-course S-1 should thus remain the standard adjuvant chemotherapy for pathological stage II gastric cancer.
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Affiliation(s)
- Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka Prefecture, 411-8777, Japan
| | - Junki Mizusawa
- JCOG Data Center/Operations Office, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Souya Nunobe
- Gastroenterological Surgery, Cancer Institute Ariake Hospital, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Yasunori Nishida
- Department of Surgery, Keiyukai Sapporo Hospital, Kita 1-1, Hondori 14, Shiroishi-Ku, Sapporo, 003-0027, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan
| | - Masahide Kaji
- Department of Surgery, Toyama Prefectural Central Hospital, Nishinagae 2-2-78, Toyama, 930-8550, Japan
| | - Takashi Nomura
- Department of Surgery, Yamagata Prefectural Central Hospital, Aoyanagi 1800, Yamagata, 990-2292, Japan
| | - Shinji Hato
- Department of Gastroenterological Surgery, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-Umemotomachi, Matsuyama, 791-0280, Japan
| | - Yasuhiro Choda
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-Ku, Hiroshima, 730-8518, Japan
| | - Hiroshi Yabusaki
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Kawagishimachi, Chuo-Ku, Niigata, 951-8566, Japan
| | - Kazuhiro Yoshida
- Department of Gastroenterological Surgery and Pediatric Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, 501-1193, Japan
| | - Kazunari Misawa
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya, 464-8681, Japan
| | - Toru Masuzawa
- Department of Surgery, Kansai Rosai Hospital, Inabaso 3-1-69, Amagasaki, 660-8511, Japan
| | - Masahiro Tsuda
- Department of Gastroenterological Oncology, Hyogo Cancer Center, Kitaouji-Cho 13-70, Akashi, 673-8558, Japan
| | - Yasuyuki Kawachi
- Department of Surgery, Nagaoka Chuo General Hospital, 2041 Kawasakimachi, Nagaoka, 940-8653, Japan
| | - Hiroshi Katayama
- JCOG Data Center/Operations Office, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Narikazu Boku
- Department of Oncology and General Medicine, Institute of Medical Science, IMSUT Hospital, University of Tokyo, 4-6-1, Shiroganedai, Mitato-Ku, Tokyo, 108-8639, Japan
| | - Takeshi Sano
- Gastroenterological Surgery, Cancer Institute Ariake Hospital, 3-8-31 Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Mitsuru Sasako
- Department of Multidisciplinary Surgical Oncology, Hyogo College of Medicine, Mukogawacho 1-1, Nishinomiya, 663-8131, Japan
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10
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Miyoshi T, Ito H, Wakabayashi M, Hashimoto T, Sekino Y, Suzuki K, Tsuboi M, Moriya Y, Yoshino I, Isaka T, Hattori A, Mimae T, Isaka M, Maniwa T, Endo M, Yoshioka H, Nakagawa K, Nakajima R, Tsutani Y, Saji H, Okada M, Aokage K, Fukuda H, Watanabe SI. Risk factors for loss of pulmonary function after wedge resection for peripheral ground-glass opacity dominant lung cancer. Eur J Cardiothorac Surg 2023; 64:ezad365. [PMID: 37930048 DOI: 10.1093/ejcts/ezad365] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES This study aimed to identify the risk factors for pulmonary functional deterioration after wedge resection for early-stage lung cancer with ground-glass opacity, which remain unclear, particularly in low-risk patients. METHODS We analysed 237 patients who underwent wedge resection for peripheral early-stage lung cancer in JCOG0804/WJOG4507L, a phase III, single-arm confirmatory trial. The changes in forced expiratory volume in 1 s were calculated pre- and postoperatively, and a cutoff value of -10%, the previously reported reduction rate after lobectomy, was used to divide the patients into 2 groups: the severely reduced group (≤-10%) and normal group (>-10%). These groups were compared to identify predictors for severe reduction. RESULTS Thirty-seven (16%) patients experienced severe reduction. Lesions with a total tumour size ≥1 cm were significantly more frequent in the severely reduced group than in the normal group (89.2% vs 71.5%; P = 0.024). A total tumour size of ≥1 cm [odds ratio (OR), 3.287; 95% confidence interval (CI), 1.114-9.699: P = 0.031] and pleural indentation (OR, 2.474; 95% CI, 1.039-5.890: P = 0.041) were significant predictive factors in the univariable analysis. In the multivariable analysis, pleural indentation (OR, 2.667; 95% CI, 1.082-6.574; P = 0.033) was an independent predictive factor, whereas smoking status and total tumour size were marginally significant. CONCLUSIONS Of the low-risk patients who underwent pulmonary wedge resection for early-stage lung cancer, 16% experienced severe reduction in pulmonary function. Pleural indentation may be a risk factor for severely reduced pulmonary function in pulmonary wedge resection.
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Affiliation(s)
- Tomohiro Miyoshi
- Division of Thoracic Surgery, Department of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Masashi Wakabayashi
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tadayoshi Hashimoto
- Translational Research Support Section, National Cancer Center Hospital East, Chiba, Japan
| | - Yuta Sekino
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, Department of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Yasumitsu Moriya
- Department of Thoracic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Ichiro Yoshino
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Tetsuya Isaka
- Department of Thoracic Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Mitsuhiro Isaka
- Department of Thoracic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Tomohiro Maniwa
- Department of Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Makoto Endo
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Kazuo Nakagawa
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Ryu Nakajima
- Department of General Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yasuhiro Tsutani
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Keiju Aokage
- Division of Thoracic Surgery, Department of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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11
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Maniwa T, Okami J, Miyoshi T, Wakabayashi M, Yoshioka H, Mimae T, Endo M, Hattori A, Nakagawa K, Isaka T, Isaka M, Kita R, Sekino Y, Mitome N, Aokage K, Saji H, Nakajima R, Okada M, Tsuboi M, Asamura H, Fukuda H, Watanabe SI. Lymph node dissection in small peripheral lung cancer: Supplemental analysis of JCOG0802/WJOG4607L. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01099-1. [PMID: 38000629 DOI: 10.1016/j.jtcvs.2023.11.023] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/30/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE The optimal region of lymph node dissection (LND) during segmentectomy in patients with small peripheral non-small cell lung cancer requires clarification. Through a supplemental analysis of the Japan Clinical Oncology Group (JCOG) 0802/West Japan Oncology Group (WJOG) 4607L, we investigated the associated factors, distribution, and recurrence pattern of lymph node metastases (LNMs) and proposed the optimal LND region. METHODS Of the 1106 patients included in the JCOG0802/WJOG4607L, 1056 patients with LNDs were included in this supplemental analysis. We investigated the distribution and recurrence pattern of LNMs along with the radiologic findings (with ground-glass opacity, part-solid tumor; without ground-grass opacity component, pure-solid tumor). RESULTS The radiologic findings were the only significant factor for LNMs. Of 533 patients with part-solid tumors, 8 (1.5%) had LNMs. Further, only 3 (0.5%) patients had pN2 disease, and no patients had interlobar LNMs from nonadjacent segments. Of the 523 patients with pure-solid tumors, 55 (10.5%) had LNMs, and 28 (5.4%) had pN2 disease. Five patients had metastases to nonadjacent interlobar lymph nodes (LNs). Two (2.0%) patients with S6 tumors had upper mediastinal LNMs. In addition, the incidence of mediastinal LN recurrence in patients with S6 lung cancer was greater in those who underwent selective LND than those who underwent systematic LND (P = .0455). CONCLUSIONS Nonadjacent interlobar and mediastinal LND have little impact on pathologic nodal staging in patients with part-solid tumors. In contrast, selective LND is recommended at least for patients with pure-solid tumors.
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Affiliation(s)
- Tomohiro Maniwa
- Department of Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Jiro Okami
- Department of Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan.
| | - Tomohiro Miyoshi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Masashi Wakabayashi
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Makoto Endo
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Isaka
- Department of Thoracic Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Mitsuhiro Isaka
- Department of Thoracic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Ryosuke Kita
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yuta Sekino
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Mitome
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Hisashi Saji
- Department of Chest Surgery, St Marianna University School of Medicine, Kawasaki, Japan
| | - Ryu Nakajima
- Department of General Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Morihito Okada
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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12
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Yokota T, Zenda S, Kodaira T, Kiyota N, Fujimoto Y, Wasano K, Takahashi R, Mizowaki T, Homma A, Sasaki K, Machida R, Sekino Y, Fukuda H. Novel approach of prophylactic radiation to reduce toxicities comparing 2-step40 with 56-Gy simultaneous integrated boost intensity-modulated radiation therapy for locally advanced squamous cell carcinoma of the head and neck, an intergroup phase III trial (JCOG1912, NEW BRIDGE). BMC Cancer 2023; 23:1068. [PMID: 37932681 PMCID: PMC10626703 DOI: 10.1186/s12885-023-11503-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Chemoradiotherapy (CRT) with concurrent cisplatin is the standard of care as a nonsurgical definitive treatment for patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, CRT is associated with increased severe late adverse events, including swallowing dysfunction, xerostomia, ototoxicity, and hypothyroidism. Few strategies aimed at less invasive CRT without compromising treatment outcomes have been successful. The purpose of this study is to confirm the non-inferiority of reduced dose prophylactic radiation with 40 Gy compared to standard dose prophylactic radiation with 56 Gy in terms of the time to treatment failure (TTF) among patients with clinical stage III-IVB LA-SCCHN. METHODS This study is a multicenter, two-arm, open-label, randomized phase III trial. Patients with LA-SCCHN excluding p16 positive oropharynx cancer are randomized to the standard arm or experimental arm. A total dose of 70 Gy for tumors with concurrent cisplatin at 100 mg/m2 are administered in both arms. For prophylactic field, patients in the standard arm receive a total dose of 56 Gy in 35 fractions for 7 weeks using simultaneous integrated boost (SIB56) and those in the experimental arm receive 40 Gy in 20 fractions using two-step methods for 4 weeks (2-step40). A total of 400 patients will be enrolled from 52 Japanese institutions within 5 years. The primary endpoint is TTF, and the secondary endpoints are overall survival, complete response rate, progression-free survival, locoregional relapse-free survival, acute and late adverse events, quality of life score, and swallowing function score. DISCUSSION If the experimental arm is non-inferior to the standard arm in terms of TTF and superior on the safety endpoints, the 2-step40 procedure is the more useful treatment than SIB56 for definitive CRT. TRIAL REGISTRATION This trial has been registered in the Japan Registry of Clinical Trials as jRCTs031210100 ( https://jrct.niph.go.jp/latest-detail/jRCTs031210100 ). Date of Registration: May 2021.
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Affiliation(s)
- Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan, 1-1 Kanoko-den, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Cancer Center, Kobe University Hospital, Kobe, Japan
| | - Yasushi Fujimoto
- Department of Otolaryngology, Aichi Medical University, Nagakute, Japan
| | - Koichiro Wasano
- Department of Otolaryngology-Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Ryo Takahashi
- Section of Radiation Safety and Quality Assurance, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takashi Mizowaki
- Departments of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keita Sasaki
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Ryunosuke Machida
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yuta Sekino
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
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13
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Hashimoto T, Tsukamoto S, Murofushi K, Ito Y, Hirano H, Tsukada Y, Sasaki K, Mizusawa J, Fukuda H, Takashima A, Kanemitsu Y. Total neoadjuvant therapy followed by a watch-and-wait strategy for patients with rectal cancer (TOWARd): protocol for single-arm phase II/III confirmatory trial (JCOG2010). BJS Open 2023; 7:zrad110. [PMID: 37931233 PMCID: PMC10627521 DOI: 10.1093/bjsopen/zrad110] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Radical surgery is the standard treatment for rectal cancer, but can impact quality of life. Recently, the concept of total neoadjuvant therapy with a watch-and-wait strategy has been proposed in which patients with a cCR after total neoadjuvant therapy do not proceed to surgery. However, most investigations of a watch-and-wait strategy have reported cases where cCR was achieved coincidentally via total neoadjuvant therapy. The aim is to assess whether total neoadjuvant therapy is effective in early-stage rectal cancer in patients that achieve cCR and are offered a watch-and-wait strategy. METHODS JCOG2010 (TOWARd) is a multi-institutional, single-arm phase II/III confirmatory investigation of the safety and efficacy of total neoadjuvant therapy followed by a watch-and-wait strategy for rectal cancer. Key eligibility criteria include cT2-3 N0 M0 rectal adenocarcinoma, tumour diameter less than or equal to 5 cm, age 18-75 years, performance status 0-1, and no history of pelvic irradiation or rectal surgery. Total neoadjuvant therapy involves neoadjuvant chemoradiotherapy (capecitabine and radiotherapy: 45 Gy/25 fractions to the whole pelvis plus boost of 5.4 Gy/3 fractions to the primary tumour) followed by consolidation chemotherapy (four cycles of capecitabine/oxaliplatin). Patients will be re-staged every 8 weeks after total neoadjuvant therapy, and those who achieve cCR will undergo a watch-and-wait strategy, those with near complete response will undergo a watch-and-wait strategy or local resection, and those with an incomplete response will undergo radical surgery. The primary endpoint is the cCR rate in phase II and 5-year overall survival in phase III. Secondary endpoints include postoperative anal, urinary, and sexual function. A total of 105 patients (phase II, 40 patients; phase III, 65 patients) will be enrolled over 3.5 years. CONCLUSION This trial will determine whether total neoadjuvant therapy and a watch-and-wait strategy is an effective alternative to radical surgery for early-stage rectal cancer in patients with cT2-3 N0 M0 and tumour size less than or equal to 5 cm. REGISTRATION NUMBER jRCTs031220288 (https://jrct.niph.go.jp/en-latest-detail/jRCTs031220288).
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Affiliation(s)
- Tadayoshi Hashimoto
- Japan Clinical Oncology Group Data Centre/Operations Office, National Cancer Centre Hospital, Tokyo, Japan
- Translational Research Support Section, National Cancer Centre Hospital East, Kashiwa, Japan
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Centre Hospital East, Kashiwa, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Centre Hospital, Tokyo, Japan
| | - Keiko Murofushi
- Division of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Disease Centre Komagome Hospital, Tokyo, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Hidekazu Hirano
- Department of Gastrointestinal Medical Oncology, National Cancer Centre Hospital, Tokyo, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Centre Hospital East, Kashiwa, Japan
| | - Keita Sasaki
- Japan Clinical Oncology Group Data Centre/Operations Office, National Cancer Centre Hospital, Tokyo, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Centre/Operations Office, National Cancer Centre Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Centre/Operations Office, National Cancer Centre Hospital, Tokyo, Japan
| | - Atsuo Takashima
- Department of Gastrointestinal Medical Oncology, National Cancer Centre Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Centre Hospital, Tokyo, Japan
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14
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Hashimoto T, Nakayama I, Ohashi M, Mizusawa J, Kawachi H, Kita R, Fukuda H, Kurokawa Y, Boku N, Yoshikawa T, Terashima M. Randomized phase II study comparing neoadjuvant 5-fluorouracil/oxaliplatin/docetaxel versus docetaxel/oxaliplatin/S-1 for patients with type 4 or large type 3 gastric cancer. Future Oncol 2023; 19:2147-2155. [PMID: 37882373 DOI: 10.2217/fon-2023-0605] [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] [Indexed: 10/27/2023] Open
Abstract
Macroscopic type 4 and large type 3 gastric cancer, mostly overlapping with scirrhous or linitis plastica type, exhibit a highly invasive nature and show unfavorable prognosis after curative surgery, even with adjuvant chemotherapy. A randomized phase III trial (JCOG0501) failed to demonstrate a survival advantage of neoadjuvant chemotherapy with S-1 plus cisplatin for this population. The current authors initiated a randomized phase II study comparing neoadjuvant chemotherapy with 5-fluorouracil/oxaliplatin/docetaxel versus docetaxel/oxaliplatin/S-1 for type 4 and large type 3 gastric cancer. 76 patients are planned to be enrolled over two years. The primary end point is the proportion of patients with a pathological response (grade 1b or higher) and secondary end points include overall survival and adverse events. Clinical Trial Registration: jRCTs031230231 (rctportal.niph.go.jp).
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Affiliation(s)
- Tadayoshi Hashimoto
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
- Translational Research Support Section, National Cancer Center Hospital East, Kashiwa, Japan
- Department of Gastroenterology & Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Izuma Nakayama
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Cancer Institute Ariak Hospital, Tokyo, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Kawachi
- Department of Pathology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ryosuke Kita
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Narikazu Boku
- Department of Oncology & General Medicine, IMSUT Hospital, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi, 411-8777, Japan
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15
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Hashimoto T, Maruyama S, Takii Y, Mizusawa J, Kataoka T, Fukuda H, Tsukamoto S, Takashima A, Hamaguchi T, Kanemitsu Y. A randomized phase II study comparing preoperative mFOLFOX6 versus FOLFOXIRI for locally advanced colon cancer: JCOG2006. Future Oncol 2023; 19:1897-1904. [PMID: 37750332 DOI: 10.2217/fon-2023-0091] [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] [Indexed: 09/27/2023] Open
Abstract
The prognosis of locally advanced colon cancer (LACC) with surgical resection followed only by adjuvant chemotherapy is poor. Preoperative chemotherapy for LACC patients with risk factors such as cT4bN+ or cT3-4aN2-3 has attracted attention. Here, the authors describe the rationale and design of JCOG2006, a randomized phase II study comparing preoperative chemotherapy with mFOLFOX6 versus FOLFOXIRI for LACC. Their efficacy and safety are evaluated and a determination of which is the more promising treatment will be conducted in a subsequent phase III trial. A total of 86 patients will be accrued from 44 institutions over 2 years. The primary end point is the proportion of patients with a Tumor Regression Score of 0-2, and secondary end points include overall survival, response rate and adverse events. Clinical Trial Registration: jRCTs031210365 (https://jrct.niph.go.jp/).
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Affiliation(s)
- Tadayoshi Hashimoto
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Maruyama
- Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yasumasa Takii
- Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Kataoka
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Atsuo Takashima
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Hamaguchi
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
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16
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Hashimoto T, Tsukada Y, Ito M, Kanato K, Mizusawa J, Fukuda H, Tsukamoto S, Takashima A, Kanemitsu Y. Utility of circulating tumour DNA for prognosis and prediction of therapeutic effect in locally recurrent rectal cancer: study protocol for a multi-institutional, prospective observational study (JCOG1801A1, CAP-LR study). BMJ Open 2023; 13:e073217. [PMID: 37586869 PMCID: PMC10432635 DOI: 10.1136/bmjopen-2023-073217] [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: 02/27/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION In locally recurrent rectal cancer (LRRC), surgery is a standard treatment for resectable disease. However, short-term and long-term outcomes are unsatisfactory due to the invasive nature of surgical procedures and the high proportion of local recurrence. Consequently, the identification of reliable prognostic and predictive biomarkers to guide treatment decisions may improve outcomes. The presence of circulating tumour DNA (ctDNA) in plasma after surgery may signify the presence of minimal residual disease (MRD) in various cancers. Therefore, we have launched a multi-institutional prospective observational study of ctDNA for MRD detection in conjunction with JCOG1801, a randomised, controlled phase III trial evaluating the efficacy of preoperative chemoradiotherapy (pre-CRT) compared with up-front surgery for LRRC (jRCTs031190076, NCT04288999). METHODS AND ANALYSIS JCOG1801A1 is the first correlative study that assesses ctDNA in LRRC patients enrolled in JCOG1801. Patients randomised to up-front surgery will provide whole blood samples at three time points (prior to surgery, after surgery and after postoperative chemotherapy); those to pre-CRT will provide at five time points (prior to pre-CRT, after pre-CRT, prior to surgery, after surgery and after postoperative chemotherapy). Cell-free DNA will be extracted from plasma and analysed by Guardant Reveal, a tumour tissue-agnostic assay that assesses both genomic alterations and methylation patterns to determine the presence or absence of ctDNA. We will compare the prognosis and treatment response of patients according to their ctDNA status after surgery and at other time points. ETHICS AND DISSEMINATION The study protocol received approval from the Institutional Review Board of National Cancer Center Hospital East on behalf of the participating institutions in February 2023. The study is conducted in accordance with the precepts established in the Declaration of Helsinki and Ethical Guidelines for Medical and Biological Research Involving Human Subjects. Written informed consent will be obtained from all eligible patients prior to registration.
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Affiliation(s)
- Tadayoshi Hashimoto
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
- Translational Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keisuke Kanato
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Atsuo Takashima
- Department of Gastrointestinal Medical Oncology, National Cancer Center Japan, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
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17
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Hashimoto T, Otsu S, Hironaka S, Takashima A, Mizusawa J, Kataoka T, Fukuda H, Tsukamoto S, Hamaguchi T, Kanemitsu Y. Phase II biomarker identification study of anti-VEGF agents with FOLFIRI for pretreated metastatic colorectal cancer. Future Oncol 2023; 19:1593-1600. [PMID: 37584156 DOI: 10.2217/fon-2023-0097] [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] [Indexed: 08/17/2023] Open
Abstract
Chemotherapy plus antiangiogenic agents, including bevacizumab, ramucirumab and aflibercept, is a standard second-line treatment for patients with metastatic colorectal cancer, but which specific agents should be selected is ambiguous due to a lack of clear evidence from prospective studies. Previous reports have suggested ramucirumab and aflibercept could be more effective than bevacizumab in patients with high VEGF-D and high VEGF-A, respectively. JCOG2004 is a three-arm, randomized, phase II study to identify predictive biomarkers for these agents in patients who have failed first-line treatment. The study will enroll 345 patients from 52 institutions for 2 years, with progression-free survival in high VEGF-D (bevacizumab vs ramucirumab) and high VEGF-A (bevacizumab vs aflibercept) serving as the primary end point. Clinical Trial Registration: jRCTs031220058 (www.jrct.niph.go.jp).
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Affiliation(s)
- Tadayoshi Hashimoto
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Otsu
- Department of Medical Oncology & Hematology, Oita University Faculty of Medicine, Yufu, Japan
| | - Shuichi Hironaka
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Atsuo Takashima
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Kataoka
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Hamaguchi
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
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18
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Ito Y, Hamaguchi T, Takashima A, Mizusawa J, Shimada Y, Shiozawa M, Mizoguchi N, Kodaira T, Komori K, Ohue M, Konishi K, Teraishi F, Kinouchi M, Murata K, Fujita F, Watanabe M, Iinuma G, Ishida F, Saida Y, Matsuda T, Katayama H, Fukuda H, Kanemitsu Y. Definitive S-1/mitomycin-C chemoradiotherapy for stage II/III anal canal squamous cell carcinoma: a phase I/II dose-finding and single-arm confirmatory study (JCOG0903). Int J Clin Oncol 2023:10.1007/s10147-023-02361-7. [PMID: 37286878 DOI: 10.1007/s10147-023-02361-7] [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: 10/01/2022] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Definitive chemoradiotherapy (CRT) with 5-fluorouracil plus mitomycin-C is a standard treatment for stage II/III squamous cell carcinoma of the anal canal (SCCA). We performed this dose-finding and single-arm confirmatory trial of CRT with S-1 plus mitomycin-C to determine the recommended dose (RD) of S-1 and evaluate its efficacy and safety for locally advanced SCCA. METHODS Patients with clinical stage II/III SCCA (UICC 6th) received CRT comprising mitomycin-C (10 mg/m2 on days 1 and 29) and S-1 (60 mg/m2/day at level 0 and 80 mg/m2/day at level 1 on days 1-14 and 29-42) with concurrent radiotherapy (59.4 Gy). Dose-finding used a 3 + 3 cohort design. The primary endpoint of the confirmatory trial was 3-year event-free survival. The sample size was 65, with one-sided alpha of 5%, power of 80%, and expected and threshold values of 75% and 60%, respectively. RESULTS Sixty-nine patients (dose-finding, n = 10; confirmatory, n = 59) were enrolled. The RD of S-1 was determined as 80 mg/m2/day. Three-year event-free survival in 63 eligible patients who received the RD was 65.0% (90% confidence interval 54.1-73.9). Three-year overall, progression-free, and colostomy-free survival rates were 87.3%, 85.7%, and 76.2%, respectively; the complete response rate was 81% on central review. Common grade 3/4 acute toxicities were leukopenia (63.1%), neutropenia (40.0%), diarrhea (20.0%), radiation dermatitis (15.4%), and febrile neutropenia (3.1%). No treatment-related deaths occurred. CONCLUSIONS Although the primary endpoint was not met, S-1/mitomycin-C chemoradiotherapy had an acceptable toxicity profile and favorable 3-year survival and could be a treatment option for locally advanced SCCA. CLINICAL TRIAL INFORMATION jRCTs031180002.
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Affiliation(s)
- Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8666, Japan.
| | - Tetsuya Hamaguchi
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Atsuo Takashima
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center, National Cancer Center Hospital, Tokyo, Japan.
| | - Yasuhiro Shimada
- Division of Clinical Oncology, Kochi Health Sciences Center, Kochi, Japan
| | - Manabu Shiozawa
- Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Nobutaka Mizoguchi
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Fuminori Teraishi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | | | - Kohei Murata
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Gen Iinuma
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yoshihisa Saida
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
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19
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Endo M, Kataoka T, Fujiwara T, Tsukushi S, Takahashi M, Kobayashi E, Yamada Y, Tanaka T, Nezu Y, Hiraga H, Wasa J, Nagano A, Nakano K, Nakayama R, Hamada T, Kawano M, Torigoe T, Sakamoto A, Asanuma K, Morii T, Machida R, Sekino Y, Fukuda H, Oda Y, Ozaki T, Tanaka K. Protocol for the 2ND-STEP study, Japan Clinical Oncology Group study JCOG1802: a randomized phase II trial of second-line treatment for advanced soft tissue sarcoma comparing trabectedin, eribulin and pazopanib. BMC Cancer 2023; 23:219. [PMID: 36890471 PMCID: PMC9996999 DOI: 10.1186/s12885-023-10693-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a rare type of malignancy comprising a variety of histological diagnoses. Chemotherapy constitutes the standard treatment for advanced STS. Doxorubicin-based regimens, which include the administration of doxorubicin alone or in combination with ifosfamide or dacarbazine, are widely accepted as first-line chemotherapy for advanced STS. Trabectedin, eribulin, pazopanib, and gemcitabine plus docetaxel (GD), which is the empirical standard therapy in Japan, are major candidates for second-line chemotherapy for advanced STS, although clear evidence of the superiority of any one regimen is lacking. The Bone and Soft Tissue Tumor Study Group of the Japan Clinical Oncology Group (JCOG) conducts this trial to select the most promising regimen among trabectedin, eribulin, and pazopanib for comparison with GD as the test arm regimen in a future phase III trial of second-line treatment for patients with advanced STS. METHODS The JCOG1802 study is a multicenter, selection design, randomized phase II trial comparing trabectedin (1.2 mg/m2 intravenously, every 3 weeks), eribulin (1.4 mg/m2 intravenously, days 1 and 8, every 3 weeks), and pazopanib (800 mg orally, every day) in patients with unresectable or metastatic STS refractory to doxorubicin-based first-line chemotherapy. The principal eligibility criteria are patients aged 16 years or above; unresectable and/or metastatic STS; exacerbation within 6 months prior to registration; histopathological diagnosis of STS other than Ewing sarcoma, embryonal/alveolar rhabdomyosarcoma, well-differentiated liposarcoma and myxoid liposarcoma; prior doxorubicin-based chemotherapy for STS, and Eastern Cooperative Oncology Group performance status 0 to 2. The primary endpoint is progression-free survival, and the secondary endpoints include overall survival, disease-control rate, response rate, and adverse events. The total planned sample size to correctly select the most promising regimen with a probability of > 80% is 120. Thirty-seven institutions in Japan will participate at the start of this trial. DISCUSSION This is the first randomized trial to evaluate trabectedin, eribulin, and pazopanib as second-line therapies for advanced STS. We endeavor to perform a subsequent phase III trial comparing the best regimen selected by this study (JCOG1802) with GD. TRIAL REGISTRATION This study was registered with the Japan Registry of Clinical Trials ( jRCTs031190152 ) on December 5, 2019.
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Affiliation(s)
- Makoto Endo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoko Kataoka
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Toshifumi Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Tsukushi
- Department of Orthopaedic Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Masanobu Takahashi
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eisuke Kobayashi
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoko Yamada
- Department of Breast and Medical Oncology, Saitama Cancer Center, Saitama, Japan
| | - Takaaki Tanaka
- Department of Orthopaedic Surgery, Fukui University School of Medicine, Fukui, Japan
| | - Yutaka Nezu
- Department of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroaki Hiraga
- Department of Musculoskeletal Oncology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Junji Wasa
- Division of Orthopaedic Oncology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Akihito Nagano
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Kenji Nakano
- Department of Medical Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Hamada
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Yufu City Oita, Hasama, 879-5593, Japan
| | - Tomoaki Torigoe
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Akio Sakamoto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takeshi Morii
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, Mitaka, Japan
| | - Ryunosuke Machida
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yuta Sekino
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Yufu City Oita, Hasama, 879-5593, Japan. .,Department of Advanced Medical Sciences, Oita University, 1-1 Idaigaoka, Yufu City Oita, Hasama, 879-5593, Japan.
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20
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Ishiki H, Kikawa Y, Terada M, Mizusawa J, Honda M, Iwatani T, Mizutani T, Mori K, Nakamura N, Miyaji T, Yamaguchi T, Ando M, Nakamura K, Fukuda H, Kiyota N. Patient-reported outcome and quality of life research policy: Japan Clinical Oncology Group (JCOG) policy. Jpn J Clin Oncol 2023; 53:195-202. [PMID: 36702740 PMCID: PMC9991489 DOI: 10.1093/jjco/hyad007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023] Open
Abstract
Assessments of patient-reported outcomes and health-related quality of life in cancer clinical trials have been increasingly emphasized recently because patient and public involvement in cancer treatment development has been promoted by regulatory authorities and academic societies. To assess patient experiences during and after cancer treatment, there is interest in implementing patient-reported outcome and health-related quality of life assessments into cancer clinical trials. The Japan Clinical Oncology Group quality of life ad hoc committee previously created a version of the Quality of Life Assessment Policy in 2006. Recently, there has been increasing demand from Japan Clinical Oncology Group researchers to assess patient-reported outcome/health-related quality of life in clinical trials. Although guidelines are available regarding planning and reporting clinical trials that include patient-reported outcome/health-related quality of life as an endpoint, there are still issues regarding the lack of consensus on standardized methods for analysing and interpreting the results. Hence, it was considered necessary to reorganize the Japan Clinical Oncology Group patient-reported outcome/quality of life research committee and to revise the former patient-reported outcome/quality of life research policy to promote patient-reported outcome/health-related quality of life research in future Japan Clinical Oncology Group trials. The purpose of this Japan Clinical Oncology Group patient-reported outcome/quality of life research policy is to define patient-reported outcome/health-related quality of life research and provide guidelines for including patient-reported outcome/health-related quality of life as an endpoint in Japan Clinical Oncology Group trials.
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Affiliation(s)
- Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Kikawa
- Department of Breast Surgery, Kansai Medical University, Osaka, Japan
| | - Mitsumi Terada
- Department of International Clinical Development, National Cancer Center Hospital, Tokyo, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group (JCOG) Data Center, National Cancer Center Hospital, Tokyo, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Tsuguo Iwatani
- Departments of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Tomonori Mizutani
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Keita Mori
- Department of Biostatistics, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naoki Nakamura
- Department of Radiation Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tempei Miyaji
- Division of Supportive Care, Survivorship and Translational Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, University Hospital, Nagoya, Japan
| | - Kenichi Nakamura
- JCOG Data Center/Operations Office, National Cancer Center, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group (JCOG) Data Center, National Cancer Center Hospital, Tokyo, Japan
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Cancer Center, Kobe University Hospital, Kobe, Japan
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21
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Aokage K, Suzuki K, Saji H, Wakabayashi M, Kataoka T, Sekino Y, Fukuda H, Endo M, Hattori A, Mimae T, Miyoshi T, Isaka M, Yoshioka H, Nakajima R, Nakagawa K, Okami J, Ito H, Kuroda H, Tsuboi M, Okumura N, Takahama M, Ohde Y, Aoki T, Tsutani Y, Okada M, Watanabe SI. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): a multicentre, single-arm, confirmatory, phase 3 trial. Lancet Respir Med 2023:S2213-2600(23)00041-3. [PMID: 36893780 DOI: 10.1016/s2213-2600(23)00041-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Although segmentectomy is a widely used surgical procedure, lobectomy is the standard procedure for resectable non-small-cell lung cancer (NSCLC). This study aimed to evaluate the efficacy and safety of segmentectomy for NSCLC up to 3 cm in size, including ground-glass opacity (GGO) and predominant GGO. METHODS A multicentre, single-arm, confirmatory phase 3 trial was conducted across 42 institutions (hospitals, university hospitals, and cancer centres) in Japan. Segmentectomy with hilar, interlobar, and intrapulmonary lymph node dissection was performed as protocol surgery for patients with a tumour diameter of up to 3 cm, including GGO and dominant GGO. Eligible patients were those aged 20-79 years with an Eastern Cooperative Oncology Group performance score of 0 or 1 and clinical stage IA tumour confirmed by thin-sliced CT. The primary endpoint was 5-year relapse-free survival (RFS). This study is registered with the University Hospital Medical Information Network Clinical Trials (UMIN000011819), and is ongoing. FINDINGS A total of 396 patients were registered from Sept 20, 2013, to Nov 13, 2015, of whom 357 underwent segmentectomy. At a median follow-up of 5·4 years (IQR 5·0-6·0), the 5-year RFS was 98·0% (95% CI 95·9-99·1). This finding exceeded the 87% of the pre-set threshold 5-year RFS and the primary endpoint was met. Grade 3 or 4 early postoperative complications occurred in seven patients (2%), but no grade 5 treatment-related deaths occurred. INTERPRETATION Segmentectomy should be considered as part of standard treatment for patients with predominantly GGO NSCLC with a tumour size of 3 cm or less in diameter, including GGO even if it exceeds 2 cm. FUNDING National Cancer Centre Research and Development Fund and Japan Agency for Medical Research and Development.
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Affiliation(s)
- Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hisashi Saji
- Division of Thoracic Surgery, St Marianna University School of Medicine, Kawasaki, Japan
| | - Masashi Wakabayashi
- JCOG Data Center and Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Kataoka
- JCOG Data Center and Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yuta Sekino
- JCOG Data Center and Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- JCOG Data Center and Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Endo
- Division of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takahiro Mimae
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tomohiro Miyoshi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Mitsuhiro Isaka
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Ryu Nakajima
- Division of Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Kazuo Nakagawa
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Jiro Okami
- Division of Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyuki Ito
- Division of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroaki Kuroda
- Division of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Norihito Okumura
- Division of Thoracic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Makoto Takahama
- Division of Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tadashi Aoki
- Division of Thoracic Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yasuhiro Tsutani
- Division of Thoracic Surgery, Kindai University Hospital, Osaka, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Shun-Ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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22
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Ozaka M, Nakachi K, Kobayashi S, Ohba A, Imaoka H, Terashima T, Ishii H, Mizusawa J, Katayama H, Kataoka T, Okusaka T, Ikeda M, Sasahira N, Miwa H, Mizukoshi E, Okano N, Mizuno N, Yamamoto T, Komatsu Y, Todaka A, Kamata K, Furukawa M, Fujimori N, Katanuma A, Takayama Y, Tsumura H, Fukuda H, Ueno M, Furuse J. A randomised phase II study of modified FOLFIRINOX versus gemcitabine plus nab-paclitaxel for locally advanced pancreatic cancer (JCOG1407). Eur J Cancer 2023; 181:135-144. [PMID: 36652891 DOI: 10.1016/j.ejca.2022.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 10/24/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
AIM We compared the efficacy of modified 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (mFOLFIRINOX) with that of gemcitabine plus nab-paclitaxel (GnP) for locally advanced pancreatic cancer (LAPC). METHODS Patients with untreated LAPC were randomly assigned (1:1) to receive mFOLFIRINOX or GnP. One-year overall survival (OS) was the primary endpoint. The major secondary end-points included progression-free survival (PFS), response rate (RR), carbohydrate antigen 19-9 (CA19-9) response, and adverse events. The sample size was 124 patients to select a more effective regimen with a minimum probability of 0.85 and to examine the null hypothesis of the 1-year OS <53%. RESULTS Of the 126 patients enrolled from 29 institutions, 125 were deemed eligible. The 1-year OS was 77.4% (95% CI, 64.9-86.0) and 82.5% (95% CI, 70.7-89.9) in the mFOLFIRINOX and GnP arms, respectively. The median PFS was 11.2 (95% CI, 9.9-15.9) and 9.4 months (95% CI, 7.4-12.8) in the mFOLFIRINOX and GnP arms, respectively. The RR and CA19-9 response rate were 30.9% (95% CI, 19.1-44.8) and 57.1% (95% CI, 41.0-72.3) and 42.1% (95% CI 29.1-55.9) and 85.0% (95% CI, 70.2-94.3) in the mFOLFIRINOX and GnP arms, respectively. Grade 3-4 diarrhoea and anorexia were predominant in the mFOLFIRINOX arm. CONCLUSION GnP was considered the candidate for a subsequent phase III trial because of its better RR, CA19-9 response, and mild gastrointestinal toxicities. Both regimens displayed higher efficacy in the 1-year survival than in the historical data of gemcitabine monotherapy.
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Affiliation(s)
- Masato Ozaka
- Department of Hepato-Biliary-Pancreatic Medicine, Gastroenterology Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Kohei Nakachi
- Department of Medical Oncology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Satoshi Kobayashi
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - Akihiro Ohba
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Imaoka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeshi Terashima
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Hiroshi Ishii
- Clinical Research Center, Chiba Cancer Center, Chiba, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Kataoka
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naoki Sasahira
- Department of Hepato-Biliary-Pancreatic Medicine, Gastroenterology Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Haruo Miwa
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama, Japan
| | - Eishiro Mizukoshi
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Naohiro Okano
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tomohisa Yamamoto
- Department of Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - Yoshito Komatsu
- Department of Gastroenterology, Hokkaido University Hospital, Sapporo, Japan
| | - Akiko Todaka
- Divison of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masayuki Furukawa
- Department of Hepato-Biliary-Pancreatology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Nao Fujimori
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Yukiko Takayama
- Department of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidetaka Tsumura
- Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Ueno
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - Junji Furuse
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan; Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
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23
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Nunobe S, Yoshikawa T, Nishida Y, Yamada T, Kaji M, Takagane A, Teshima S, Matsushita H, Tanaka R, Hihara J, Katayama H, Mizusawa J, Fukuda H, Boku N, Terashima M. Five-year follow-up results of a randomized phase III trial comparing 4 and 8 courses of S-1 adjuvant chemotherapy for pathological stage II gastric cancer: JCOG1104 (OPAS-1). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.381] [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: 01/25/2023] Open
Abstract
381 Background: Postoperative S-1 (80 mg/m2/day for 4 weeks and 2 weeks rest in one course) for 1 year corresponding to 8 courses is a standard adjuvant chemotherapy for pathological stage (pStage) II gastric cancer. To shorten the duration of S-1 chemotherapy, we conducted a phase III trial to confirm non-inferiority in relapse-free survival (RFS) of 4 courses of S-1 to 8 courses of S-1 for pStage II gastric cancer. When 590 patients were enrolled, the study was closed at the first interim analysis because of futility. The RFS at 3 years was 89.8% for 4-courses and 93.1% for 8-courses (HR 1.84, 95% confidence interval (CI) 0.93-3.63). This is a final 5-year follow-up results of this study. Methods: Key eligibility criteria were pStage II except for T1 and T3N0 (7th edition of TNM), ECOG performance status 0-1, R0 resection with D2 lymph node dissection for >clinical stage (cStage) II or D1+ lymph node dissection for cStage I, within 7 weeks after surgery, and age between 20 and 80 years. The total sample size was determined to be 1,000 with a 3-year RFS of 85% in both arms and non-inferiority margin of hazard ratio (HR) of 1.37, with one-sided alpha of 5% and 80% power. Results: Between Feb 2012 and Mar 2017, 590 patients, 295 for each arm, were enrolled. When closing the study, the patients who were allocated to the 4-courses arm were informed of the primary results and the recommendation to continue S-1 until 8 courses as an off-protocol when they were receiving S-1. The cut-off date for the final follow-up data was March 22, 2022 with a median follow-up period for surviving patients of 6.0 years (IQR; 5.0-7.2). In 4-courses arm, 27 patients were receiving S-1 when the study was closed at the interim analysis. Among them, 22 patients expressed their will to continue until 8 courses. The RFS at 3/5 years was 90.1%/85.6% for 4-courses and 92.2%/87.7% for 8-courses (HR 1.27, 95% CI 0.85-1.89). The overall survival at 3/5 years was 93.2%/88.6 for 4-courses and 94.9%/89.7 for the 8-courses (HR 1.12, 95% CI 0.72-1.75). The HR of the cumulative incidence of the recurrence was 1.38 (95% CI 0.85-2.24) for the 4-courses against 8-courses. Recurrence was frequently observed in patients who received up to 4 courses of S-1 (38 for 4-courses vs. 28 for 8 courses). The HR of the cumulative incidence of the peritoneal recurrence was 1.54 (95% CI 0.82-2.89) for the 4-courses against 8-courses. Conclusions: This final follow-up data confirmed the primary results presented at the interim analysis. S-1 adjuvant chemotherapy for 1 year for pStage II gastric cancer is highly recommended. Clinical trial information: 000007306 .
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Affiliation(s)
- Souya Nunobe
- Cancer Institute Hospital, Department of Gastroenterological Surgery, Tokyo, Japan
| | - Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Masahide Kaji
- Department of Surgery, Toyama prefectural central hospital, Toyama, Japan
| | | | - Shin Teshima
- Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai-Shi, Japan
| | - Hisayuki Matsushita
- Department of Esophageal and Gastric Surgery, Tochigi Cancer Center, Utsunomiya, Japan
| | - Ryo Tanaka
- Osaka Medical and Pharmaceutical University, Department of General and Gastroenterological Surgery, Osaka, Japan
| | - Jun Hihara
- Department of Gastroenterological Surgery, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima-Shi Minami-Ku, Japan
| | - Hiroshi Katayama
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Chuo-Ku, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Chuo-Ku, Japan
| | | | - Narikazu Boku
- IMSTU Hospital, Institute of Medical Science, University of Tokyo, Department of Medical Oncology, Tokyo, Japan
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24
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Nihei K, Minashi K, Yano T, Shimoda T, Fukuda H, Muto M, Mizuaswa J, Takizawa K, Aoyama I, Ishiyama A, Kawata N, Kikuchi D, Hanaoka N, Oda I, Morita Y, Tajika M, Fujiwara J, Yamamoto Y, Katada C, Hori S, Doyama H, Oyama T, Nebiki H, Amagai K, Kubota Y, Inokuchi Y, Kobayashi N, Suzuki T, Hirasawa K, Takeuchi T, Kadota T. Final Analysis of Diagnostic Endoscopic Resection Followed by Selective Chemoradiotherapy for Stage I Esophageal Cancer: JCOG0508. Gastroenterology 2023; 164:296-299.e2. [PMID: 36240951 DOI: 10.1053/j.gastro.2022.10.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Keiji Nihei
- Department of Radiation Oncology, Osaka Medical and Pharmaceutical University, Osaka, Japan.
| | - Keiko Minashi
- Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tadakazu Shimoda
- Department of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Junki Mizuaswa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kohei Takizawa
- Department of Endoscopy, Koyukai Shin-Sapporo Hospital, Hokkaido, Japan
| | - Ikuo Aoyama
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto
| | - Akiyoshi Ishiyama
- Department of Upper GI Medicine, Cancer Institute Hospital of JFCR, Tokyo
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka
| | | | - Noboru Hanaoka
- Department of Gastroenterology, Osaka Red Cross Hospital, Osaka
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo
| | - Yoshinori Morita
- Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Hyogo
| | | | - Junko Fujiwara
- Department of Endoscopy, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo
| | | | - Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa
| | - Shinichiro Hori
- Department of Gastroenterology, NHO Shikoku Cancer Center, Matsuyama
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa
| | - Tsuneo Oyama
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano
| | - Hiroko Nebiki
- Department of Gastroenterology, Osaka City General Hospital, Osaka
| | - Kenji Amagai
- Department of Gastroenterology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Ibaraki
| | - Yutaro Kubota
- Department of Gastroenterology, Showa University Hospital, Tokyo
| | | | | | | | - Kingo Hirasawa
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama
| | - Toshihisa Takeuchi
- Department of Gastroenterology, Osaka Medical and Pharmaceutical University, Osaka
| | - Tomohiro Kadota
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
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Tsukamoto S, Murofushi K, Ito Y, Hirano H, Tsukada Y, Sasaki K, Katayama H, Mizusawa J, Fukuda H, Kanemitsu Y. Single-arm confirmatory trial of total neoadjuvant therapy and watch-and-wait strategy for patients with low rectal cancer: Japan Clinical Oncology Group study (JCOG2010, TOWARd study). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.tps269] [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: 01/25/2023] Open
Abstract
TPS269 Background: Radical surgery is the standard treatment for advanced lower rectal cancer, but postoperative complications and sequelae are major problems. Recently, some patients treated with preoperative chemoradiotherapy (CRT) have been reported to achieve a clinical complete response (cCR) and be cured with a subsequent watch-and-wait strategy (W&W) without surgery. Moreover, the introduction of total neoadjuvant therapy (TNT) consisting of CRT and systemic chemotherapy has increased proportion of cCR. However, most previous studies on W&W have reported cases in which cCR was achieved incidentally as a result of preoperative CRT or TNT for advanced lower rectal cancer. It is unclear whether combining TNT that is highly effective in early stage rectal cancer and subsequent W&W without surgery is an effective intention-to-cure treatment for advanced lower rectal cancer when cCR is obtained after TNT. The purpose of this single-arm confirmatory trial is to evaluate the efficacy and safety of TNT and intended W&W for cT2-T3 advanced lower rectal cancer with a tumor diameter of 5 cm or less. Methods: Key eligibility criteria include low rectal adenocarcinoma with tumor diameter 5 cm or less, cT2 or cT3 tumor depth, no lymph node metastasis, no distant metastasis, no history of pelvic irradiation or rectal surgery, age 18-75 years, and sufficient organ function. Eligible patients are receiving TNT. CRT consists of the standard dose of capecitabine (1650 mg/m2/day) and radiotherapy (45 Gy/25 fractions to whole pelvis plus boost of 5.4 Gy/3 fractions to primary tumor). Consolidation chemotherapy consists of 4 courses of CAPOX (oxaliplatin 130 mg/m2 on day1 and capecitabine 2000 mg/m2/day on day1-14). After completing TNT, patients will be re-staged according to Memorial Sloan Kettering Cancer Center Criteria. Patients with cCR at the primary site will move to W&W, patients with a near complete response will move to either W&W or undergo local resection, and patients with an incomplete response will undergo total mesorectal excision. All patients will be followed every 3 months for 2 years after re-staging, and every 6 months for 3 years after that. The primary endpoint in phase II is the proportion of cCR at re-staging by central review and in phase III is 5-year overall survival (OS). In the phase II part, 40 patients were required with a one-sided alpha of 5%, power of 80%, a threshold value of 20%, and an expected value of 40%. Based on the results of previous studies, we set the threshold 5-year OS at 87% in the phase III part. The sample size was calculated as 105 including the phase II part with a one-sided alpha of 5%, power of 80%, and the expected 5-year OS of 95%. The first patient was enrolled in September 2022. Clinical trial information: jRCTs031220288 .
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Affiliation(s)
- Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Keiko Murofushi
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yoshinori Ito
- Showa University School of Medicine, Shinagawa-Ku, Japan
| | - Hidekazu Hirano
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keita Sasaki
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Katayama
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Junki Mizusawa
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
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26
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Kinoshita T, Yoshikawa T, Ojima T, Omori T, Cho H, Honda M, Nunobe S, Kurokawa Y, Kuroda S, Mizusawa J, Fukuda H, Boku N, Terashima M. Single-arm phase II trial to evaluate the safety of laparoscopic/robotic total gastrectomy with spleen-preserving splenic hilar dissection for locally advanced proximal gastric cancer that invades the greater curvature: JCOG1809. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.tps479] [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: 01/25/2023] Open
Abstract
TPS479 Background: The standard treatment for locally advanced proximal gastric cancer invading the greater curvature is “open total gastrectomy combined with splenectomy” (OTG+S) aiming for whole clearance of the splenic hilar lymph nodes. However, its pertinent postoperative severe complication (e.g. pancreatic fistula) is problematic. An objective of this study is to evaluate the safety of “laparoscopic or robotic total gastrectomy with spleen-preserving splenic hilar dissection” (LRSHD) as a new treatment option which has a potential to reduce surgical morbidity, subsequently to replace the current standard treatment, OTG+S. Methods: This is a multicenter single-arm phase II trial. The main eligibility criteria are as follows; clinical T2-4a resectable locally advanced proximal gastric adenocarcinoma that invades the greater curvature; without obvious lymph node metastasis at the splenic hilum nor direct invasion to the spleen/splenogastric ligament. Protocol treatment is laparoscopic or robotic total gastrectomy with splenic hilar lymph node dissection (D2 + No.10 lymphadenectomy according to the Japanese guidelines) in which the spleen is preserved with skeletonizing the splenic vessels. Quality control of surgery is assured by surgeon’s qualification and central peer review of intraoperative photo at the splenic hilum after dissection. The primary endpoint is the proportion of postoperative pancreatic fistula and/or intra-abdominal abscess formation with Clavien-Dindo Grade III or higher (within 30 days after surgery). Secondary endpoints are intraoperative blood loss, operation time, mortality, overall postoperative complication, number of yield splenic hilar nodes, number of metastatic splenic hilar nodes, conversion to splenectomy, conversion to laparotomy, relapse-free survival, and overall survival. Sample size was set as 85 patients to obtain 80% power considering that 15% of patients are judged as unresectable intraoperatively, with the hypothesis that the primary endpoint would have an expected value of 7% and a threshold value of 16% in one-sided alpha of 0.1. Planned accrual period is 5 years. The accrual began in August 2019. As of August 2022, 53 of the planned 85 patients (62.4%) have been enrolled. When the safety of LRSHD is proved by this study, a non-inferiority phase III trial will be consequently launched. Clinical trial registry number: UMIN000037580. Clinical trial information: UMIN000037580 .
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Affiliation(s)
- Takahiro Kinoshita
- Department of Gastric Surgery, National Cancer Center Hospital Japan East, Kashiwa, Japan
| | - Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Toshiyasu Ojima
- Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Takeshi Omori
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Haruhiko Cho
- Tokyo Metropolitan Komagome Hospital, Department of Surgery, Tokyo, Japan
| | | | - Souya Nunobe
- Cancer Institute Hospital, Department of Gastroenterological Surgery, Tokyo, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
| | | | - Junki Mizusawa
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Narikazu Boku
- IMSTU Hospital, Institute of Medical Science, University of Tokyo, Department of Medical Oncology, Tokyo, Japan
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Mishima K, Nishikawa R, Narita Y, Mizusawa J, Sumi M, Koga T, Sasaki N, Kinoshita M, Nagane M, Arakawa Y, Yoshimoto K, Shibahara I, Shinojima N, Asano K, Tsurubuchi T, Sasaki H, Asai A, Sasayama T, Momii Y, Sasaki A, Nakamura S, Kojima M, Tamaru J, Tsuchiya K, Gomyo M, Abe K, Natsumeda M, Yamasaki F, Katayama H, Fukuda H. Randomized phase III study of high-dose methotrexate and whole-brain radiotherapy with/without temozolomide for newly diagnosed primary CNS lymphoma: JCOG1114C. Neuro Oncol 2022; 25:687-698. [PMID: 36334050 PMCID: PMC10076938 DOI: 10.1093/neuonc/noac246] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The goal was to determine whether the addition of temozolomide (TMZ) to the standard treatment of high-dose methotrexate (HD-MTX) and whole-brain radiotherapy (WBRT) for primary central nervous system lymphoma (PCNSL) improves survival. METHODS An open-label, randomized, phase III trial was conducted in Japan, enrolling immunocompetent patients aged 20-70 years with histologically confirmed, newly diagnosed PCNSL. After administration of HD-MTX, patients were randomly assigned to receive WBRT (30 Gy) ± 10 Gy boost (arm A) or WBRT ± boost with concomitant and maintenance TMZ for two years (arm B). The primary endpoint was overall survival (OS). RESULTS Between September 29, 2014 and October 15, 2018, 134 patients were enrolled, of whom 122 were randomly assigned and analyzed. At the planned interim analysis, two-year OS was 86.8% (95% confidence interval [CI]: 72.5-94.0%) in arm A and 71.4% (56.0-82.2%) in arm B. The hazard ratio was 2.18 (95% CI: 0.95 to 4.98), with the predicted probability of showing the superiority of arm B at the final analysis estimated to be 1.3%. The study was terminated early due to futility. O 6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status was measured in 115 tumors, and it was neither prognostic nor predictive of TMZ response. CONCLUSIONS This study failed to demonstrate the benefit of concomitant and maintenance TMZ in newly diagnosed PCNSL.
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Affiliation(s)
- Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital
| | - Minako Sumi
- Radiation Oncology Department, Cancer Institute Hospital
| | - Tomoyuki Koga
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center.,Department of Neurosurgery, Faculty of Medicine, The University of Tokyo
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Manabu Kinoshita
- Department of Neurosurgery, Osaka International Cancer Institute
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Koji Yoshimoto
- Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Graduate School of Medicine
| | - Kenichiro Asano
- Department of Neurosurgery, Hirosaki University Graduate School of Medicine
| | - Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine
| | - Akio Asai
- Department of Neurosurgery, Kansai Medical University
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine
| | - Yasutomo Momii
- Department of Neurosurgery, Oita University Faculty of Medicine
| | | | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Masaru Kojima
- Department of Anatomical and Surgical Pathology, Dokkyo University School of Medicine
| | - Junichi Tamaru
- Department of Pathology, Saitama Medical Center, Saitama Medical University
| | - Kazuhiro Tsuchiya
- Department of Radiology, Saitama Medical Center, Saitama Medical University
| | - Miho Gomyo
- Department of Radiology, Kyorin University Faculty of Medicine
| | - Kayoko Abe
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, University of Niigata
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital
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28
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Mizusawa J, Tokunaga M, Machida N, Yabusaki H, Kawabata R, Imamura H, Kinoshita T, Nomura T, Nunobe S, Tsuji K, Katayama H, Fukuda H, Boku N, Yoshikawa T, Terashima M. Protocol digest of a phase III trial to evaluate the efficacy of preoperative chemotherapy with S-1 plus oxaliplatin followed by D2 gastrectomy with postoperative S-1 in locally advanced gastric cancer: Japan Clinical Oncology Group study JCOG1509 (NAGISA Trial). Jpn J Clin Oncol 2022. [DOI: 10.1093/jjco/hyac154] [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: 11/12/2022] Open
Abstract
Abstract
In Japan, postoperative chemotherapy is a standard care for stage II/III gastric cancer after curative resection with D2 lymph node dissection, and the clinical outcomes of patients with stage III gastric cancer are unsatisfactory. A combination of oral S-1 and oxaliplatin, that is the standard chemotherapy regimen for unresectable advanced/recurrent gastric cancer associated with a high response rate, was considered the most promising preoperative chemotherapy regimen. This randomized phase III trial was started in September 2016 to confirm the superiority of preoperative chemotherapy with S-1 plus oxaliplatin followed by D2 gastrectomy with postoperative chemotherapy compared with D2 gastrectomy with postoperative chemotherapy for patients with clinical T3–4N1–3 M0 locally advanced gastric cancer in terms of overall survival. A total of 470 patients will be enrolled from 63 hospitals in Japan for 8.5 years. This trial has been registered in the Japan Registry of Clinical Trials as jRCTs031180350 [https://jrct.niph.go.jp/latest-detail/jRCTs031180350].
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Affiliation(s)
- Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital , Tokyo , Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University , Tokyo , Japan
| | - Nozomu Machida
- Department of Gastroenterology, Kanagawa Cancer Center , Kanagawa , Japan
| | - Hiroshi Yabusaki
- Department of Gastroenterological Surgery, Niigata Cancer Center Hospital , Niigata , Japan
| | | | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital , Osaka , Japan
| | - Takahiro Kinoshita
- Department of Gastric Surgery, National Cancer Center Hospital East , Kashiwa , Japan
| | - Takashi Nomura
- Department of Surgery, Yamagata Prefectural Central Hospital , Yamagata , Japan
| | - Souya Nunobe
- Departement of Gastric Surgery, Cancer Institute Hospital , Tokyo , Japan
| | - Kunihiro Tsuji
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital , Tokyo , Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital , Tokyo , Japan
| | - Narikazu Boku
- Department of Oncology and General Medicine, IMSUT Hospital, Institute of Medical Science, University of Tokyo , Tokyo , Japan
| | - Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital , Tokyo , Japan
| | - Masanori Terashima
- Department of Gastric Surgery, Shizuoka Cancer Center , Shizuoka , Japan
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29
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Mizusawa J, Ohba A, Ozaka M, Katayama H, Okusaka T, Kobayashi S, Ikeda M, Terashima T, Sasahira N, Okano N, Miki I, Kaneko T, Mizuno N, Todaka A, Furukawa M, Kajiura S, Kataoka T, Fukuda H, Furuse J, Ueno M. Protocol of a randomized phase II/III study of gemcitabine plus nab-paclitaxel combination therapy versus modified FOLFIRINOX versus S-IROX for metastatic or recurrent pancreatic cancer: JCOG1611 (GENERATE). Jpn J Clin Oncol 2022. [DOI: 10.1093/jjco/hyac146] [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: 11/14/2022] Open
Abstract
Abstract
Gemcitabine plus nab-paclitaxel and combination chemotherapy with fluorouracil, leucovorin, irinotecan and oxaliplatin are a standard treatment for metastatic or recurrent pancreatic cancer. Recent studies on metastatic pancreatic cancer have demonstrated promising results of modified fluorouracil, leucovorin, irinotecan and oxaliplatin and S-1, irinotecan and oxaliplatin. A three-arm randomized phase II/III trial has been conducted since April 2019 to confirm the superiority of modified fluorouracil, leucovorin, irinotecan and oxaliplatin and S-1, irinotecan and oxaliplatin over Gemcitabine plus nab-paclitaxel in patients with metastatic or recurrent pancreatic cancer. A total of 732 patients will be enrolled from 42 Japanese institutions within 5 years. The primary endpoint is the response rate in the S-1, irinotecan and oxaliplatin arm for phase II portion and overall survival for phase III portion. The secondary endpoints for phase III portion are progression-free survival, response rate, adverse events, serious adverse events and dose intensity. This trial is registered with the Japan Registry of Clinical Trials [https://jrct.niph.go.jp/], number jRCTs031190009.
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Affiliation(s)
- Junki Mizusawa
- JCOG Data Center/Operations Office, National Cancer Center Hospital , Tokyo , Japan
| | - Akihiro Ohba
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital , Tokyo , Japan
| | - Masato Ozaka
- Department of Gastroenterology, Cancer Institute Hospital , Tokyo , Japan
| | - Hiroshi Katayama
- JCOG Data Center/Operations Office, National Cancer Center Hospital , Tokyo , Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital , Tokyo , Japan
| | - Satoshi Kobayashi
- Department of Gastroenterology, Kanagawa Cancer Center , Yokohama , Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East , Kashiwa , Japan
| | - Takeshi Terashima
- Department of Gastroenterology, Kanazawa University Hospital , Kanazawa , Japan
| | - Naoki Sasahira
- Department of Gastroenterology, Cancer Institute Hospital , Tokyo , Japan
| | - Naohiro Okano
- Department of Medical Oncology, Kyorin University Faculty of Medicine , Tokyo , Japan
| | - Ikuya Miki
- Department of Gastroenterology, Hyogo Cancer Center , Akashi , Japan
| | - Takashi Kaneko
- Gastroenterological Center, Yokohama City University Medical Center , Yokohama , Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital , Nagoya , Japan
| | - Akiko Todaka
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center , Shizuoka , Japan
| | - Masayuki Furukawa
- Department of Hepato-Biliary-Pancreatology, National Kyushu Cancer Center , Fukuoka , Japan
| | - Shinya Kajiura
- Third Department of Internal Medicine, University of Toyama Hospital , Toyama , Japan
| | - Tomoko Kataoka
- JCOG Data Center/Operations Office, National Cancer Center Hospital , Tokyo , Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital , Tokyo , Japan
| | - Junji Furuse
- Department of Gastroenterology, Kanagawa Cancer Center , Yokohama , Japan
| | - Makoto Ueno
- Department of Gastroenterology, Kanagawa Cancer Center , Yokohama , Japan
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30
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Takii Y, Mizusawa J, Kanemitsu Y, Komori K, Shiozawa M, Ohue M, Ikeda S, Takiguchi N, Kobatake T, Ike H, Sato T, Tomita N, Ota M, Sunami E, Hamaguchi T, Shida D, Katayama H, Shimada Y, Fukuda H. 414P Long-term follow-up of the randomized trial of the conventional technique versus the no-touch isolation technique for primary tumor resection in patients with colon cancer ( JCOG1006). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.552] [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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31
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Akagi T, Inomata M, Kanzaka R, Katayama H, Fukuda H, Shiomi A, Ito M, Watanabe J, Murata K, Y. Hirano, Shimomura M, Shunsuke T, Hamaguchi T, Kanemitsu Y. 416P A randomized controlled trial to compare laparoscopic surgery with open surgery for symptomatic, non-curable stage IV colorectal cancer (CRC): First efficacy results from Japan clinical oncology group study JCOG1107. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.554] [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: 11/30/2022] Open
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32
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Hiraga H, Machida R, Kawai A, Matsumoto Y, Yonemoto T, Nishida Y, Nagano A, Ae K, Yoshida S, Asanuma K, Toguchida J, Huruta D, Nakayama R, Akisue T, Hiruma T, Morii T, Tanaka K, Kataoka T, Fukuda H, Ozaki T. 1482O A phase III study comparing methotrexate (M), adriamycin (A) and cisplatin (P) with MAP + ifosfamide (MAP + IF) for the treatment of osteosarcoma: JCOG0905. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1585] [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: 11/29/2022] Open
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33
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Yamazaki K, Satake H, Takashima A, Mizusawa J, Kataoka T, Fukuda H, Ishizuka Y, Suwa Y, Numata K, Shibata N, Asayama M, Yokota M, Tsushima T, Ohta T, Yamaguchi T, Hamaguchi T, Kanemitsu Y. 446TiP Randomized phase III study of bi-weekly trifluridine/tipiracil (FTD/TPI) plus bevacizumab (BEV) vs. FTD/TPI for chemorefractory metastatic colorectal cancer (mCRC): ROBiTS/JCOG2014. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1867] [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: 11/26/2022] Open
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34
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Takeuchi H, Ito Y, Machida R, Kato K, Onozawa M, Minashi K, Yano T, Nakamura K, Tsushima T, Hara H, Okuno T, Hironaka S, Nozaki I, Ura T, Chin K, Kojima T, Seki S, Sakanaka K, Fukuda H, Kitagawa Y. A Single-Arm Confirmatory Study of Definitive Chemoradiotherapy Including Salvage Treatment for Clinical Stage II/III Esophageal Squamous Cell Carcinoma (JCOG0909 Study). Int J Radiat Oncol Biol Phys 2022; 114:454-462. [PMID: 35932949 DOI: 10.1016/j.ijrobp.2022.07.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/09/2022] [Accepted: 07/03/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Definitive chemoradiotherapy (CRT) is the standard treatment for patients with locally advanced esophageal cancer (EC) who refuse surgery as the initial therapy. However, poor survival, a high incidence of late toxicities, and severe complications after salvage surgery remain issues to be resolved. This single- arm multicenter trial (Trial name XXXX) aimed to confirm the efficacy of CRT modifications, including salvage treatment, for reducing CRT-related toxicities and facilitating salvage treatment for improved survival. METHODS AND MATERIALS Patients with clinical stage II/III EC (UICC 6th, non-T4) were eligible. Chemotherapy comprised cisplatin (75 mg/m2 on days 1and 29) and 5- fluorouracil (1,000 mg/m2/d on days 1-4 and 29-32). Radiotherapy was administered at a total dose of 50.4 Gy. Good responders received 1-2 additional cycles of chemotherapy. For residual or recurrent disease, salvage endoscopic resection (ER) or salvage surgery was performed based on specific criteria. The primary endpoint was the 3-year overall survival (OS). The calculated sample size was 95 patients, with a one-sided alpha of 5% and a power of 80%. The expected and threshold 3-year OS were 55% and 42%, respectively. RESULTS Overall, 96 patients were enrolled, and 94 were included in the efficacy analysis. A complete response was achieved in 55 patients (59%). Salvage ER and salvage surgery were performed in 5 (5%) and 25 patients (27%), respectively. R0 resection by salvage surgery was achieved in 19 patients (76%). Five patients (20%) showed grade 3 or 4 early operative complications, and 9 patients (9.6%) showed grade 3 late toxicities during the long-term follow-up. The 3-year OS was 74.2% (90% CI, 65.9%-80.8%). CONCLUSION The combination of definitive CRT and salvage treatment has lower CRT- related toxicities and yields good OS, thus making it a promising novel treatment option for patients with locally advanced EC.
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Affiliation(s)
- Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan.
| | - Ryunosuke Machida
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan.
| | - Ken Kato
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masakatsu Onozawa
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keiko Minashi
- Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kenichi Nakamura
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Tsushima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroki Hara
- Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Tatsuya Okuno
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shuichi Hironaka
- Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan
| | - Isao Nozaki
- Department of Gastroenterological Surgery, Shikoku Cancer Center Hospital, Matsuyama, Japan
| | - Takashi Ura
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Keisho Chin
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Kojima
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shiko Seki
- Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Katsuyuki Sakanaka
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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35
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Nakamura Y, Sano Y, Kataoka T, Shibata T, Fukuda H, Matsushita S, Fujisawa Y, Takenouchi T, Omodaka T, Yamamura K, Aoki M, Uchi H, Tsutsui K, Yoshikawa S, Ogata D, Yanagisawa H, Omatsu J, Ito T, Namikawa K, Yamazaki N. Confirmatory trial of narrower side margin excision for head and neck basal cell carcinoma in the Japanese (East Asian) population: JCOG2005 (J-BASE-MARGIN). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps9604] [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
TPS9604 Background: Basal cell carcinomas (BCCs), the most common type of skin cancer, frequently occur on the head and neck. Because distant metastases are extremely rare, complete excision with clear margins is the standard treatment for BCCs. In the NCCN Guidelines, the recommended surgical treatment strategies include standard excision with wider margins ( > 4 mm) or Mohs surgery or other forms of peripheral and deep en face margin assessment (PDEMA) for head and neck BCCs. However, these strategies are based on studies in the Caucasian population, with BCCs mostly arising as non-pigmented lesions and/or with poorly defined clinical borders. Conversely, in East Asians, most BCCs tend to present as pigmented lesions with well-defined clinical tumor borders. Recent retrospective studies from East Asia have reported positive side margin proportions and local recurrence proportions in BCCs excised with narrower margins that are lower than guidelines-recommended margins. Our previous study investigating 1000 East Asian BCCs also indicated that the estimated positive side margin proportions with 2- and 3-mm surgical margin excision in East Asian BCCs were 3.8% and 1.4%, respectively. Those findings may lead to very limited need for Mohs micrographic surgery or PDEMA in East Asian head and neck BCCs; however, there have been no clinical trials regarding fixed narrower margin excision for those cohorts. Methods: This is an investigator-initiated, prospective, multicenter, non-randomized phase III confirmatory trial evaluating the efficacy and safety of narrower surgical margins for the treatment of East Asian patients with head and neck, solitary, primary BCCs with sizes ranging from 3 mm to 20 mm. Eligible patients are aged ≥20 years (≤85 years in men or ≤90 years in women). Narrower margin excisions of 2 mm and 3 mm are applied to BCCs with well-defined clinical borders (cohort A) and poorly defined borders (cohort B), respectively. The primary endpoint is the 5-year local recurrence proportion, and the secondary endpoints are positive side margin proportion and incidence of adverse events. We anticipated an expected 5-year local recurrence proportion of 0.8% in both cohorts and a threshold of 3.3% in cohort A and 4.1% in cohort B. The planned sample size is 410 patients (cohort A, 250; cohort B, 160) to provide a power of 80% with one-sided alpha of 5%, assuming a 5% competing risk of death from other diseases. The planned accrual period is 5 years, and the follow-up period is 10 years; primary analysis will be performed at the completion of 5-year follow-up for all registered patients. The trial began in March 2021, and 225 patients (cohort A, 170; cohort B, 55) have already been enrolled as of January 2022. Clinical trial information: UMIN000043511.
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Affiliation(s)
- Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | | | | | - Taro Shibata
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center, National Cancer Center Hospital, Tokyo, Japan
| | - Shigeto Matsushita
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | | | - Tatsuya Takenouchi
- Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Toshikazu Omodaka
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kentaro Yamamura
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Megumi Aoki
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Hiroshi Uchi
- Department of Dermatologic-Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Keita Tsutsui
- Department of Dermatology, Fukuoka University, Fukuoka, Japan
| | | | - Dai Ogata
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroto Yanagisawa
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Jun Omatsu
- Department of Dermatology, University of Tokyo, Tokyo, Japan
| | - Takamichi Ito
- Department of Dermatology, Kyushu University, Fukuoka, Japan
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Ohue M, Iwasa S, Mizusawa J, Kanemitsu Y, Shiozawa M, Nishizawa Y, Ueno H, Katsumata K, Yasui M, Tsukamoto S, Katayama H, Fukuda H, Shimada Y. A randomized controlled trial comparing perioperative vs. postoperative mFOLFOX6 for lower rectal cancer with suspected lateral pelvic lymph node metastasis (JCOG1310): a phase II/III randomized controlled trial. Jpn J Clin Oncol 2022; 52:850-858. [PMID: 35640246 PMCID: PMC9354501 DOI: 10.1093/jjco/hyac080] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The optimal perioperative chemotherapy for lower rectal cancer with lateral pelvic lymph node metastasis remains unclear. We evaluated the efficacy and safety of perioperative mFOLFOX6 in comparison with postoperative mFOLFOX6 for rectal cancer patients undergoing total mesorectal excision with lateral lymph node dissection. Methods We conducted an open label randomized phase II/III trial in 18 Japanese institutions. We enrolled patients with histologically proven lower rectal adenocarcinoma with clinical pelvic lateral lymph node metastasis who were randomly assigned (1:1) to receive postoperative mFOLFOX6 (12 courses of intravenous oxaliplatin [85 mg/m2] with L-leucovorin [200 mg/m2] followed by 5-fluorouracil [400 mg/m2, bolus and 2400 mg/m2, continuous infusion, repeated every 2 weeks]) or perioperative mFOLFOX6 (six courses each preoperatively and postoperatively). The primary endpoint was overall survival (OS). The trial is registered with Japan Registry of Clinical Trials, number jRCTs031180230. Results Between May 2015, and May 2019, 48 patients were randomized to the postoperative arm (n = 26) and the perioperative arm (n = 22). The trial was terminated prematurely due to poor accrual. The 3-year OS in the postoperative and perioperative groups were 66.1 and 84.4%, respectively (HR 0.58, 95% CI [0.14–2.45], one-sided P = 0.23). The pathological complete response rate in the perioperative group was 9.1%. Grade 3 postoperative surgical complications were more frequently observed in the perioperative arm (50.0 vs. 12.0%). One treatment-related death due to sepsis from pelvic infection occurred in the postoperative group. Conclusions Perioperative mFOLFOX6 may be an insufficient treatment to improve survival of lower rectal cancer with lateral pelvic lymph node metastasis.
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Affiliation(s)
- Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Satoru Iwasa
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Manabu Shiozawa
- Department of Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yusuke Nishizawa
- Department of Surgery, Saitama Prefecture Cancer Center, Saitama, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Kenji Katsumata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Shimada
- Clinical Oncology Division, Kochi Health Sciences Center, Kochi, Japan
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Saji H, Okada M, Tsuboi M, Nakajima R, Suzuki K, Aokage K, Aoki T, Okami J, Yoshino I, Ito H, Okumura N, Yamaguchi M, Ikeda N, Wakabayashi M, Nakamura K, Fukuda H, Nakamura S, Mitsudomi T, Watanabe SI, Asamura H. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet 2022; 399:1607-1617. [PMID: 35461558 DOI: 10.1016/s0140-6736(21)02333-3] [Citation(s) in RCA: 420] [Impact Index Per Article: 210.0] [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: 09/06/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lobectomy is the standard of care for early-stage non-small-cell lung cancer (NSCLC). The survival and clinical benefits of segmentectomy have not been investigated in a randomised trial setting. We aimed to investigate if segmentectomy was non-inferior to lobectomy in patients with small-sized peripheral NSCLC. METHODS We conducted this randomised, controlled, non-inferiority trial at 70 institutions in Japan. Patients with clinical stage IA NSCLC (tumour diameter ≤2 cm; consolidation-to-tumour ratio >0·5) were randomly assigned 1:1 to receive either lobectomy or segmentectomy. Randomisation was done via the minimisation method, with balancing for the institution, histological type, sex, age, and thin-section CT findings. Treatment allocation was not concealed from investigators and patients. The primary endpoint was overall survival for all randomly assigned patients. The secondary endpoints were postoperative respiratory function (6 months and 12 months), relapse-free survival, proportion of local relapse, adverse events, proportion of segmentectomy completion, duration of hospital stay, duration of chest tube placement, duration of surgery, amount of blood loss, and the number of automatic surgical staples used. Overall survival was analysed on an intention-to-treat basis with a non-inferiority margin of 1·54 for the upper limit of the 95% CI of the hazard ratio (HR) and estimated using a stratified Cox regression model. This study is registered with UMIN Clinical Trials Registry, UMIN000002317. FINDINGS Between Aug, 10, 2009, and Oct 21, 2014, 1106 patients (intention-to-treat population) were enrolled to receive lobectomy (n=554) or segmentectomy (n=552). Patient baseline clinicopathological factors were well balanced between the groups. In the segmentectomy group, 22 patients were switched to lobectomies and one patient received wide wedge resection. At a median follow-up of 7·3 years (range 0·0-10·9), the 5-year overall survival was 94·3% (92·1-96·0) for segmentectomy and 91·1% for lobectomy (95% CI 88·4-93·2); superiority and non-inferiority in overall survival were confirmed using a stratified Cox regression model (HR 0·663; 95% CI 0·474-0·927; one-sided p<0·0001 for non-inferiority; p=0·0082 for superiority). Improved overall survival was observed consistently across all predefined subgroups in the segmentectomy group. At 1 year follow-up, the significant difference in the reduction of median forced expiratory volume in 1 sec between the two groups was 3·5% (p<0·0001), which did not reach the predefined threshold for clinical significance of 10%. The 5-year relapse-free survival was 88·0% (95% CI 85·0-90·4) for segmentectomy and 87·9% (84·8-90·3) for lobectomy (HR 0·998; 95% CI 0·753-1·323; p=0·9889). The proportions of patients with local relapse were 10·5% for segmentectomy and 5·4% for lobectomy (p=0·0018). 52 (63%) of 83 patients and 27 (47%) of 58 patients died of other diseases after lobectomy and segmentectomy, respectively. No 30-day or 90-day mortality was observed. One or more postoperative complications of grade 2 or worse occurred at similar frequencies in both groups (142 [26%] patients who received lobectomy, 148 [27%] who received segmentectomy). INTERPRETATION To our knowledge, this study was the first phase 3 trial to show the benefits of segmentectomy versus lobectomy in overall survival of patients with small-peripheral NSCLC. The findings suggest that segmentectomy should be the standard surgical procedure for this population of patients. FUNDING National Cancer Center Research and the Ministry of Health, Labour, and Welfare of Japan.
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Affiliation(s)
- Hisashi Saji
- Department of Chest Surgery, St Marianna University School of Medicine, Kawasaki, Japan.
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ryu Nakajima
- Department of Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Keiju Aokage
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tadashi Aoki
- Department of Thoracic Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Norihito Okumura
- Department of Thoracic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masafumi Yamaguchi
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masashi Wakabayashi
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kenichi Nakamura
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | | | - Tetsuya Mitsudomi
- Department of Thoracic Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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Iwatani T, Hara F, Shien T, Takahashi M, Masuda N, Sagara Y, Sasaki K, Mizusawa J, Fukuda H, Shiroiwa T, Iwata H. Abstract P3-16-04: Estimation of willingness-to-pay for breast cancer treatments through contingent valuation method in Japanese breast cancer patients (JCOG1709A): The main study findings. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p3-16-04] [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
Background In 2019, the Japanese government has introduced the economic valuation to healthcare system. However, the threshold for determining cost-effectiveness-analysis has yet to be adequately studied. Therefore, we have designed a study to examine the financial value of “life” and “health” based on willingness-to-pay (WTP) considered by patients with primary and metastatic breast cancer (PBC and MBC) in Japan. Methods This study is conducted by forty-five hospitals under the Breast Cancer Study Group of Japan Clinical Oncology Group (JCOG). In the preliminary study, 168 patients (84 patients with PBC and 84 patients with MBC) from 20 to 79 years of age paying medical costs were examined their WTP for setting up the dichotomous-choice method survey form for using in the main study. Virtual scenario-specific treatments to avoid the recurrence and death of breast cancer for one year for PBC patients, and to prolong the survival period for one year for the patients with MBC were presented. The patients were evaluated how much money would pay to receive the treatment in a self-written answer and the amount of WTP that would be presented in the main study was determined. In the main study, 1,620 patients (810 patients with PBC and 810 patients with MBC) were surveyed to their WTP for hypothetical scenarios using the dichotomous-choice method survey form. With the two-step dichotomous-choice method, if the first stage response was yes, a higher amount was displayed for the second stage. If the first stage response was no, a lower amount was shown for the second stage. For the main analysis, the acceptance probability curve was calculated using the parametric method. The calculation was based on the obtained responses and median WTP, which was determined by calculating the amount at which the acceptance probability curve is at 50%. The obtained amount was converted to WTP per one QALY based on the displayed question content. Results Completed surveys were collected from 716 PBC patients (88.4%) and 702 patients (86.7%). Based on the preliminary study, the amount of WTP offering in the first stage was set 5 million yen (JPY) (50,000 USD), and offering in the second stage was 7 million JPY (70,000 USD) for those who responded accepting the scenario treatment and 3 million JPY (30,000 USD) for those who responded refusing. We obtained point estimates of WTP for each virtual scenario treatments. The WTP of the two hypothetical scenarios for PBC patients were as follows; scenario 1) the treatment to gain one year without recurrence: 2.06 million JPY (20,600 USD), scenario 2) the treatment that reduces risk of recurrence by 40%: 2.40 million JPY (24,000 USD). The WTP of the two hypothetical scenarios for MBC patients were as follows; scenario 3) the treatment that can prolong survival for one year in current health condition: 2.81 million JPY (28,100 USD), scenario 4) the treatment that can prolong survival by one year in the health condition before having breast cancer: 2.92 million JPY (29,200 USD). Conclusion We created hypothetical 1-quality-adjusted survival year (QALY) scenarios for breast cancer patients with different disease status and validated them using the contingent valuation method. Our results demonstrate that WTP per 1QALY varies with the disease status of breast cancer. Therefore, we conclude that we cannot simply use a uniform threshold when examining the cost-effectiveness of medical interventions in breast cancer as a unit of cost/QALY.
Citation Format: Tsuguo Iwatani, Fumikata Hara, Tadahiko Shien, Masato Takahashi, Norikazu Masuda, Yasuaki Sagara, Keita Sasaki, Junki Mizusawa, Haruhiko Fukuda, Takaru Shiroiwa, Hiroji Iwata. Estimation of willingness-to-pay for breast cancer treatments through contingent valuation method in Japanese breast cancer patients (JCOG1709A): The main study findings [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-16-04.
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Affiliation(s)
- Tsuguo Iwatani
- Department of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Fumikata Hara
- Department of Breast Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Masato Takahashi
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Norikazu Masuda
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yasuaki Sagara
- Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan
| | - Keita Sasaki
- Japan Clinical Oncology Group (JCOG) Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group (JCOG) Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group (JCOG) Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Takaru Shiroiwa
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Kikuchi K, Yamazaki N, Nozawa K, Fukuda H, Shibata T, Machida R, Hamaguchi T, Takashima A, Shoji H, Boku N, Takatsuka S, Takenouchi T, Nishina T, Yoshikawa S, Takahashi M, Hasegawa A, Kawazoe A, Masuishi T, Mizutani H, Kiyohara Y. Topical corticosteroid therapy for facial acneiform eruption due to EGFR inhibitors in metastatic colorectal cancer patients: a randomized controlled trial comparing starting with a very strong or a weak topical corticosteroid (FAEISS study, NCCH1512, colorectal part). Support Care Cancer 2022; 30:4497-4504. [PMID: 35113224 DOI: 10.1007/s00520-022-06874-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/13/2021] [Accepted: 01/27/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Although pre-emptive therapy with oral tetracycline, moisturizer, sunscreen, and topical corticosteroid is useful for preventing acneiform eruption (AfE) due to epidermal growth factor receptor (EGFR) inhibitors, no studies have examined the efficacy of topical corticosteroids themselves, or investigated the optimal potency of corticosteroid for treating facial AfE (FAfE). PATIENTS AND METHODS Screened patients with RAS wild-type colorectal cancer started pre-emptive therapy with oral minocycline and moisturizer on initiation of cetuximab or panitumumab therapy. Patients who developed grade 1 or 2 FAfE were randomly allocated to two groups: a ranking-down (RD) group that started with a very strong corticosteroid and serially ranked down every 2 weeks unless FAfE exacerbated; and a ranking-up (RU) group that started with a weak corticosteroid and serially ranked up at exacerbation. FAfE grade, patient quality of life, and adverse events (AEs) with topical corticosteroid were evaluated every 2 weeks. The primary endpoint was the total number of times grade 2 or higher FAfE was identified in the central review of the 8-week treatment period. RESULTS No significant differences in total numbers of grade 2 or higher FAfE or in AEs caused by topical corticosteroids were observed between groups during the 8 weeks. Incidence of grade 2 or higher FAfE tended to be lower in the RD group during the first 2 weeks. CONCLUSION Considering the long-term care of FAfE, the RU regimen appears suitable and should be considered the standard treatment for FAfE due to EGFR inhibitor therapy. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN000024113).
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Affiliation(s)
- Katsuko Kikuchi
- Tohoku University School of Medicine, Sendai, Japan.
- Sendai Taihaku Dermatology Clinic, AEON Supercenter 2F, 1-21-1 Kagitori Honcho, Taihaku Ku, Sendai, Miyagi, 982-0805, Japan.
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Keiko Nozawa
- Department of Nursing, Faculty of Nursing, Mejiro University, Saitama, Japan
- Appearance Support Center, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Data Management Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taro Shibata
- Biostatistics Section, Research Management Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ryunosuke Machida
- Biostatistics Section, Research Management Division, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Hamaguchi
- Department of Medical Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Atsuo Takashima
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hirokazu Shoji
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Narikazu Boku
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Sumiko Takatsuka
- Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Tatsuya Takenouchi
- Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Tomohiro Nishina
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Shusuke Yoshikawa
- Dermatology Division, Shizuoka Cancer Center Hospital, Sunto-gun, Japan
| | - Masanobu Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Akiko Hasegawa
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akihito Kawazoe
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toshiki Masuishi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - Yoshio Kiyohara
- Dermatology Division, Shizuoka Cancer Center Hospital, Sunto-gun, Japan
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Ohba A, Ozaka M, Mizusawa J, Katayama H, Okusaka T, Kobayashi S, Ikeda M, Kaneko S, Sasahira N, Okano N, Furukawa M, Miki I, Mizuno N, Yasuda I, Fujimori N, Kataoka T, Ueno M, Ishii H, Fukuda H, Furuse J. Randomized multicenter phase II/III study of gemcitabine plus nab-paclitaxel or modified FOLFIRINOX or S-IROX in patients with metastatic or recurrent pancreatic cancer (JCOG1611, GENERATE). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.tps627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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
TPS627 Background: Pancreatic cancer is one of the most dismal cancers with few effective drugs. Both FOLFIRINOX (FFX) and gemcitabine plus nab-paclitaxel (GnP) showed superiority in overall survival (OS) to gemcitabine in phase III studies and became the standard of care for first-line chemotherapy. However, to date, there is no prospective randomized controlled studies comparing FFX and GnP. In addition, the original FFX has the problems of high toxicity and complicated administration, and we have been developing modified FFX with dose reduction of irinotecan and without bolus fluorouracil and S-IROX, which replaces continuous intravenous fluorouracil with orally administered fluoropyrimidine of S-1. The modified FFX showed median OS of 11.2months [95% confidence interval (CI), 9.0-not calculated] as good as the original FFX in a phase II study, and the S-IROX showed a high objective response rate (ORR) of 57.1% (95% CI, 34.0–78.2%) in a phase I study. This phase II/III study aims to confirm the superiority of modified FFX and S-IROX to GnP in metastatic or recurrent pancreatic cancer. Methods: The main eligibility criteria are metastatic or recurrent pancreatic cancer, histologically diagnosed as adenocarcinoma or adenosquamous carcinoma, no prior chemotherapy for pancreatic cancer, Eastern Cooperative Oncology Group Performance Status 0 or 1, and age 20-75 years old. Enrolled patients are randomized 1:1:1 to GnP, modified FFX, or S-IROX. GnP is consisted of nab-paclitaxel (125 mg/m2) and gemcitabine (1000 mg/m2) on days 1, 8, and 15, every 4 weeks, modified FFX is consisted of oxaliplatin (85 mg/m2), irinotecan (150 mg/m2), l-leucovorin (200 mg/m2), and fluorouracil (2400 mg/m2, 46-hour continuous infusion), every 2 weeks, and S-IROX is consisted of oxaliplatin (85 mg/m2), irinotecan (150 mg/m2) and S-1 (80 mg/m2, days 1-7), every 2 weeks. All regimens are administered until disease progression or unacceptable toxicity. The primary endpoint of the phase II part is the ORR to S-IROX with the null hypothesis of a threshold ORR of less than 20%, which decide whether to proceed to the phase III part in three arms or two arms (GnP and modified FFX). The primary endpoint of the phase III part is OS, and secondary endpoints are progression-free survival, ORR, incidence of adverse events (AEs) and serious AEs, and dose intensity. We calculated a sample of 732 patients to maintain 80% power at a one-sided alpha error of 2.5% in each comparison, and the hazard ratios of modified FFX and S-IROX versus GnP were estimated at 0.73 each. The study started patient accrual in April 2019 and 349 patients have been enrolled as of September 2021. Clinical trial registry: jRCTs031190009. Clinical trial information: jRCTs031190009.
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Affiliation(s)
- Akihiro Ohba
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masato Ozaka
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Junki Mizusawa
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Katayama
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Kobayashi
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Naoki Sasahira
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Naohiro Okano
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Masayuki Furukawa
- Department of Hepatobiliary-Pancreatology, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Ikuya Miki
- Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama Hospital, Toyama, Japan
| | - Nao Fujimori
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoko Kataoka
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Ueno
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroshi Ishii
- Clinical Research Center, Chiba Cancer Center, Chiba, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
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Hamaguchi T, Takashima A, Mizusawa J, Shimada Y, Nagashima F, Ando M, Ojima H, Denda T, Watanabe J, Shinozaki K, Baba H, Asayama M, Fukushima T, Masuishi T, Nakata K, Tsukamoto S, Katayama H, Nakamura K, Fukuda H, Kanemitsu Y. A randomized phase III trial of mFOLFOX7 or CapeOX plus bevacizumab versus 5-FU/ l-LV or capecitabine plus bevacizumab as initial therapy in elderly patients with metastatic colorectal cancer: JCOG1018 study (RESPECT). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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
10 Background: It is uncertain if the addition of oxaliplatin (OX) to fluoropyrimidine plus bevacizumab (BEV) is suitable as initial therapy in elderly patients (pts) with metastatic colorectal cancer (MCRC). Therefore, we conducted a randomized controlled trial to confirm the superiority of the addition of OX in terms of progression-free survival (PFS). This JCOG trial was originally planned as a paralell study with NCCTG, but the NCCTG trial was terminated early. Methods: Key eligibility criteria included unresectable metastatic colorectal cancer, and histologically confirmed adenocarcinoma, aged 70-74 with PS 2 or 75 or older with ECOG PS 0-2. Eligible pts were randomized (1:1) to either no addition of OX or addition. Whether using 5-FU+levoleucovorin calcium (5-FU/ l-LV) or capecitabine (CAPE) was declared before study entry; options included 5-FU/ l-LV+BEV (C), CAPE+BEV (D), mFOLFOX7+BEV (E), or CapeOX+BEV (F). 5-FU/ l-LV regimen omitted bolus 5-FU from the original sLV5FU regimen. The dose of CAPE was adjusted by estimated creatinine clearance. The primary endpoint was PFS. The planned sample size was 250 pts in total to detect a hazard ratio (HR) of 0.75, with a one-sided alpha of 5% and 70% power. The decision rule is that the primary endpoint is met, and the point estimate of HR of overall survival (OS) is less than 0.8. Results: Between Sep 2012 and Mar 2019, 251 pts were randomized. 125 pts were allocated to no addition of OX and 126 pts to addition. Median age was 79, aged 70-74/75-79/80-84/85+:5%/45%/37%/13%, PS 0/1/2:53%/39%/7%. Of 251 pts, 241 pts had PFS events and 223 pts had OS events. Median PFS (mPFS) was 9.4 months (M) (95%CI 8.3–10.3) in no addition of OX and 10.0M (9.0–11.2) in addition (HR 0.837, 90.5%CI [0.673–1.042], one-sided p = 0.086). Median OS was 21.3M (18.7-24.3) in no addition and 19.7M (15.5–25.5) in addition of OX (HR 1.054 [0.810–1.372]). Response rate was 29.5% (21.2-38.8) in no addition of OX and 47.7% (38.1-57.5) in addition. Proportion of pts whose EQ-5D scores improved from baseline to post-treatment in overall score did not differ (odds ratio 0.94 (0.51-1.75)). The deaths of 1 pt in no addition of OX and in 3 pts in addition were deemed treatment-related. Conclusions: The addition of OX has no survival benefit over no addition. OX was not recommended for elderly MCRC pts as initial therapy. Clinical trial information: UMIN000008866.[Table: see text]
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Affiliation(s)
- Tetsuya Hamaguchi
- Department of Medical Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Atsuo Takashima
- Department of Gastrointestinal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Junki Mizusawa
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Shimada
- Clinical Oncology Division, Kochi Health Sciences Center, Kochi, Japan
| | - Fumio Nagashima
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Aichi, Japan
| | - Hitoshi Ojima
- Gastrointestinal Surgery, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Tadamichi Denda
- Division of Gastroenterology, Chiba Cancer Center, Chiba, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsunori Shinozaki
- Division of Clinical Oncology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masako Asayama
- Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Tadao Fukushima
- Division of Surgery, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan
| | - Toshiki Masuishi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Ken Nakata
- Department of Surgery, Sakai City Medical Center, Osaka, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Katayama
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | | | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Tokyo, Japan
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Oda Y, Tanaka K, Hirose T, Hasegawa T, Hiruta N, Hisaoka M, Yoshimoto M, Otsuka H, Bekki H, Ishii T, Endo M, Kunisada T, Hiruma T, Tsuchiya H, Katagiri H, Matsumoto Y, Kawai A, Nakayama R, Kawashima H, Takenaka S, Emori M, Watanuki M, Yoshida Y, Okamoto T, Mizusawa J, Fukuda H, Ozaki T, Iwamoto Y, Nojima T. Standardization of evaluation method and prognostic significance of histological response to preoperative chemotherapy in high-grade non-round cell soft tissue sarcomas. BMC Cancer 2022; 22:94. [PMID: 35062915 PMCID: PMC8783422 DOI: 10.1186/s12885-022-09195-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 01/12/2022] [Indexed: 12/30/2022] Open
Abstract
Background Preoperative chemotherapy is widely applied to high-grade localized soft tissue sarcomas (STSs); however, the prognostic significance of histological response to chemotherapy remains controversial. This study aimed to standardize evaluation method of histological response to chemotherapy with high agreement score among pathologists, and to establish a cut-off value closely related to prognosis. Methods Using data and specimens from the patients who had registered in the Japan Clinical Oncology Group study, JCOG0304, a phase II trial evaluating the efficacy of perioperative chemotherapy with doxorubicin (DOX) and ifosfamide (IFO), we evaluated histological response to preoperative chemotherapy at the central review board. Results A total of 64 patients were eligible for this study. The percentage of viable tumor area ranged from 0.1% to 97.0%, with median value of 35.7%. Regarding concordance proportion between pathologists, the weighted kappa coefficient (κ) score in all patients was 0.71, indicating that the established evaluation method achieved substantial agreement score. When the cut-off value of the percentage of the residual tumor area was set as 25%, the p-value for the difference in overall survival showed the minimum value. Hazard ratio of the non-responder with percentage of the residual tumor < 25%, to the responder was 4.029 (95% confidence interval 0.893–18.188, p = 0.070). Conclusion The standardized evaluation method of pathological response to preoperative chemotherapy showed a substantial agreement in the weighted κ score. The evaluation method established here was useful for estimating of the prognosis in STS patients who were administered perioperative chemotherapy with DOX and IFO. Trial registration UMIN Clinical Trials Registry C000000096. Registered 30 August, 2005 (retrospectively registered).
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Aokage K, Tsuboi M, Zenke Y, Horinouchi H, Nakamura N, Ishikura S, Nishikawa H, Kumagai S, Koyama S, Kanato K, Kataoka T, Wakabayashi M, Fukutani M, Fukuda H, Ohe Y, Watanabe SI. Study protocol for JCOG1807C (DEEP OCEAN): a interventional prospective trial to evaluate the efficacy and safety of durvalumab before and after operation or durvalumab as maintenance therapy after chemoradiotherapy against superior sulcus non-small cell lung cancer. Jpn J Clin Oncol 2022; 52:383-387. [PMID: 34999817 PMCID: PMC8985519 DOI: 10.1093/jjco/hyab208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/13/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background Superior sulcus tumours (SSTs) are relatively uncommon and one of the most intractable lung cancers among non-small cell lung cancer (NSCLC). We planned a multicenter, single-arm confirmatory trial of new multidisciplinary treatment using immune-checkpoint inhibitor. The aim is to evaluate the safety and efficacy of new multidisciplinary treatment with perioperative durvalumab after chemoradiotherapy (CRT). Methods The primary endpoint is 3-year overall survival. Patients receive induction CRT with sequential two courses of durvalumab, followed by surgical resection for resectable SST. The regimen for CRT is two courses of cisplatin and S-1, and concurrent radiotherapy (66 Gy/33 Fr). After surgery, 22 courses of post-operative durvalumab therapy are administered. For unresectable SST, an additional 22 courses of durvalumab are administered after induction durvalumab. Results In two cases as a safety cohort, the safety of intervention treatment up to 30 days after surgery was examined, and there were no special safety signals. Patient enrollment has now resumed in the main cohort. Conclusions The results of this study may contribute to the establishment of a new standard of care for SST, which is an intractable NSCLC.
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Affiliation(s)
- Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba
| | - Yoshitaka Zenke
- Division of Thoracic Oncology, National Cancer Center Hospital East, Chiba
| | | | - Naoki Nakamura
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa
| | | | - Hiroyoshi Nishikawa
- Division of Cancer Immunology, Research Institute/Exploratory Oncology Research & Clinical Trial Center (EPOC), National Cancer Center, Tokyo, Chiba
| | - Shogo Kumagai
- Division of Cancer Immunology, Research Institute/Exploratory Oncology Research & Clinical Trial Center (EPOC), National Cancer Center, Tokyo, Chiba
| | - Shohei Koyama
- Division of Cancer Immunology, Research Institute/Exploratory Oncology Research & Clinical Trial Center (EPOC), National Cancer Center, Tokyo, Chiba
| | - Keisuke Kanato
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo
| | - Tomoko Kataoka
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo
| | | | - Miki Fukutani
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, 277-8577
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo
| | - Yuichiro Ohe
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo
| | - Shun-Ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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Kanemitsu Y, Shimizu Y, Mizusawa J, Inaba Y, Hamaguchi T, Shida D, Ohue M, Komori K, Shiomi A, Shiozawa M, Watanabe J, Suto T, Kinugasa Y, Takii Y, Bando H, Kobatake T, Inomata M, Shimada Y, Katayama H, Fukuda H. Hepatectomy Followed by mFOLFOX6 Versus Hepatectomy Alone for Liver-Only Metastatic Colorectal Cancer (JCOG0603): A Phase II or III Randomized Controlled Trial. J Clin Oncol 2021; 39:3789-3799. [PMID: 34520230 DOI: 10.1200/jco.21.01032] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Adjuvant chemotherapy after hepatectomy is controversial in liver-only metastatic colorectal cancer (CRC). We conducted a randomized controlled trial to examine if adjuvant modified infusional fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) is superior to hepatectomy alone for liver-only metastasis from CRC. PATIENTS AND METHODS In this phase II or III trial (JCOG0603), patients age 20-75 years with confirmed CRC and an unlimited number of liver metastatic lesions were randomly assigned to hepatectomy alone or 12 courses of adjuvant mFOLFOX6 after hepatectomy. The primary end point of phase III was disease-free survival (DFS) in intention-to-treat analysis. RESULTS Between March 2007 and January 2019, 300 patients were randomly assigned to hepatectomy alone (149 patients) or hepatectomy followed by chemotherapy (151 patients). At the third interim analysis of phase III with median follow-up of 53.6 months, the trial was terminated early according to the protocol because DFS was significantly longer in patients treated with hepatectomy followed by chemotherapy. With median follow-up of 59.2 months, the updated 5-year DFS was 38.7% (95% CI, 30.4 to 46.8) for hepatectomy alone compared with 49.8% (95% CI, 41.0 to 58.0) for chemotherapy (hazard ratio, 0.67; 95% CI, 0.50 to 0.92; one-sided P = .006). However, the updated 5-year overall survival (OS) was 83.1% (95% CI, 74.9 to 88.9) with hepatectomy alone and 71.2% (95% CI, 61.7 to 78.8) with hepatectomy followed by chemotherapy. In the chemotherapy arm, the most common grade 3 or higher severe adverse event was neutropenia (50% of patients), followed by sensory neuropathy (10%) and allergic reaction (4%). One patient died of unknown cause after three courses of mFOLFOX6 administration. CONCLUSION DFS did not correlate with OS for liver-only metastatic CRC. Adjuvant chemotherapy with mFOLFOX6 improves DFS among patients treated with hepatectomy for CRC liver metastasis. It remains unclear whether chemotherapy improves OS.
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Affiliation(s)
| | | | | | | | - Tetsuya Hamaguchi
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Dai Shida
- National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Akio Shiomi
- Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | | | - Jun Watanabe
- Yokohama City University Medical Center, Yokohama, Japan
| | - Takeshi Suto
- Yamagata Prefectural Central Hospital, Yamagata, Japan
| | | | | | | | - Takaya Kobatake
- National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
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Arakawa Y, Sasaki K, Mineharu Y, Uto M, Mizowaki T, Mizusawa J, Sekino Y, Ono T, Aoyama H, Satomi K, Ichimura K, Kinoshita M, Ohno M, Ito Y, Nishikawa R, Fukuda H, Nishimura Y, Narita Y. A randomized phase III study of short-course radiotherapy combined with Temozolomide in elderly patients with newly diagnosed glioblastoma; Japan clinical oncology group study JCOG1910 (AgedGlio-PIII). BMC Cancer 2021; 21:1105. [PMID: 34654402 PMCID: PMC8518265 DOI: 10.1186/s12885-021-08834-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/04/2021] [Indexed: 01/02/2023] Open
Abstract
Background The current standard treatment for elderly patients with newly diagnosed glioblastoma is surgery followed by short-course radiotherapy with temozolomide. In recent studies, 40 Gy in 15 fractions vs. 60 Gy in 30 fractions, 34 Gy in 10 fractions vs. 60 Gy in 30 fractions, and 40 Gy in 15 fractions vs. 25 Gy in 5 fractions have been reported as non-inferior. The addition of temozolomide increased the survival benefit of radiotherapy with 40 Gy in 15 fractions. However, the optimal regimen for radiotherapy plus concomitant temozolomide remains unresolved. Methods This multi-institutional randomized phase III trial was commenced to confirm the non-inferiority of radiotherapy comprising 25 Gy in 5 fractions with concomitant (150 mg/m2/day, 5 days) and adjuvant temozolomide over 40 Gy in 15 fractions with concomitant (75 mg/m2/day, every day from first to last day of radiation) and adjuvant temozolomide in terms of overall survival (OS) in elderly patients with newly diagnosed glioblastoma. A total of 270 patients will be accrued from 51 Japanese institutions in 4 years and follow-up will last 2 years. Patients 71 years of age or older, or 71–75 years old with resection of less than 90% of the contrast-enhanced region, will be registered and randomly assigned to each group with 1:1 allocation. The primary endpoint is OS, and the secondary endpoints are progression-free survival, frequency of adverse events, proportion of Karnofsky performance status preservation, and proportion of health-related quality of life preservation. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in April 2020. Ethics approval was granted by the National Cancer Center Hospital Certified Review Board. Patient enrollment began in August 2020. Discussion If the primary endpoint is met, short-course radiotherapy comprising 25 Gy in 5 fractions with concomitant and adjuvant temozolomide will be a standard of care for elderly patients with newly diagnosed glioblastoma. Trial registration Registry number: jRCTs031200099. Date of Registration: 27/Aug/2020. Date of First Participant Enrollment: 4/Sep/2020.
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Affiliation(s)
- Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Keita Sasaki
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yohei Mineharu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Megumi Uto
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Junki Mizusawa
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yuta Sekino
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tomohiro Ono
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kaishi Satomi
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Koichi Ichimura
- Department of Brain Disease Translational Research, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Manabu Kinoshita
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Makoto Ohno
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University Graduate School of Medicine, Tokyo, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
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Moriyama S, Hieda M, Fukuda H, Kawano S, Yokoyama T, Fukata M, Kusaba H, Maruyama T, Baba E, Akashi K. Impact of hypertension on clinical outcome in patients treated with vascular endothelial growth factor inhibitors. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2308] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vascular endothelial growth factor (VEGF) family is overexpressed in the tumor microenvironment and induces tumor angiogenesis.1 VEGF signaling pathway (VSP) inhibitors are essential therapeutic drugs for solid cancer patients.2 However, VSP inhibitors often provoke drug-specific anti-angiogenesis in normal tissues, which was referred to as on-target toxicity.2 Hypertension (HTN) is one of the most frequent adverse events caused by VSP inhibitors. A previous report demonstrated that VSP inhibitor-induced hypertension is a favorable prognostic factor, contrarily.3However, multiple VSP inhibitors are administered in various cancer types, and then the relation between VSP inhibitor-associated hypertension and clinical outcome is still controversial.
Purpose
The aim of this study is to elucidate the impacts of HTN and the timing of onset on clinical outcome during cancer therapy with VSP inhibitors.
Method
We reviewed 2,348 patients who were treated with VSP inhibitors from the LIFE Study database, consisting of 14 municipality-level information from claims data between 2016 and 2020. According to the timing of HTN onset mode, the patients were stratified into 3 groups; (1) new-onset HTN group (n=334): de novo development after VSP inhibitor administration, (2) pre-existing HTN group (n=1,363): existing HTN at baseline, including aggravation after VSP inhibitor initiation, and (3) no HTN group (n=651) (Figure 1). The time to treatment failure (TTF) was applied as a surrogate clinical indicator of overall survival. Event-free survival analysis with the log-rank test was conducted for time to first treatment failure amongst the 3 groups. In addition, Cox proportional hazard models adjusted with clinical characteristics were performed to investigate independent factors for TTF.
Results
In the event-free survival analysis, both the new-onset HTN and the pre-existing HTN were associated with prolongation of TTF, compared to the non-HTN (p<0.001 and p<0.001, respectively, by Bonferroni correction) (Figure 2). The New-onset HTN was significantly associated with longer TTF than pre-existing HTN (p<0.001). In Cox proportional hazard model adjusted with age, sex, past medical history, primary cancer lesion, and type of VSP inhibitors, the new-onset HTN and the pre-existing HTN were independent favorable factors, compared to the non-HTN [new-onset HTN: Hazard ratio (HR) 0.62, 95% confidence interval (CI) 0.54 - 0.71, p<0.001; and pre-existing HTN: HR 0.85, 95% CI 0.77 - 0.94, p<0.005]. Moreover, the New-onset HTN was also a significant factor for longer TTF, compared to the pre-existing HTN [HR 0.72, 95% CI 0.64 - 0.82, p<0.001].
Conclusion
In patients treated with VSP inhibitors, both new-onset and pre-existing HTN are independent factors for a favorable clinical outcome, especially new-onset HTN after VSP inhibitors administration.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science (JSPS) Grants-in-Aid for Scientific Research (KAKENHI) Figure 1. Patient screening and enrollmentFigure 2. HTN & TTF
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Affiliation(s)
- S Moriyama
- Kyushu University Hospital, Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| | - M Hieda
- Kyushu University Hospital, Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| | - H Fukuda
- Kyushu University, Health Care Administration and Management, Fukuoka, Japan
| | - S Kawano
- Kyushu University Hospital, Department of Clinical Immunology & Rheumatology/Infectious Disease, Fukuoka, Japan
| | - T Yokoyama
- Kyushu University Hospital, Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| | - M Fukata
- Kyushu University Hospital, Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| | - H Kusaba
- Kyushu University Hospital, Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| | - T Maruyama
- Kyushu University, Campus Life Health Center, Fukuoka, Japan
| | - E Baba
- Kyushu University, Department of Oncology and Social Medicine, Fukuoka, Japan
| | - K Akashi
- Kyushu University Hospital, Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
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Yamada T, Kurokawa Y, Mizusawa J, Takeno A, Hihara J, Imamura H, Takagane A, Nunobe S, Fukuda H, Takiguchi S, Doki Y, Boku N, Yoshikawa T, Terashima M, Sano T, Sasako M. 1399P Risk factors for body weight loss after gastrectomy for gastric cancer analysed from the JCOG1001 phase III trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1508] [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: 11/16/2022] Open
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Ishihara R, Mizusawa J, Kushima R, Matsuura N, Yano T, Kataoka T, Fukuda H, Hanaoka N, Yoshio T, Abe S, Yamamoto Y, Nagata S, Ono H, Tamaoki M, Yoshida N, Takizawa K, Muto M. Assessment of the Diagnostic Performance of Endoscopic Ultrasonography After Conventional Endoscopy for the Evaluation of Esophageal Squamous Cell Carcinoma Invasion Depth. JAMA Netw Open 2021; 4:e2125317. [PMID: 34524432 PMCID: PMC8444025 DOI: 10.1001/jamanetworkopen.2021.25317] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Distinguishing between mucosal and submucosal cancers is important for selecting the optimal treatment for patients with esophageal squamous cell carcinoma (ESCC); however, standard procedures for diagnosing cancer invasion depth have not yet been determined. OBJECTIVE To evaluate the diagnostic performance of endoscopic ultrasonography (EUS) after conventional endoscopy for the evaluation of ESCC invasion depth. DESIGN, SETTING, AND PARTICIPANTS This prospective single-arm confirmatory diagnostic study comprising 372 patients with T1 esophageal cancer was conducted at 41 secondary or tertiary hospitals in Japan. Enrollment began on July 20, 2017; patients were enrolled in 2 steps, with the first registration occurring from August 4, 2017, to December 11, 2019, and the second from August 9, 2017, to December 11, 2019. After the completion of all first and second registration examinations, patients received treatment and were followed up for 30 days, with follow-up ending on February 14, 2020. Patients were eligible for inclusion if they had pathologically or endoscopically diagnosed esophageal cancer with T1 clinical depth of invasion. INTERVENTIONS In the first registration, nonmagnifying endoscopy (non-ME) and magnifying endoscopy (ME) were used to diagnose cancer invasion depth. In the second registration, patients from the first registration who had cancers invading the muscularis mucosa or submucosa were enrolled and received EUS. After completion of the protocol examinations, patients received treatment with endoscopic resection or esophagectomy. The pathological results of the resected specimens were used as the reference standard for evaluating cancer invasion depth. MAIN OUTCOMES AND MEASURES The primary end point was the proportion of overdiagnosis of submucosal cancer (defined as invasion depth >200 μm) after receipt of non-ME and ME, with or without the addition of EUS. The secondary end points were underdiagnosis, sensitivity, and specificity. RESULTS Among 372 patients enrolled in the first registration, 371 received non-ME and ME. Of those, 300 patients were enrolled in the second registration, and 293 patients received EUS. A total of 269 patients (217 men [80.7%]; median age, 69 years; interquartile range, 62-75 years) were included in the final analysis. The addition of EUS was associated with a 6.6% increase in the proportion of overdiagnosis (from 16 of 74 patients [21.6%; 95% CI, 12.9%-32.7%] after non-ME and ME to 29 of 103 patients [28.2%; 95% CI, 19.7%-37.9%] after the addition of EUS; 1-sided P = .93). All subgroup analyses found similar increases in overdiagnosis of submucosal cancer. The addition of EUS was associated with a 4.5% reduction in the proportion of underdiagnosis (from 57 of 195 patients [29.2%; 95% CI, 23.0%-36.2%] after non-ME and ME to 41 of 166 patients [24.7%; 95% CI, 18.3%-32.0%] after the addition of EUS). After non-ME and ME, diagnostic sensitivity was 50.4% (95% CI, 41.0%-59.9%), specificity was 89.6% (95% CI, 83.7%-93.9%), and accuracy was 72.9% (95% CI, 67.1%-78.1%). After the addition of EUS, diagnostic sensitivity was 64.3% (95% CI, 54.9%-73.1%), specificity was 81.2% (95% CI, 74.1%-87.0%), and accuracy was 74.0% (95% CI, 68.3%-79.1%). CONCLUSIONS AND RELEVANCE This study found that the addition of EUS was not associated with improvements in the diagnostic accuracy of cancer invasion depth. These findings do not support the routine use of EUS after conventional endoscopy for evaluating the invasion depth among patients with T1 ESCC.
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Affiliation(s)
- Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Ryoji Kushima
- Department of Clinical Laboratory Medicine (Diagnostic Pathology), Shiga University of Medical Science, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tomoko Kataoka
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Noboru Hanaoka
- Department of Gastroenterology, Osaka Red Cross Hospital, Osaka, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshinobu Yamamoto
- Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masashi Tamaoki
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naohiro Yoshida
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Aokage K, Suzuki K, Wakabayashi M, Mizutani T, Hattori A, Fukuda H, Watanabe SI. Predicting pathological lymph node status in clinical stage IA peripheral lung adenocarcinoma. Eur J Cardiothorac Surg 2021; 60:64-71. [PMID: 33514999 DOI: 10.1093/ejcts/ezaa478] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/19/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Even with current diagnostic technology, it is difficult to accurately predict pathological lymph node status (PLNS). This study aimed to develop a prediction model of PLNS in peripheral adenocarcinoma with a dominant solid component, based on clinical and radiological factors on thin-section computed tomography, to identify patients to whom wedge resection or other local therapies could be applied. METHODS Of 811 patients enrolled in a prospective multi-institutional study (JCOG0201), 420 patients with clinical stage IA peripheral lung adenocarcinoma having a dominant solid component were included. Multivariable logistic regression was performed to develop a model based on clinical and centrally reviewed radiological factors. Leave-one-out cross-validation and external validation analyses were performed, using independent data from 221 patients. Sensitivity, specificity and concordance statistics were calculated to evaluate diagnostic performance. RESULTS The formula for calculating the probability of pathological lymph node metastasis included the following variables: tumour diameter (including ground-glass opacity), consolidation-to-tumour ratio and density of solid component. The concordance statistic was 0.8041. When the cut-off value associated with the risk of incorrectly predicting negative pathological lymph node metastasis (pN-) was 4.9%, diagnostic sensitivity and specificity in predicting PLNS were 95.7% and 46.0%, respectively. The concordance statistic for the external validation set was 0.7972, and diagnostic sensitivity and specificity in predicting PLNS were 95.4% and 40.5%, respectively. CONCLUSIONS The proposed model is clinically useful and successfully predicts pN- in patients with clinical stage IA peripheral lung adenocarcinoma with a dominant solid component.
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Affiliation(s)
- Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masashi Wakabayashi
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tomonori Mizutani
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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Shimoyama R, Nakagawa K, Ishikura S, Wakabayashi M, Sasaki T, Yoshioka H, Hashimoto T, Kataoka T, Fukuda H, Watanabe SI. A multi-institutional randomized phase III trial comparing postoperative radiotherapy to observation after adjuvant chemotherapy in patients with pathological N2 Stage III non-small cell lung cancer: Japan Clinical Oncology Group Study JCOG1916 (J-PORT study). Jpn J Clin Oncol 2021; 51:999-1003. [PMID: 33772279 DOI: 10.1093/jjco/hyab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
The standard treatment for pathological N2 Stage III non-small cell lung cancer with negative surgical margins in Japan is cisplatin-based adjuvant chemotherapy. However, recent studies suggest that the addition of thoracic radiotherapy after adjuvant chemotherapy prolongs survival. While thoracic radiotherapy is considered to prolong survival by improving locoregional control, it is known to increase radiation-induced adverse events. We began a randomized controlled trial in January 2021 in Japan to confirm the superiority of radiotherapy over observation after adjuvant chemotherapy in pathological N2 Stage III non-small cell lung cancer patients with negative surgical margins. We aim to accrue 330 patients from 47 institutions over 5 years. The primary endpoint is relapse-free survival; the secondary endpoints are overall survival, proportion of patients completing radiotherapy in the radiotherapy arm, early adverse events, late adverse events in the radiotherapy arm, serious adverse events and local recurrence.
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Affiliation(s)
- Ryo Shimoyama
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Ishikura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Masashi Wakabayashi
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tomonari Sasaki
- Division of Medical Quantum Science, Department of Health Sciences, Kyushu University Faculty of Medical Sciences, Fukuoka, Japan
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Tadayoshi Hashimoto
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Kataoka
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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