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Morishita N, Miura M, Kobayashi Y, Matsunaga R, Maeda T, Ochi M, Horiuchi T. P-039 Male age is associated with sperm DNA integrity: Selection of high DNA integrity sperm by microfluidics sorting is critical to clinical outcomes in older patients. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.036] [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
Study question
Does sperm DNA integrity affect clinical outcomes of ICSI?
Summary answer
Use of high DNA integrity sperm selected by microfluidics sperm sorting results in lower miscarriage rates in the patients of 39-years old and more.
What is known already
High sperm DNA damage is associated with decreased normal fertilization, embryo development and pregnancy rates, and an increased miscarriage rate. On the other hand, oocytes from older women have decreased pregnancy rate, and increased miscarriage rate because of possibility of low ability to repair sperm with DNA fragmentation, and dramatical increases of aneuploidy as women age. A microfluidic sperm selection chamber (MSS, ZyMōt™; DxNow) is a device designed to collect sperm with higher chromatin integrity than density gradient centrifugation (DGC).
Study design, size, duration
Sperm analysis was performed by sperm chromatin dispersion (SCD) test and comet assay in the same sample of 15 cases between October 2020 and February 2021. ICSI outcomes by DGC and MSS were compared with blastocyst development, and pregnancy rates in vitrified-thawed single blastocyst transfers cycle for 518 cases between August 2018 and May 2021.
Participants/materials, setting, methods
SCD test was optimized as a rapid procedure, with sperm showing a halo deemed normal, and those without a halo abnormal. Comet assay results were analyzed using CometScore 2.0, with comparison of %Tail DNA. ICSI outcomes were analyzed using multiple logistics regressions of male and female ages.
Main results and the role of chance
We found a positive correlation between male age and sperm DNA fragmentation rates in raw semen using SCD test (r = 0.70) and Comet assay (r = 0.42). Higher DNA integrity sperm could select using MSS than DGC. In this study with ICSI outcomes, 170 of 318 (53.5%) blastocyst transfers resulted in pregnancy, and 49 (28.8%) subsequently miscarried. The data were classified according to less than or more than 39 years old of male age detected by multiple logistics regressions. In patients with ≥39 years of male age, the female age was significantly higher and blastocyst and pregnancy rates were significantly lower, and the miscarriage rate was significantly higher than <39 years of male age. Since sperm DNA fragmentation increased in accordance with male age, we compared MSS and DGC in the patients with male age ≥39 years. There was no significant difference in blastocyst, pregnancy, and miscarriage rates in female age <39 years. While in ≥ 39 years of female age, blastocyst and pregnancy rates in MSS were not significantly different from DGC, but the miscarriage rate in MSS was significantly lower than in DGC (27.3 vs. 57.1%).
Limitations, reasons for caution
The sample size for each study was small. Analysis of sperm DNA fragmentation and samples in ICSI outcomes were not the same. The retrospective nature of ICSI outcomes in this study does not allow controlling of unknown confounders.
Wider implications of the findings
Sperm DNA fragmentation depended on male age affected fertility outcomes. However, when male age is higher, masking the effect of male age by female age. In this study, we found out the improvement of ICSI outcome by using high DNA integrity sperm selected by MSS in both ≥39 years.
Trial registration number
Not applicable
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Affiliation(s)
- N Morishita
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
| | - M Miura
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
| | - Y Kobayashi
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
| | - R Matsunaga
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
| | - T Maeda
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
| | - M Ochi
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
| | - T Horiuchi
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
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Hirashima T, Noda Y, Suzuki H, Nasu S, Tanaka A, Morishita N, Ryota N, Iwata K, Okada Y, Okamoto N. Extracellular Water-to-total Body Water Ratio as an Objective Biomarker for Frailty in Lung Cancer Patients. Anticancer Res 2021; 41:1655-1662. [PMID: 33788762 DOI: 10.21873/anticanres.14928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/15/2021] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Our previous study revealed the association between extracellular water-to-total body water ratio (ECW/TBW) and the therapeutic durability of chemotherapy and/or immune checkpoint inhibitors in advanced lung cancer. We retrospectively examined the usefulness of ECW/TBW in detecting frailty compared to other bioelectrical impedance (BIA) parameters in a larger number of patients. PATIENTS AND METHODS Lung cancer patients underwent BIA before anti-cancer therapy at our hospital between June 1, 2018 and July 31, 2020. RESULTS Of 99 patients, 26 were assigned to ECW/TBW≥0.4 (higher group: HG) and 57 to ECW/TBW<0.4 (lower group: LG). ECW/TBW increased significantly with performance deterioration and ageing. HG patients had significantly shorter time-to-treatment failure (TTF) than LG patients. In patients with performance status 0-1, those in the HG had shorter TTF than those in the LG. ECW/TBW was the only independent predictor of TTF according to multivariate analysis. CONCLUSION ECW/TBW is an objective biomarker for detecting frailty among lung cancer patients.
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Affiliation(s)
- Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan;
| | - Yoshimi Noda
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan.,Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Noriko Ryota
- Department of Nursing, Osaka Habikino Medical Center, Osaka, Japan
| | - Kaori Iwata
- Department of Nursing, Osaka Habikino Medical Center, Osaka, Japan
| | - Yukari Okada
- Department of Nursing, Osaka Habikino Medical Center, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
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Nasu S, Kawahara K, Han Y, Okamoto N, Tamura Y, Suzuki H, Shiroyama T, Samejima Y, Kanai T, Noda Y, Tanaka A, Morishita N, Ueda K, Hashimoto S, Hirashima T, Nagai T. Transbronchial Cryobiopsy for Miliary Tuberculosis Mimicking Hypersensitivity Pneumonitis. Intern Med 2021; 60:445-448. [PMID: 32963150 PMCID: PMC7925263 DOI: 10.2169/internalmedicine.4511-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Miliary tuberculosis is a potentially lethal type of tuberculosis that results from the hematogenous dissemination of Mycobacterium tuberculosis bacilli. We herein describe the case of a 34-year-old man that presented with a one-month history of cough and fever, while his sputum smear results were negative. Chest computed tomography revealed bilateral centrilobular ground-glass opacification (GGO), suggestive of hypersensitivity pneumonitis; thus, bronchoscopy was performed. Cryobiopsy specimens revealed necrotic granulomas. A re-examination of sputum after bronchoscopy identified Mycobacterium tuberculosis, and miliary tuberculosis was diagnosed. A cryobiopsy might be useful for diagnosing miliary tuberculosis pathologically, particularly when miliary nodules may be masked by GGO.
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Affiliation(s)
- Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Kunimitsu Kawahara
- Department of Pathology Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Japan
| | - Yuki Han
- Department of Infectious Diseases, Osaka Habikino Medical Center, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Yoshitaka Tamura
- Department of Infectious Diseases, Osaka Habikino Medical Center, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | | | - Yumiko Samejima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Tomohiro Kanai
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Yoshimi Noda
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Kayo Ueda
- Department of Pathology Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Japan
| | - Shoji Hashimoto
- Department of Infectious Diseases, Osaka Habikino Medical Center, Japan
| | | | - Takayuki Nagai
- Department of Infectious Diseases, Osaka Habikino Medical Center, Japan
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Hirashima T, Kanai T, Suzuki H, Yoshida H, Matsusita A, Kawasumi H, Nasu S, Tanaka A, Morishita N, Kawahara K, Tamura Y, Okamoto N. Significance of Pre-treatment Interferon-gamma Release in Patients With Non-small-cell Lung Cancer Receiving Immune Checkpoint Inhibitors. Anticancer Res 2020; 40:6971-6978. [PMID: 33288591 DOI: 10.21873/anticanres.14721] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We retrospectively investigated the significance of pre-treatment interferon-gamma release (IGR) as a biomarker for predicting the efficacy of immune checkpoint inhibitor treatment (ICI-tx). PATIENTS AND METHODS This study included non-small-cell lung cancer patients who received ICI-tx between January 1, 2016 and April 30, 2019. IGR was measured using the positive control of an enzyme-linked immunosorbent assay. We defined the pre-treatment cut-off level of IGR as 10 IU/ml. RESULTS Fifty-four patients were divided into two groups; those with an IGR ≤10 IU/ml (lower group: LG) (n=15) and those with >10 IU/ml (higher group: HG) (n=39). The time to treatment failure (TTF) in the HG was significantly longer than that in the LG. In multivariate analyses, C-reactive protein and IGR levels were significant risk factors for TTF. CONCLUSION Pre-treatment IGR level of >10 IU/ml is recommended to identify those patients who will respond favourably to ICI-tx.
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Affiliation(s)
- Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Tomohiro Kanai
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan.,Department of Respiratory Medicine. Osaka General Medical Center, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hiroko Yoshida
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Akane Matsusita
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Hiromi Kawasumi
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Kunimitsu Kawahara
- Department of Clinical Pathology, Osaka Habikino Medical Center, Osaka, Japan
| | - Yoshitaka Tamura
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
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Samejima Y, Iuchi A, Kanai T, Noda Y, Nasu S, Tanaka A, Morishita N, Suzuki H, Okamoto N, Harada H, Ezumi A, Ueda K, Kawahara K, Hirashima T. Development of Severe Heart Failure in a Patient with Squamous Non-small-cell Lung Cancer During Nivolumab Treatment. Intern Med 2020; 59:2003-2008. [PMID: 32448839 PMCID: PMC7492128 DOI: 10.2169/internalmedicine.4550-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Cardiac side effects associated with immune checkpoint inhibitors (ICIs) are an uncommon but serious complication with a relatively high mortality. We experienced a case of cardiomyopathy induced by nivolumab. Echocardiography showed diffuse hypo-kinesis of the left ventricular cardiac wall and a significant decrease in the ejection fraction, like dilated cardiomyopathy. The myocardial biopsy showed non-inflammatory change; cardiac function gradually improved after treatment of acute heart failure without a corticosteroid. Although non-inflammatory left ventricular dysfunction induced by ICIs is rare, it is a reported cardiovascular toxicity. Physicians should consider this complication when treating patients with ICIs for malignant diseases.
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Affiliation(s)
- Yumiko Samejima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Atsuhiko Iuchi
- Department of Cardiovascular Medicine, Osaka Habikino Medical Center, Japan
| | - Tomohiro Kanai
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Yoshimi Noda
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Hiroshi Harada
- Department of Cardiovascular Medicine, Osaka Habikino Medical Center, Japan
| | - Akira Ezumi
- Department of Cardiovascular Medicine, Osaka Habikino Medical Center, Japan
| | - Kayo Ueda
- Department of Clinical Pathology, Osaka Habikino Medical Center, Japan
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Noda Y, Suzuki H, Kanai T, Samejima Y, Nasu S, Tanaka A, Morishita N, Okamoto N, Hirashima T. The Association Between Extracellular Water-to-Total Body Water Ratio and Therapeutic Durability for Advanced Lung Cancer. Anticancer Res 2020; 40:3931-3937. [PMID: 32620634 DOI: 10.21873/anticanres.14384] [Citation(s) in RCA: 14] [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: 04/19/2020] [Revised: 04/23/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Extracellular water-to-total body water ratio (ECW/TBW) measured by bioelectrical impedance analysis (BIA) reportedly predicts clinical outcomes of various diseases. The aim of this retrospective study was to examine the association between ECW/TBW and therapeutic durability of chemotherapy and/or immune checkpoint inhibitors in advanced lung cancer. PATIENTS AND METHODS Patients with advanced lung cancer underwent BIA before chemotherapy and/or treatment with immune checkpoint inhibitors at our hospital between June 2018 and November 2019. RESULTS Of 75 patients, 18 with ECW/TBW ≥0.4 were assigned to the overhydrated group (OH-G) and 57 patients ECW/TBW <0.4 were assigned to the non-overhydrated group (NOH-G). The median time-to-treatment failure was significantly shorter in the OH-G than in the NOH-G (p=0.003). Multivariate analysis revealed that ECW/TBW ≥0.4 predicted treatment failure [hazard ratio (HR)=2.508, 95% confidence interval (CI)=1.19-5.27; p=0.01]. CONCLUSION The ECW/TBW may be an objective parameter for predicting therapeutic durability in advanced lung cancer.
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Affiliation(s)
- Yoshimi Noda
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Tomohiro Kanai
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Yumiko Samejima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
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Nasu S, Suzuki H, Shiroyama T, Tanaka A, Samejima Y, Kanai T, Noda Y, Morishita N, Okamoto N, Hirashima T. Safety and efficacy of afatinib for the treatment of non-small-cell lung cancer following osimertinib-induced interstitial lung disease: A retrospective study. Invest New Drugs 2020; 38:1915-1920. [PMID: 32542461 DOI: 10.1007/s10637-020-00963-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/11/2020] [Indexed: 12/28/2022]
Abstract
Background Osimertinib is one of the first-line treatments for advanced non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. However, the occurrence rate of osimertinib-induced interstitial lung disease (ILD) is particularly high in Japanese patients and little information on subsequent cancer treatment options after recovery from osimertinib-induced ILD is currently available. Thus, this study aims to determine the safety and efficacy of afatinib for the treatment of NSCLC following osimertinib-induced ILD. Methods We retrospectively investigated the clinical courses of all NSCLC patients with EGFR mutations at our facility between August 2018 and September 2019, who received osimertinib as first-line treatment and were subsequently treated with afatinib after developing osimertinib-induced ILD. Results Forty-two patients received osimertinib treatment at our facility during the study period, and four patients received afatinib after developing osimertinib-induced ILD. All events of ILD improved either spontaneously or with steroid therapy before the initiation of afatinib. For the four patients who were retrospectively reviewed, the overall response rate to afatinib therapy was 75%, and the disease control rate was 100%. During the study period, no ILD recurrence was observed in any of the four patients. Conclusions According to our study findings, afatinib treatment after osimertinib-induced ILD is considered safe and effective and it can be used as one of the treatment options for NSCLC following osimertinib-induced ILD.
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Affiliation(s)
- Shingo Nasu
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583- 8588, Japan.
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583- 8588, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583- 8588, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583- 8588, Japan
| | - Yumiko Samejima
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583- 8588, Japan
| | - Tomohiro Kanai
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583- 8588, Japan
| | - Yoshimi Noda
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583- 8588, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583- 8588, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583- 8588, Japan
| | - Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583- 8588, Japan
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Kanai T, Suzuki H, Yoshida H, Matsushita A, Kawasumi H, Samejima Y, Noda Y, Nasu S, Tanaka A, Morishita N, Hashimoto S, Kawahara K, Tamura Y, Okamoto N, Tanaka T, Hirashima T. Significance of Quantitative Interferon-gamma Levels in Non-small-cell Lung Cancer Patients' Response to Immune Checkpoint Inhibitors. Anticancer Res 2020; 40:2787-2793. [PMID: 32366425 DOI: 10.21873/anticanres.14251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/23/2020] [Accepted: 03/26/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We aimed to study the association between the quantitative interferon-gamma (IFN-γ) levels and clinical outcomes in non-small-cell lung cancer (NSCLC) patients receiving immune checkpoint inhibitors (ICIs). PATIENTS AND METHODS Sample collection for IFN-γ release assay (IGRA) was performed within 14 days before treatment (T1), on day 22±7 (T3), and on day 43±7 (T4). The stored specimens over 10 IU/ml in IGRA were re-examined using the dilution method (with saline as the dilution medium). The patients were classified into Lower and Higher groups by 7.06 IU/ml as a cut-off of IFN-γ levels at T1. RESULTS Median progression-free survival in the Higher group was significantly longer than that in the Lower group. IFN-γ levels in the non-progression disease group were significantly higher than those in the progression disease group. IFN-γ levels at T1 in patients with immune-related adverse events were significantly lower compared to those at T3. CONCLUSION IFN-γ could be a biomarker for NSCLC patients receiving ICIs.
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Affiliation(s)
- Tomohiro Kanai
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hiroko Yoshida
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Akane Matsushita
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Hiromi Kawasumi
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Yumiko Samejima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Yoshimi Noda
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Shoji Hashimoto
- Department of Allergy, Osaka Habikino Medical Center, Osaka, Japan
| | - Kunimitsu Kawahara
- Department of Clinical Pathology, Osaka Habikino Medical Center, Osaka, Japan
| | - Yoshitaka Tamura
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Toshio Tanaka
- Department of Allergy, Osaka Habikino Medical Center, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
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Hirashima T, Kanai T, Suzuki H, Yoshida H, Matsushita A, Kawasumi H, Samejima Y, Noda Y, Nasu S, Tanaka A, Morishita N, Hashimoto S, Kawahara K, Tamura Y, Okamoto N, Tanaka T. The Levels of Interferon-gamma Release as a Biomarker for Non-small-cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors. Anticancer Res 2019; 39:6231-6240. [PMID: 31704852 DOI: 10.21873/anticanres.13832] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The present study aimed to prospectively examine the usefulness of interferon-gamma (IFN-γ) release (IGR) as a biomarker in non-small-cell lung cancer patients receiving immune checkpoint inhibitor treatment (ICI-Tx). PATIENTS AND METHODS IGR was measured using enzyme-linked immunosorbent assay at four time points: within 14 days before ICI-Tx (T1), and 8±3 (T2), 22±7 (T3), and 43±7 (T4) days after ICI-Tx. RESULTS Twenty-nine patients were divided into three groups based on IFN-γ levels in the IGR-positive control: Group-1 (n=8) with <10 IU/ml at T1, Group-2 (n=12) with a decrease in IFN-γ levels to <10 IU/ml at T3 and/or T4, and Group-3 (n=9) without changes in IFN-γ levels. Early progression and ICI-induced interstitial pneumonitis were frequently observed in Group-1 and Group-2, respectively. Group-3 exhibited more treatment cycles than the other groups. All three groups showed clear differences in clinical outcomes. CONCLUSION IFN-γ levels could be a biomarker for ICI-Tx.
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Affiliation(s)
- Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Tomohiro Kanai
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hiroko Yoshida
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Akane Matsushita
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Hiromi Kawasumi
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Yumiko Samejima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Yoshimi Noda
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Shoji Hashimoto
- Department of Allergy, Osaka Habikino Medical Center, Osaka, Japan
| | - Kunimitsu Kawahara
- Department of Clinical Pathology, Osaka Habikino Medical Center, Osaka, Japan
| | - Yoshitaka Tamura
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Toshio Tanaka
- Department of Allergy, Osaka Habikino Medical Center, Osaka, Japan
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Nasu S, Okamoto N, Suzuki H, Shiroyama T, Tanaka A, Samejima Y, Kanai T, Noda Y, Morita S, Morishita N, Ueda K, Kawahara K, Hirashima T. Comparison of the Utilities of Cryobiopsy and Forceps Biopsy for Peripheral Lung Cancer. Anticancer Res 2019; 39:5683-5688. [PMID: 31570467 DOI: 10.21873/anticanres.13766] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study aimed to compare the efficacies of cryobiopsy and forceps biopsy for peripheral lung cancer detection. PATIENTS AND METHODS A retrospective review of peripheral lung cancer cases between December 2017 and April 2019 was conducted. Forceps biopsy was performed followed by cryobiopsy using a guide sheath (GS). Diagnostic yields were compared between cryobiopsy and forceps biopsy. RESULTS A total of 53 lung cancer lesions were evaluated. The diagnostic yields of forceps biopsy and cryobiopsy were 86.8% and 81.1%, respectively. Univariate and multivariate analyses indicated that cryobiopsy with a GS was significantly associated with increased diagnostic yield (odds ratio(OR)=11.6; p=0.044). Among the four patients who tested positive on cryobiopsy and negative on forceps biopsy, one had diffused pulmonary metastases and the others showed intratumoural air bronchograms. CONCLUSION Cryobiopsy using a GS can significantly increase diagnostic yield and help identify lesions with intratumoural air bronchograms and external wall lesions.
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Affiliation(s)
- Shingo Nasu
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
| | - Yumiko Samejima
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
| | - Tomohiro Kanai
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
| | - Yoshimi Noda
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
| | - Satomu Morita
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
| | - Kayo Ueda
- Department of Pathology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
| | - Kunimitsu Kawahara
- Department of Pathology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Osaka, Japan
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Masuhiro K, Koh G, Takata S, Nasu S, Takada H, Morita S, Tanaka A, Shiroyama T, Morishita N, Suzuki H, Okamoto N, Kawasumi H, Konishi C, Hirashima T. A case of successful concurrent anti-cancer treatment in a patient who developed follicular lymphoma during treatment with afatinib for advanced lung adenocarcinoma. Respir Med Case Rep 2019; 28:100862. [PMID: 31194139 PMCID: PMC6554495 DOI: 10.1016/j.rmcr.2019.100862] [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: 02/12/2019] [Revised: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022] Open
Abstract
The present report describes the case of a 64-year-old woman with advanced lung adenocarcinoma expressing mutant epidermal growth factor receptor (EGFR). The patient developed follicular lymphoma during treatment with the EGFR-tyrosine kinase inhibitor afatinib. Standard immunochemotherapy for follicular lymphoma was introduced in addition to continuing treatment with afatinib for lung cancer. Immunochemotherapy was effective and improved the patient's performance status while afatinib controlled the progression of lung cancer. Our case study suggests that it is safe to introduce standard immunochemotherapy for patients who develop malignant lymphoma while continuing treatment with tyrosine kinase inhibitors for lung adenocarcinoma expressing mutant EGFR.
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Key Words
- ALK, anaplastic lymphoma kinase
- Afatinib
- CT, computed tomography
- Double primary malignant tumors
- EGFR-TKIs, epidermal growth factor receptor-tyrosine kinase inhibitors
- FL, follicular lymphoma
- Follicular lymphoma
- LAD, lung adenocarcinoma
- Lung cancer
- Metachronous
- NSCLC, non-small cell lung cancer
- R-CHOP, cyclophosphamide, doxorubicin, vincristine, predonisone with rituximab
- Synchronous
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Affiliation(s)
- Kentaro Masuhiro
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Genju Koh
- Department of Oncology, Yao Tokushukai General Hospital, Osaka, Japan
| | - So Takata
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hiromune Takada
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Satomu Morita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hiromi Kawasumi
- Department of Clinical Laboratory, Osaka Habikino Medical Center, Osaka, Japan
| | - Chihiro Konishi
- Department of Pharmacy, Yao Tokushukai General Hospital, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
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12
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Nasu S, Suzuki H, Moriizumi K, Hara Y, Tanaka S, Takada H, Morita S, Tanaka A, Shiroyama T, Morishita N, Okamoto N, Hirashima T. Re-challenge chemotherapy in patients with sensitive relapse small-cell lung cancer and interstitial lung disease. J Thorac Dis 2019; 11:514-520. [PMID: 30962995 DOI: 10.21037/jtd.2019.01.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Treatment modalities for small-cell lung cancer (SCLC) with pre-existing interstitial lung disease (ILD) are limited. Although re-challenge with first-line chemotherapy can be effective for sensitive relapse SCLC, its safety and efficacy are uncertain in cases with ILD. This study aimed to investigate both the efficacy and safety of re-challenge chemotherapy in patients with sensitive relapse SCLC with ILD. Methods Patients with sensitive relapse SCLC with ILD who received re-challenge chemotherapy were studied retrospectively. Sensitive relapse was defined as a treatment-free interval (TFI) of more than 60 days after first-line platinum-based treatment. The endpoints were progression-free survival (PFS), overall survival (OS), and safety. Results Re-challenge platinum and etoposide were administered in 11 patients, with the median re-challenge cycle of 3. The overall response rate was 55%. The median PFS and OS from the time of re-challenge treatment were 4 months (95% CI, 2.9-NA) and 9.2 months (95% CI, 8.0-NA), respectively. One patient developed acute exacerbation of ILD 173 days after the last course of re-challenge treatment. Conclusions Re-challenge chemotherapy can be effective and considered in SCLC patients with pre-existing ILD.
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Affiliation(s)
- Shingo Nasu
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Kazunori Moriizumi
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Yuki Hara
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Satoshi Tanaka
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Hiromune Takada
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Satomu Morita
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
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13
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Nasu S, Shiroyama T, Morita S, Takata S, Takada H, Masuhiro K, Tanaka A, Morishita N, Suzuki H, Okamoto N, Hirashima T. Osimertinib Treatment Was Unsuccessful for Lung Adenocarcinoma with G719S, S768I, and T790M Mutations. Intern Med 2018; 57:3643-3645. [PMID: 30146570 PMCID: PMC6355418 DOI: 10.2169/internalmedicine.0923-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Epidermal growth factor receptor (EGFR) T790M mutations are the most frequent mechanism of resistance to first- and second-generation tyrosine kinase inhibitors, and osimertinib is an effective treatment for patients with both EGFR-activating mutations and T790M resistance mutations. We describe the case of a 68-year-old woman with lung adenocarcinoma with G719S, S768I, and T790M mutations in which osimertinib treatment was unsuccessful. The patient died of disease progression one month after discontinuing osimertinib treatment. This case suggests that osimertinib may be ineffective for treating patients with uncommon mutations such as G719S when the patient has also acquired a T790M resistance mutation.
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Affiliation(s)
- Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | | | - Satomu Morita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - So Takata
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Hiromune Takada
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Kentaro Masuhiro
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
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14
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Hirashima T, Tamura Y, Han Y, Hashimoto S, Tanaka A, Shiroyama T, Morishita N, Suzuki H, Okamoto N, Akada S, Fujishima M, Kadota Y, Sakata K, Nishitani A, Miyazaki S, Nagai T. Efficacy and safety of concurrent anti-Cancer and anti-tuberculosis chemotherapy in Cancer patients with active Mycobacterium tuberculosis: a retrospective study. BMC Cancer 2018; 18:975. [PMID: 30314434 PMCID: PMC6186130 DOI: 10.1186/s12885-018-4889-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 10/02/2018] [Indexed: 12/18/2022] Open
Abstract
Background In our previous study, colorectal cancer (CRC) patients with active Mycobacterium tuberculosis (MTB) tolerated concurrent anti-cancer chemotherapy (anti-CCT) and anti-MTB chemotherapy. In this study, we retrospectively confirmed the efficacy and safety of concurrent chemotherapy in a greater number of patients with different types of malignancies. Methods We enrolled 30 patients who were treated concurrently with anti-CCT and anti-MTB regimens between January 2006 and February 2016. Cancer and MTB treatments were administered according to the approved guidelines. Results Patient demographics included: men/woman: 24/6; median age: 66.5 years; Eastern Cooperative Oncology Group performance status 0–1/2/3–4: 24/4/2; Stage IIB–IIIC/IV/recurrence: 6/22/2; lung cancer (LC)/CRC/other: 15/10/5; and MTB diagnosis (before or during anti-CCT): 20/10 (LC: 8/7; CRC: 8/2; other: 4/1). For anti-CCT, 23 patients received two cytotoxic agents with or without targeted agents and 7 patients received a single cytotoxic or targeted agent. The overall response rate was 36.7%. Regarding anti-MTB chemotherapy, 22 patients received a daily drug combination containing isoniazid, rifampicin, and ethambutol, plus pyrazinamide in 15 of the 22 patients, followed by daily isoniazid and rifampicin; the remaining 8 patients received other combinations. Hematological adverse events of Grade ≥ 3 were observed in 19 (67.9%) of 28 patients; laboratory data were lost for the remaining 2. Grade 3 lymphopenia and higher were significantly more frequent in LC compared to other malignancies (P < 0.005). Non-hematological adverse events of Grade ≥ 3 were observed in 5 (16.7%) of 30 patients. One CRC patient experienced Grade 3 hemoptysis and another 2 experienced Grade 3 anaphylaxis. One patient with cholangiocellular carcinoma and gastric cancer experienced Grade 3 pseudomembranous colitis as a result of a Clostridium difficile infection. One patient (3.3%) died of pemetrexed-induced pneumonitis. The success of the anti-MTB chemotherapy was 70.0%. There were no MTB-related treatment failures. The median overall survival (months, 95.0% confidence interval) was 10.5 (8.7–36.7), 8.7 (4.7–10.0), 36.7 (minimum 2.2), and 14.4 (minimum 9.6) for all patients combined, LC, CRC, and Other malignancies, respectively. LC patients experienced delayed MTB diagnosis and shorter overall survival. Conclusions Concurrent chemotherapy is effective and safe for treating cancer patients with active MTB.
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Affiliation(s)
- Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan.
| | - Yoshitaka Tamura
- Departments of Clinical Laboratory, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Yuki Han
- Departments of Infectious Diseases, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Shoji Hashimoto
- Departments of Infectious Diseases, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Oncology, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Shinobu Akada
- Departments of Gynecology, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Makoto Fujishima
- Departments of Breast Surgery, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Yoshihisa Kadota
- Departments of Thoracic Surgery, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Kazuya Sakata
- Departments of Gastroenterological Surgery, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Akiko Nishitani
- Departments of Gastroenterological Surgery, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Satoru Miyazaki
- Departments of Gastroenterological Surgery, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Takayuki Nagai
- Departments of Infectious Diseases, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan
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15
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Masuhiro K, Shiroyama T, Suzuki H, Takata SO, Nasu S, Takada H, Morita S, Tanaka A, Morishita N, Okamoto N, Hirashima T. Impact of Pleural Effusion on Outcomes of Patients Receiving Osimertinib for NSCLC Harboring EGFR T790M. Anticancer Res 2018; 38:3567-3571. [PMID: 29848711 DOI: 10.21873/anticanres.12629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Osimertinib has demonstrated promising efficacy in patients with epidermal growth factor receptor (EGFR) T790M-positive non-small cell lung cancer (NSCLC). We investigated the efficacy of osimertinib in such patients presenting with pleural effusion, which has been unclear to date. PATIENTS AND METHODS The medical records of all patients treated with osimertinib for advanced NSCLC with EGFR T790M between April 2016 and July 2017 at our Institution were retrospectively reviewed. Time to treatment failure (TTF) and overall survival (OS) were determined as endpoints. RESULTS Twenty-three patients (seven with pleural effusions) were treated with osimertinib. Patients with pleural effusion had significantly shorter median TTF than those without (3.7 vs. 12.8 months, respectively, p=0.021), as well as shorter median OS (7.8 months vs. not attained, respectively, p=0.002). Metastasis to the brain, bone, and liver did not significantly influence our endpoints. CONCLUSION Osimertinib monotherapy is less effective in patients with NSCLC with pleural effusions.
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Affiliation(s)
- Kentaro Masuhiro
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan
| | - S O Takata
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan
| | - Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan
| | - Hiromune Takada
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan
| | - Satomu Morita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan
| | - Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Japan
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16
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Tamiya M, Suzuki H, Shiroyama T, Tanaka A, Morishita N, Okamoto N, Sakai K, Shigeoka H, Kawahara K, Hirashima T. Clinical predictors of bevacizumab-associated intestinal perforation in non-small cell lung cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Habikino Medical Center, Habikino, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Habikino Medical Center, Habikino, Japan
| | - Ayako Tanaka
- Department of Thoracic Malignancy, Osaka Habikino Medical Center, Habikino, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Habikino Medical Center, Habikino, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Habikino Medical Center, Habikino, Japan
| | - Kenichi Sakai
- Department of Surgery, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Hironori Shigeoka
- Department of Emergency & Critical Care Medicine, Kindai University Faculty of Medicine, Sayama, Japan
| | | | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Habikino Medical Center, Habikino, Japan
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17
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Nasu S, Suzuki H, Shiroyama T, Tanaka A, Iwata K, Ryota N, Ueda Y, Takata SO, Masuhiro K, Morita S, Morishita N, Okamoto N, Hirashima T. Skin Rash Can Be a Useful Marker for Afatinib Efficacy. Anticancer Res 2018; 38:1783-1788. [PMID: 29491117 DOI: 10.21873/anticanres.12416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 01/18/2018] [Accepted: 01/24/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Although afatinib has a strong efficacy, it can be toxic; hence, we aimed to determine markers of response to afatinib in order to assess prognosis. PATIENTS AND METHODS Information on clinical background, therapeutic effects, and adverse events was collected retrospectively at one Institution from patients treated with afatinib as initial epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI). We examined the relationship between different adverse events and their effects on prognosis. RESULTS Afatinib was used in 32 patients as the initial EGFR-TKI. Adverse events of grade 3 or higher including diarrhoea (12.5%), paronychia (6.3%), and stomatitis (3.1%) were experienced by patients. The median progression-free survival (PFS) was 15.4 months. A relationship between skin rash severity and PFS was observed. CONCLUSION Grade 2 or higher skin rash might be a marker for long-term efficacy of afatinib when administered as a first-line treatment.
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Affiliation(s)
- Shingo Nasu
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Kaori Iwata
- Department of Nursing, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Noriko Ryota
- Department of Nursing, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Yuki Ueda
- Department of Pharmacy, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - S O Takata
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Kentaro Masuhiro
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Satomu Morita
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka, Japan
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18
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Shiroyama T, Nasu S, Tanaka A, Takata S, Masuhiro K, Takada H, Morita S, Morishita N, Suzuki H, Okamoto N, Kawahara K, Hirashima T. Transformation to small cell lung cancer after first-line afatinib treatment. Respir Med Case Rep 2018; 23:188-190. [PMID: 29719814 PMCID: PMC5925950 DOI: 10.1016/j.rmcr.2018.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/28/2018] [Indexed: 11/18/2022] Open
Abstract
Acquiring resistance to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) is inevitable. Transformation to small cell lung cancer (SCLC) is reported as a possible mechanism of this acquired resistance. We describe the case of a 35-year-old man with lung adenocarcinoma harboring EGFR exon 19 deletion. After 7 months of successful treatment with afatinib, he experienced relapse and rebiopsy revealed SCLC with EGFR exon 19 deletion. Tumor marker tests at this point showed normal levels of serum neuron-specific enolase and pro-gastrin releasing peptide. Our case highlights the importance of rebiopsy for revealing SCLC transformation, a potential mechanism of acquired resistance to afatinib as with other EGFR-TKIs, and normal-range values of tumor markers for SCLC cannot exclude the possibility of SCLC transformation.
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Affiliation(s)
- Takayuki Shiroyama
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
- Corresponding author. Department of Thoracic Oncology, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino City, Osaka, 583-8588, Japan.
| | - Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - So Takata
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Kentaro Masuhiro
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hiromune Takada
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Satomu Morita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | | | - Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
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Satoh S, Shiroyama T, Tamiya M, Nasu S, Tanaka A, Morita S, Morishita N, Suzuki H, Okamoto N, Hirashima T. Successful osimertinib rechallenge after osimertinib-induced pneumonitis in a patient with lung adenocarcinoma. Respir Med Case Rep 2017; 23:68-70. [PMID: 29487786 PMCID: PMC5805846 DOI: 10.1016/j.rmcr.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/06/2017] [Accepted: 12/09/2017] [Indexed: 11/25/2022] Open
Abstract
Pneumonitis is a serious adverse event of EGFR-TKI treatment. Although several cases of EGFR-TKI rechallenge after EGFR-TKI-induced pneumonitis have been reported, little is known about post-pneumonitis osimertinib rechallenge. We describe a 69-year-old never-smoking Japanese woman with postoperative recurrent lung adenocarcinoma retreated with osimertinib after osimertinib-induced pneumonitis. Although osimertinib rechallenge must be carefully chosen based on risk/benefit analysis, osimertinib rechallenge after osimertinib-induced pneumonitis may be an option, with limited alternative therapeutic options.
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Affiliation(s)
- Shingo Satoh
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Motohiro Tamiya
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Satomu Morita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
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Tamiya M, Tamiya A, Shiroyama T, Takeoka S, Naito Y, Omachi N, Kimura Y, Morishita N, Suzuki H, Okamoto N, Okishio K, Kawaguchi T, Atagi S, Hirashima T. Phase1 study of cisplatin plus pemetrexed with erlotinib and bevacizumab for chemotherapy-naïve advanced non-squamous non-small cell lung cancer with EGFR mutations. Invest New Drugs 2017; 36:608-614. [PMID: 29101518 DOI: 10.1007/s10637-017-0527-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/22/2017] [Indexed: 12/23/2022]
Abstract
Background Cisplatin and pemetrexed are very effective against advanced non-squamous non-small cell lung cancer (NSCLC) without EGFR mutations. Erlotinib plus bevacizumab are highly effective against advanced NSCLCs with activating EGFR mutations. We performed this phase I 'Quartet Trial' to determine the safety and efficacy of all 4 agents as a first-line treatment for non-squamous NSCLC patients harboring activating EGFR mutations. Patients and Methods Patients received escalating quartet-agent doses every 3 weeks for 4 cycles. We examined the dose-limiting toxicity (DLT) to determine the maximum tolerated dose (MTD) and recommended dose (RD). Results Ten patients (3 men and 7 women) with a median age of 69 years were enrolled. Four and 6 patients had exon 19 and 21 mutations, respectively; 8 received maintenance therapy without unexpected or cumulative toxicities. One of 6 patients experienced grade 3 vagal reflex at 60 mg/m2 cisplatin plus 500 mg/m2 pemetrexed with 150 mg erlotinib and 15 mg/kg bevacizumab, which was designated the RD. Four patients experienced no DLT with 75 mg/m2 cisplatin plus 500 mg/m2 pemetrexed with 150 mg erlotinib and 15 mg/kg bevacizumab (designated the MTD); however, 3 underwent dose reduction due to severe toxicities (grade 3 gastrointestinal hemorrhage, skin rash, nausea, and febrile neutropenia) during induction chemotherapy. The most frequent DLT-phase adverse events were nausea, anorexia, and fatigue. The overall response rate was 100%. Furthermore, the progression-free and overall survival rates were 17.9 and 32.0 months, respectively. Conclusions This quartet chemotherapy regimen was tolerable and effective in our patient population (UMIN000012536).
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Affiliation(s)
- Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, 3-1-69 Otemachi Chuo-ku, Osaka, 541-8567, Japan.
| | - Akihiro Tamiya
- Department of Internal Medicine, Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Sawa Takeoka
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Yujiro Naito
- Department of Internal Medicine, Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Naoki Omachi
- Department of Internal Medicine, Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yohei Kimura
- Department of Internal Medicine, Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Kyoichi Okishio
- Department of Clinical Research Center, Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shinji Atagi
- Department of Clinical Research Center, Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Tomonori Hirashima
- Department of Internal Medicine, Kinki-chuo Chest Medical Center, Sakai, Japan
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Tanaka A, Tamiya A, Tamiya M, Morita S, Shiroyama T, Saijo N, Minomo S, Tsuji T, Takeuchi N, Omachi N, Morishita N, Suzuki H, Okamoto N, Okishio K, Hirashima T, Atagi S. Final analysis of phase II trial of carboplatin, S-1, and gefitinib as first-line triplet chemotherapy for advanced non-small cell lung cancer patients with activating epidermal growth factor receptor mutations. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx671.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Naito M, Naoki Y, Takata S, Ishii S, Taniguchi Y, Saijo N, Tamiya A, Omachi N, Okishio K, Morita S, Tanaka A, Shiroyama T, Morishita N, Suzuki H, Okamoto N, Hirashima T, Atagi S. The efficacy of dose reduced crizotinib for advanced ALK-positive non-small cell lung cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx671.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Tamiya M, Tamiya A, Shiroyama T, Takeoka S, Naito Y, Omachi N, Kimura Y, Morishita N, Suzuki H, Okamoto N, Okishio K, Kawaguchi T, Atagi S, Hirashima T. P3.02b-087 Dose Escalation Study of CDDP plus PEM with Erlotinib and Bev Followed by PEM with Erlotinib and Bev for Non-SQ NSCLC Harboring EGFR Mutations. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1754] [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: 10/20/2022]
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Tamiya M, Shiroyama T, Nishihara T, Nishida T, Hayama M, Tanaka A, Morishita N, Suzuki H, Okamoto N, Hirashima T. Afatinib successfully treated leptomeningeal metastasis during erlotinib treatment in a patient with EGFR-mutant (Exon18:G719S) lung adenocarcinoma as a second-line chemotherapy. Asia Pac J Clin Oncol 2016; 13:e531-e533. [PMID: 28004883 DOI: 10.1111/ajco.12643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/26/2016] [Accepted: 10/03/2016] [Indexed: 11/28/2022]
Abstract
Exon18 mutations are detected in 3.6% of epidermal growth factor receptor mutations. Exon 18 mutations as driver mutations have higher sensitivities in vitro to second-generation (G)-tyrosine kinase inhibitors (TKIs) than to first G- and third G-TKIs at clinically relevant doses. In clinical trial, first G-TKIs have moderate but insufficient efficacy, and afatinib was more active in uncommon epidermal growth factor receptor mutations. Here, we present a case of a woman who was initially prescribed erlotinib for lung adenocarcinoma with an exon18 mutation. She developed a leptomeningeal metastasis during treatment and was switched to afatinib. Subsequently, her symptoms improved and she is currently treated with maintenance afatinib therapy. This report suggests improved efficacy of afatinib compared to erlotinib for refractory leptomeningeal metastasis in exon18 mutation.
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Affiliation(s)
- Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Takashi Nishihara
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Takuji Nishida
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Manabu Hayama
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
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Shiroyama T, Hayama M, Satoh S, Nasu S, Tanaka A, Morita S, Morishita N, Suzuki H, Okamoto N, Hirashima T. Successful retreatment with osimertinib after osimertinib-induced acute pulmonary embolism in a patient with lung adenocarcinoma: A case report. Respir Med Case Rep 2016; 20:25-27. [PMID: 27896061 PMCID: PMC5121160 DOI: 10.1016/j.rmcr.2016.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 10/31/2016] [Accepted: 11/04/2016] [Indexed: 11/16/2022] Open
Abstract
Pulmonary embolism (PE) can be life-threatening, and it is challenging to diagnose because of its nonspecific signs and symptoms. PE is also an important potential risk of osimertinib treatment, however, clinical courses regarding retreatment after osimertinib-induced acute pulmonary embolism remain unclear. We described a 77-year-old woman with postoperative recurrent lung adenocarcinoma who developed osimertinib-induced acute PE. She received apixaban and was later successfully retreated with osimertinib. This case suggests that retreatment with osimertinib after osimertinib-induced acute PE may be a treatment option when alternative therapeutic options are limited.
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Affiliation(s)
- Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Manabu Hayama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Shingo Satoh
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Shingo Nasu
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Satomu Morita
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
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Usui N, Kondo Y, Ryota N, Suzuki H, Okamoto N, Sando M, Tani E, Hamaguchi M, Tanaka A, Tamiya M, Shiroyama T, Morishita N, Tanaka E, Hirashima T. Mandatory dexamethasone strictly monitored by pharmacists reduces the severity of pemetrexed-induced skin rash. Eur J Hosp Pharm 2016; 24:283-285. [PMID: 29308196 PMCID: PMC5739825 DOI: 10.1136/ejhpharm-2016-000957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/09/2016] [Accepted: 07/06/2016] [Indexed: 11/09/2022] Open
Abstract
Objective The present study aimed to retrospectively examine the effectiveness of mandatory dexamethasone (m-DEX) strictly monitored by pharmacists collaborating with medical physicians and nurses for reducing pemetrexed (PEM)-induced skin rash in patients with non-squamous non-small-cell lung cancer (ns-NSCLC). Methods We compared the rash grades during the first cycle of PEM-containing regimens between patients who received m-DEX after February 2012 and those who received dexamethasone (DEX) at their physician's discretion (d-DEX) before January 2012. Results Of 163 patients with ns-NSCLC included in this study, 89 received d-DEX and 74 received m-DEX. The mean DEX doses the night before and the day after PEM administration were significantly higher in the m-DEX group than in the d-DEX group. The frequency of grade ≥2 skin rash was significantly lower in the m-DEX group than in the d-DEX group. Conclusions The use of m-DEX strictly monitored by pharmacists might significantly reduce the severity of PEM-induced skin rash.
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Affiliation(s)
- Naoko Usui
- Department of Pharmacy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Yoko Kondo
- Department of Pharmacy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Noriko Ryota
- Department of Nursing, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Masumi Sando
- Department of Pharmacy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Eriko Tani
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Masanari Hamaguchi
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Emiko Tanaka
- Department of Pharmacy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Osaka, Japan
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Tamiya M, Tamiya A, Yasue T, Nakao K, Omachi N, Shiroyama T, Tani E, Hamaguchi M, Morishita N, Suzuki H, Okamoto N, Okishio K, Kawaguchi T, Atagi S, Hirashima T. Vascular Endothelial Growth Factor in Plasma and Pleural Effusion Is a Biomarker for Outcome After Bevacizumab plus Carboplatin-Paclitaxel Treatment for Non-small Cell Lung Cancer with Malignant Pleural Effusion. Anticancer Res 2016; 36:2939-2944. [PMID: 27272808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/27/2016] [Indexed: 06/06/2023]
Abstract
AIM Malignant effusion is associated with high serum and plasma levels of vascular endothelial growth factor (VEGF). There are no biomarkers of outcome for bevacizumab treatment in patients with malignant pleural effusion (MPE). We previously reported that carboplatin-paclitaxel plus bevacizumab was effective for patients with advanced non-squamous non-small cell lung cancer (NSCLC) and MPE, although we did not evaluate the relationship between treatment outcomes and plasma or pleural effusion levels of VEGF. Therefore, this study evaluated whether plasma or pleural effusion VEGF might predict bevacizumab treatment outcome. PATIENTS AND METHODS We enrolled 23 patients with NSCLC and MPE between September 2010 and June 2012. Plasma VEGF levels were measured in 19 patients and pleural VEGF levels were measured in 22 patients. RESULTS Compared to patients with a low plasma VEGF level, patients with a high level exhibited significantly shorter overall survival (OS: 13.8 vs. 6.5 months, p=0.04), progression-free survival (PFS: 8.7 vs. 4.8 months, p<0.01), and period to re-accumulation of MPE (pPFS: 9.7 vs. 6.2 months, p=0.02). Compared to patients with a low VEGF level in pleural effusion, patients with a high VEGF level exhibited significantly shorter OS (19.6 vs. 6.9 months, p<0.01) and pPFS (9.6 vs. 6.7 months, p=0.04), although there was no significant difference in their PFS (6.6 vs. 5.9 months, p=0.18). CONCLUSION VEGF levels in the plasma and pleural effusion may predict the outcome of bevacizumab treatment in patients with NSCLC and MPE.
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Affiliation(s)
- Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Akihiro Tamiya
- Department of Thoracic Oncology, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Tomomi Yasue
- Clinical Laboratory, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Keiko Nakao
- Department of Thoracic Oncology, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Naoki Omachi
- Department of Thoracic Oncology, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Eriko Tani
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Masanari Hamaguchi
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Kyoichi Okishio
- Clinical Research Center, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shinji Atagi
- Clinical Research Center, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
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Hayama M, Okamoto N, Suzuki H, Tamiya M, Shiroyama T, Tanaka A, Nishida T, Nishihara T, Uehara N, Morishita N, Kawahara K, Hirashima T. Radial endobronchial ultrasound with a guide sheath for diagnosis of peripheral cavitary lung lesions: a retrospective study. BMC Pulm Med 2016; 16:76. [PMID: 27170169 PMCID: PMC4866378 DOI: 10.1186/s12890-016-0244-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background Radial endobronchial ultrasound with a guide sheath (EBUS-GS) has improved the diagnostic outcomes of peripheral lung lesions. However, to our knowledge, reports on the use of EBUS-GS for diagnosis of cavitary lesions are unavailable. Therefore, this study aimed to assess the effectiveness and safety of EBUS-GS for diagnosis of peripheral cavitary lung lesions (PCLLs). Methods This study was a single-institution retrospective review of PCLLs examined by using EBUS-GS between July 2013 and October 2015. The diagnostic results of different EBUS-GS samples, including cytologic, histopathologic, and microbiologic samples, were analysed separately. Results Of 696 radial EBUS procedures performed during the study period, 50 were performed for examination of PCLLs. The overall diagnostic yield for EBUS-GS was 80 % (40/50). Regarding 27 malignant lesions, the diagnostic yields for cytologic and histopathologic samples were 63.0 % (17/27) and 74.1 % (20/27), respectively. Regarding 23 benign lesions, the diagnostic yields for histopathologic and microbiologic samples were 69.6 % (16/23) and 47.8 % (11/23), respectively. Uni- and multivariate analyses indicated that the EBUS probe being within the lesion was the only factor significantly associated with increased diagnostic yield (odds ratio, 7.04; P = 0.03). Although pulmonary infection occurred after the procedure in 1 patient (2.0 %), no other complications, including pneumothorax or significant haemorrhage, were reported. Conclusion EBUS-GS was found to be an effective and safe procedure for diagnosis of PCLLs.
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Affiliation(s)
- Manabu Hayama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan.
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Ayako Tanaka
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Takuji Nishida
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Takashi Nishihara
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Nobuko Uehara
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Kunimitsu Kawahara
- Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
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Shiroyama T, Tamiya M, Hayama M, Nishihara T, Nishida T, Tanaka A, Morishita N, Suzuki H, Okamoto N, Kawahara K, Hirashima T. A heterochronic genetic change from an EGFR mutation to an ALK rearrangement in a patient with lung adenocarcinoma: a case report. J Thorac Dis 2016; 8:E345-8. [PMID: 27162697 DOI: 10.21037/jtd.2016.03.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An 87-year-old man with postoperative recurrent lung adenocarcinoma was treated with gefitinib. At the beginning of treatment, surgically resected archived tumor tissue revealed a deletion in exon 19 of the EGFR gene, but no ALK gene rearrangement. After gefitinib treatment for 9 months, the disease progressed. Bronchoscopic rebiopsy was used to evaluate resistance mechanisms, and revealed lung adenocarcinoma with wild-type EGFR genes and a newly emerged ALK gene rearrangement. Treatment was switched to alectinib and a partial response was achieved within 4 weeks. This is a rare case of heterochronic genetic change to an ALK gene rearrangement in EGFR mutant lung adenocarcinoma.
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Affiliation(s)
- Takayuki Shiroyama
- 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Motohiro Tamiya
- 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Manabu Hayama
- 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Takashi Nishihara
- 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Takuji Nishida
- 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Ayako Tanaka
- 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Naoko Morishita
- 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Hidekazu Suzuki
- 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Norio Okamoto
- 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Kunimitsu Kawahara
- 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Tomonori Hirashima
- 1 Department of Thoracic Malignancy, 2 Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
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30
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Hayama M, Suzuki H, Shiroyama T, Tamiya M, Okamoto N, Tanaka A, Morishita N, Nishida T, Nishihara T, Hirashima T. Chemotherapy for patients with advanced lung cancer receiving long-term oxygen therapy. J Thorac Dis 2016; 8:116-23. [PMID: 26904219 DOI: 10.3978/j.issn.2072-1439.2016.01.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Long-term oxygen therapy (LTOT) is sometimes prescribed for patients with advanced lung cancer who are potential candidates for chemotherapy. The aim of this study was to assess the usefulness of chemotherapy for patients with this disease who require LTOT. METHODS The medical records of 40 patients with advanced lung cancer who received LTOT while undergoing systemic chemotherapy at our institution between January 2009 and December 2014 were retrospectively reviewed. Chemotherapy consisted of cytotoxic or molecular-targeted agents. RESULTS Twenty-four patients had adenocarcinoma, 6 had squamous cell carcinoma, and 10 had small cell lung cancer (SCLC). The median survival time from the date of the first chemotherapy cycle performed in conjunction with LTOT was 194 days. In a multivariate analysis, the only factor significantly associated with better prognosis was the line (first or second) of the first chemotherapy with LTOT (hazard ratio =0.42; 95% confidence interval, 0.18 to 0.94). Among the 40 patients, 10 (25%) received chemotherapy during the last 30 days of their lives, 2 of whom died of chemotherapy-related adverse events. CONCLUSIONS Chemotherapy for patients with advanced lung cancer who receive LTOT may be acceptable if it is the first- or second-line treatment. However, we should be mindful of the potential overuse of chemotherapy and its negative impact on quality of life.
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Affiliation(s)
- Manabu Hayama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Japan
| | - Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Japan
| | - Ayako Tanaka
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Japan
| | - Takuji Nishida
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Japan
| | - Takashi Nishihara
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino City, Japan
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Shiroyama T, Okamoto N, Tamiya M, Hamaguchi M, Tanaka A, Nishida T, Hayama M, Nishihara T, Morishita N, Suzuki H, Hirashima T. Effective Management of Persistent Pneumothorax Using a Thopaz® Digital Drainage System Combined with an Endobronchial Watanabe Spigot. Intern Med 2016; 55:663-5. [PMID: 26984087 DOI: 10.2169/internalmedicine.55.5939] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 72-year-old man with salivary gland cancer and multiple pulmonary metastases suffering from intractable pneumothorax was transferred to our institution; he was inoperable because of a low pulmonary function. A chest tube had been placed more than a month prior to this admission. A digital drainage system was used for 24-h monitoring of air leaks (Thopaz®). Using the Thopaz® system, we performed endoscopic bronchial occlusion using an endobronchial Watanabe spigot (EWS) to reduce air leaks. Finally, the air leaks ceased, and the chest tube was removed five days after EWS placement. We herein report a case of persistent pneumothorax that was successfully treated by endoscopic bronchial EWS placement with the aid of a Thopaz® system.
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Affiliation(s)
- Takayuki Shiroyama
- Department of Thoracic Malignancy, Prefectural Medical Center for Respiratory and Allergic Diseases, Japan
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32
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Nishihara T, Hayama M, Okamoto N, Tanaka A, Nishida T, Shiroyama T, Tamiya M, Morishita N, Suzuki H, Matsuoka H, Hirashima T. Endoscopic Bronchial Occlusion with Silicon Spigots for the Treatment of an Alveolar-pleural Fistula during Anti-tuberculosis Therapy for Tuberculous Empyema. Intern Med 2016; 55:2055-9. [PMID: 27477414 DOI: 10.2169/internalmedicine.55.6672] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A prolonged air leak caused by pulmonary tuberculosis is difficult to treat, and little is known about optimal treatment strategies. We herein report the case of a 60-year-old man who demonstrated tuberculous empyema with a fistula. An air leak from a tuberculous cavity in his left upper lobe persisted for approximately 4 months; surgical repair could not be performed due to a poor physical status and undernourishment. However, the air leak was successfully treated with endobronchial occlusion using two silicone spigots in left B3b and B4, without any adverse effects or aggravation of the infection.
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Affiliation(s)
- Takashi Nishihara
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Japan
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33
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Hamaguchi M, Tamiya M, Tani E, Azuma Y, Tanaka A, Shiroyama T, Morishita N, Suzuki H, Okamoto N, Hirashima T. Nanoparticle albumin-bound paclitaxel as 2nd line chemotherapy for small cell lung cancer with interstitial lung disease. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv472.86] [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: 11/12/2022] Open
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34
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Iwata K, Ryota N, Hikita A, Sando M, Suzuki H, Tamiya M, Azuma Y, Tani E, Hamaguchi M, Tanaka A, Shiroyama T, Morishita N, Okamoto N, Futagami S, Hirashima T. [Retrospective Analysis of the Afatinib Clinical Pathway during the 28-Day Introductory Period-The Japanese Style of Collaborative Drug Therapy Management(J-CDTM)]. Gan To Kagaku Ryoho 2015; 42:967-972. [PMID: 26321711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Afatinib is a newly approved second-generation epidermal growth factor receptor-tyrosine kinase inhibito r(EGFR-TKI). Afatinib has been shown to prolongthe overall survival of patients with non-small cell lungcancer (NSCLC) with EGFR mutations compared with the standard chemotherapy. However, Grade 3 or 4 toxicities, includingdiarrhea, rash, paronychia, and stomatitis, have been observed more frequently in patients treated with afatinib than in those treated with first-generation EGFR-TKIs. Accordingly, our institution developed an afatinib clinical pathway (the afatinib pathway), which was designed by certified nurses, medical physicians, and certified pharmacists, with the goal of reducing the severity of diarrhea and rash that occur most frequently duringthe 28-day introductory period of afatinib treatment. Between May and October 2014, afatinib was administered accordingto the afatinib pathway to 14 patients with NSCLC and EGFR mutations. Of these patients, only one (7.1%) experienced Grade 3 diarrhea. No other patient experienced Grade 3 or 4 toxicity. The afatinib pathway was effective in reducingthe severities of the diarrhea and rash duringthe 28-day introductory period of the afatinib treatment. Our implementation of the afatinib pathway could be considered the Japanese style of collaborative drugtherapy management (J-CDTM).
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Affiliation(s)
- Kaori Iwata
- Team for Making the Clinical Pathway of Afatinib, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases
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35
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Tamiya M, Tokunaga S, Okada H, Suzuki H, Sasada S, Okamoto N, Morishita N, Shiroyama T, Otsuka T, Miyamoto N, Taira K, Daga H, Takeda K, Hirashima T. Evaluation of Bone Metastasis Using Serial Measurements of Serum N-Telopeptides of Type I Collagen in Patients with Lung Cancer: A Prospective Study. Anticancer Res 2015; 35:3987-3993. [PMID: 26124346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM The bone resorption biomarker cross-linked N-Telopeptides of type I collagen (NTx) has been shown to aid in the diagnosis of metastatic bone disease from lung cancer (MBDLC). Patients with MBDLC are often treated with zoledronic acid (ZA). ZA reduces the levels of NTx and also lowers the risk of skeletal adverse events in patients with MBDLC. PATIENTS AND METHODS Patients with MBDLC at initial diagnosis were included in the study. NTx was measured in serum (sNTx) once a month using the OSTEOMARKTM sNTx assay. MBDLC was assessed by monthly physical examinations and bone scintigraphy every 3 months for 12 months. RESULTS Twenty patients were enrolled between June and December 2010. The sNTx concentration at baseline was 19.8 ± 5.8 nmol bone collagen equivalents (nmol BCE)/l. In the 16 patients receiving ZA, the level of sNTx significantly decreased after the first month of treatment (baseline vs. 1 month of treatment: 21.3 ± 5.5 vs. 13.6 ± 2.7 nmol BCE/l; p<0.01). During the follow-up period, 13 of the patients treated with ZA experienced worsening of bone metastasis. There were statistically significant differences in the levels of sNTx at baseline (20.3 ± 4.8 nmol BCE/l), at the lowest levels after administration of ZA (11.8 ± 2.9 nmol BCE/l vs. baseline; p<0.001), and at the time of measurable disease progression (14.1 ± 4.6 nM BCE/l vs. baseline; p<0.05). CONCLUSION Serial measurements of sNTx in patients with MBDLC treated with ZA may effectively predict disease progression.
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Affiliation(s)
- Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Shinya Tokunaga
- Department of Clinical Oncology, Osaka City General Hospital, Miyakojimaku, Osaka, Japan
| | - Hideaki Okada
- Department of Clinical Oncology, Osaka City General Hospital, Miyakojimaku, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Shinji Sasada
- Department of Thoracic Oncology, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Tomoyuki Otsuka
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Natsuko Miyamoto
- Department of Clinical Oncology, Osaka City General Hospital, Miyakojimaku, Osaka, Japan
| | - Koichi Taira
- Department of Clinical Oncology, Osaka City General Hospital, Miyakojimaku, Osaka, Japan
| | - Haruko Daga
- Department of Clinical Oncology, Osaka City General Hospital, Miyakojimaku, Osaka, Japan
| | - Koji Takeda
- Department of Clinical Oncology, Osaka City General Hospital, Miyakojimaku, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
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36
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Oze T, Hiramatsu N, Yakushijin T, Yamada R, Harada N, Morishita N, Oshita M, Mita E, Ito T, Inui Y, Inada M, Tamura S, Yoshihara H, Imai Y, Kato M, Miyagi T, Yoshida Y, Tatsumi T, Kasahara A, Hayashi N, Takehara T. The real impact of telaprevir dosage on the antiviral and side effects of telaprevir, pegylated interferon and ribavirin therapy for chronic hepatitis C patients with HCV genotype 1. J Viral Hepat 2015; 22:254-62. [PMID: 25081140 DOI: 10.1111/jvh.12289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 05/14/2014] [Indexed: 01/28/2023]
Abstract
Triple therapy with telaprevir, pegylated interferon and ribavirin has been reported to improve antiviral efficacy but have potentially severe adverse effects in patients with chronic hepatitis C. To avoid the severe effects of telaprevir, lowering the dose has been suggested. However, impact of dosage changes on antiviral and adverse effects remains unclear. One hundred and sixty-six Japanese patients with HCV genotype 1 were treated with triple therapy. The drug exposure of each medication was calculated by averaging the dose actually taken. The overall SVR rate was 82%. The telaprevir discontinuation rate was 26%. The factors associated with discontinuation were an older age (≥65 y.o.) and a higher average dose during treatment. The telaprevir discontinuation rates were 42%, 25% and 14% in patients at ≥35, 25-35 and <25 mg/kg/day of telaprevir and 58% in older patients at ≥35 mg/kg/day of TVR. The factors associated with SVR were treatment-naïve, relapse to previous treatment, higher average telaprevir dose during treatment and completion of treatment. The SVR rate was higher, at 91%, in patients at 25-35 mg/kg/day of telaprevir than the 71% and 78% observed in those at <25 and ≥35 mg/kg/day of drug. In Japanese patients, a mean telaprevir dose of 25-35 mg/kg/day during treatment can augment its efficacy in triple therapy for patients with HCV genotype 1.
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Affiliation(s)
- T Oze
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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37
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Okamoto N, Suzuki H, Kawahara K, Honda K, Miura N, Hirashima T, Tamiya M, Morishita N, Shiroyama T, Tanaka A, Tani E, Hamaguchi M, Kitani M, Yamada T, Kawase I. The alternatively spliced actinin-4 variant as a prognostic marker for metastasis in small-cell lung cancer. Anticancer Res 2015; 35:1663-1667. [PMID: 25750325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The alternatively spliced actinin-4 variant (ACTN4va) is expressed in small-cell lung cancer (SCLC) and is thought to be a potential diagnostic marker. However, ACTN4va expression has not been examined in transbronchial biopsy specimens. MATERIALS AND METHODS We retrospectively examined the relationship between ACTN4va expression, clinical factors and survival in 104 consecutive newly-diagnosed SCLC patients. RESULTS Of the 104 screened cases, 83 (median age=69 years; transbronchial biopsy, 71) were included in our study. Survival was significantly different in the group with no distant metastasis (1996 vs. 422 days, respectively; p=0.000115) but was not significantly different with regard to ACTN4va expression in the group with distant metastasis (293 vs. 254 days, respectively; p=0.678). CONCLUSION ACTN4va expression was identifiable in small biopsy samples. ACTN4va expression was also significantly related to distant metastasis and could stratify SCLC patients according to prognosis.
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Affiliation(s)
- Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Kunimitsu Kawahara
- Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Kazufumi Honda
- Division of Chemotherapy and Clinical Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Nami Miura
- Division of Chemotherapy and Clinical Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Ayako Tanaka
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Eriko Tani
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Masanari Hamaguchi
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Masashi Kitani
- Department of Clinical Investigation, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Tesshi Yamada
- Division of Chemotherapy and Clinical Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Ichiro Kawase
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
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38
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Shiroyama T, Tanaka A, Tamiya M, Hamaguchi M, Osa A, Takeoka S, Tani E, Azuma Y, Morishita N, Suzuki H, Okamoto N, Kimura K, Kadota Y, Kawahara K, Hirashima T, Kawase I. A Rare Case of Pleomorphic Carcinoma of the Lung Harboring an Anaplastic Lymphoma Kinase (ALK) Rearrangement. Intern Med 2015; 54:2741-3. [PMID: 26521903 DOI: 10.2169/internalmedicine.54.4474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Molecular testing for anomalies, such as epidermal growth factor receptor mutations and anaplastic lymphoma kinase (ALK) rearrangement, is part of the current standard of care for non-small cell lung cancer, particularly adenocarcinoma. ALK rearrangement occurs most frequently in adenocarcinoma cells and rarely in non-adenocarcinoma cells. We herein report a rare case of pleomorphic lung carcinoma with ALK rearrangement in both its adenocarcinoma and spindle cell components. This case suggests the possibility of ALK rearrangement in pleomorphic carcinoma.
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Affiliation(s)
- Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Japan
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39
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Azuma Y, Tamiya M, Shiroyama T, Osa A, Takeoka S, Morishita N, Suzuki H, Okamoto N, Hirashima T, Kawase I. Nanoparticle Albumin-bound Paclitaxel+Carboplatin Therapy for Small Cell Lung Cancer Combined with Squamous Cell Carcinoma and Interstitial Lung Disease. Intern Med 2015; 54:2911-3. [PMID: 26568008 DOI: 10.2169/internalmedicine.54.3243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
It has recently been shown that nanoparticle albumin-bound paclitaxel (nab-PAC)+carboplatin (CBDCA) provides a favorable overall response rate in non-small cell lung cancer. This is the first case report of nab-PAC+CBDCA therapy in small cell lung cancer (SCLC). Our patient was a 72-year-old man with stage IV SCLC combined with squamous cell carcinoma and interstitial lung disease (ILD). We administered nab-PAC+CBDCA as a second-line chemotherapy. A partial response was evident after two cycles of chemotherapy, and no serious side effects occurred. The progression-free survival was 15 weeks. Second-line chemotherapy using nab-PAC+CBDCA was effective and well tolerated in an SCLC patient with ILD.
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Affiliation(s)
- Yuichiro Azuma
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Japan
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40
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Kondo Y, Tamiya M, Hirashima T, Ryota N, Sando M, Iwata K, Okamoto N, Suzuki H, Morishita N, Shiroyama T, Takeoka S, Osa A, Azuma Y, Tsuboi T, Yamato A, Shimura K, Kawase I. [Denosumab for bone metastasis of thoracic tumors-preparation of a practice manual and evaluation of its effectiveness]. Gan To Kagaku Ryoho 2014; 41:1391-1395. [PMID: 25434441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The anti-receptor activator of nuclear factor-kB ligand (RANKL) antibody denosumab is thought to be useful in the improvement of the quality of life of patients with bone metastasis from thoracic tumors, given the ease of its subcutaneous administration. However, attention has to paid to the onset of hypocalcemia when determining the optimal dosage, especially since data and methods on its prevention are limited. Our project team monitored serum calcium levels in patients receiving denosumab treatment, evaluated methods to supplement calcium and vitamin D in cases of hypocalcemia, and developed an evidence-based common manual. Subsequently, denosumab administration and hypocalcemia were evaluated as per the manual. Grade 3 hypocalcemia was observed in 2 cases before the preparation, with no new cases seen since adopting the new protocol in the manual. We conclude that the development of severe hypocalcemia associated with denosumab treatment can be avoided by prompt management of this condition in the early stages and by adopting measures listed in the practice manual.
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Affiliation(s)
- Yoko Kondo
- Dept. of Pharmacy,Osaka Prefectural Medical Center for Respiratory and Allergic Diseases
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41
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Hirashima T, Nagai T, Shigeoka H, Tamura Y, Yoshida H, Kawahara K, Kondoh Y, Sakai K, Hashimoto S, Fujishima M, Shiroyama T, Tamiya M, Morishita N, Suzuki H, Okamoto N, Kawase I. Comparison of the clinical courses and chemotherapy outcomes in metastatic colorectal cancer patients with and without active Mycobacterium tuberculosis or Mycobacterium kansasii infection: a retrospective study. BMC Cancer 2014; 14:770. [PMID: 25326267 PMCID: PMC4210613 DOI: 10.1186/1471-2407-14-770] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 10/09/2014] [Indexed: 01/06/2023] Open
Abstract
Background Although active Mycobacterium tuberculosis (MTB) or Mycobacterium Kansasii (MK) infection could be present in patients with metastatic colorectal cancer (m-CRC), no study is available on the clinical courses and chemotherapy outcomes of these patients. The present study therefore aimed to retrospectively examine whether m-CRC patients with and without active MTB or MK infection could receive cancer chemotherapy similarly. Methods This study enrolled 30 m-CRC patients who received first-line chemotherapy between January 31, 2006 and January 31, 2013 at our institution, The clinical courses and tumor response of those with and without active MTB or MK infection were examined and compared. Results Of 30 m-CRC patients, 6 had active MTB infection, 1 with active MK and the other 23 had neither MTB nor MK. No significant demographic differences were observed between patients with MTB or MK and those without. Chemotherapy response rates of all patients, those with MTB or MK, and those without were 40.0%, 28.6% and 43.5%, respectively. Among patients with MTB or MK, 1 treated with bevacizumab experienced grade-3 hemoptysis while others did not report any severe toxicity. Median survival time of all studied patients, those with MTB or MK, and those without was 26.3, 36.7 and 22.6 months, respectively. No significant difference in overall survival was observed between patients with MTB or MK and those without. Multivariate analysis revealed that performance status and liver metastasis were significant prognostic factors of overall survival (P = 0.004 and 0.030, respectively), whereas other factors, including MTB or MK infection, were not. In our study, all 7 patients with MTB or MK did not experience infection relapse during or after cancer chemotherapy. Conclusions Our results indicate that m-CRC patients with MTB or MK should be able to safely and effectively continue cancer chemotherapy to subsequently achieve comparable survival duration to those without the infection if they receive proper MTB or MK treatment.
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Affiliation(s)
- Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1 Habikino, Habikino City, Osaka 583-8588, Japan.
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42
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Usui N, Kondo Y, Okamoto N, Suzuki H, Sando M, Fukuchi Y, Tamiya M, Morishita N, Shiroyama T, Hirashima T. Evaluation of the Preventive Effect of Dexamethasone for Rash in Patients Treated with Pemetrexed. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu435.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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43
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Tamiya A, Tamiya M, Nakatani T, Shiroyama T, Kitai K, Tsuji T, Morishita N, Omachi N, Asami K, Okamoto N, Suzuki H, Okishio K, Kawaguchi T, Hirashima T, Atagi S. A phase II study of gefitinib in combination with S-1 plus carboplatin as first-line triplet chemotherapy for patients with advanced non-small cell lung cancer harboring epidermal growth factor receptor mutations. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Akihiro Tamiya
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Motohiro Tamiya
- Department of Thoracic Malignancy Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | | | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Kanako Kitai
- Department of Thoracic Malignancy, Osaka Prefectural Medical Centaer for Respiratory and Allergic Diseases, Habikino, Japan
| | - Taisuke Tsuji
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Naoko Morishita
- Osaka Prefectual Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Naoki Omachi
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Kazuhiro Asami
- National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Kyoichi Okishio
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Tomoya Kawaguchi
- National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Shinji Atagi
- National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
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44
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Suzuki H, Hirashima T, Okamoto N, Yamadori T, Tamiya M, Morishita N, Shiroyama T, Takeoka S, Osa A, Azuma Y, Kawase I. Relationship between progression-free survival and overall survival in patients with advanced non-small cell lung cancer treated with anticancer agents after first-line treatment failure. Asia Pac J Clin Oncol 2014; 11:121-8. [PMID: 24811212 DOI: 10.1111/ajco.12199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2014] [Indexed: 11/26/2022]
Abstract
AIM The hazard ratio of progression-free survival (PFS-HR) generally does not reflect that of overall survival (OS-HR) in advanced non-small cell lung cancer (NSCLC) patients treated with first-line therapy. Short survival post-progression (SPP) better reflects the PFS-HR and OS-HR in simulations. We aimed to evaluate whether the PFS-HR reflects the OS-HR in NSCLC clinical trials for post-first-line treatments. METHOD We reviewed clinical studies of post-first-line anticancer agents for NSCLC. We examined the sample size of the experimental arm (EA), median PFS (mPFS) or median time to progression in the EA, median overall survival (mOS) in the EA, the PFS-HR and the OS-HR. SPP was defined as the difference between mOS and mPFS. The association between mPFS and SPP, mPFS and mOS, and the PFS-HR and OS-HR was tested. We sought for the optimal point of correlation of PFS-HR and OS-HR by every 1 month of SPP. RESULTS We identified 32 trials (34 arms). mPFS and mOS were weakly correlated (correlation coefficient [r] = 0.376; P = 0.0286). The PFS-HR and OS-HR were also moderately correlated (r = 0.415; P = 0.015). The maximum r value was 0.770 (SPP < 6 months; P < 0.0001) when we tested the associations between the PFS-HR and OS-HR for SPP using 1-month increments. The estimated regression equation at this point was OS-HR = 0.679 × (PFS-HR) + 0.349. CONCLUSION The PFS-HR and OS-HR were strongly correlated in advanced NSCLC patients treated with post-first-line anticancer agents, with a SPP of less than 6 months.
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Affiliation(s)
- Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino Habikino-shi, Osaka, Japan
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Harada N, Hiramatsu N, Oze T, Morishita N, Yamada R, Hikita H, Miyazaki M, Yakushijin T, Miyagi T, Yoshida Y, Tatsumi T, Kanto T, Kasahara A, Oshita M, Mita E, Hagiwara H, Inui Y, Katayama K, Tamura S, Yoshihara H, Imai Y, Inoue A, Hayashi N, Takehara T. Risk factors for hepatocellular carcinoma in hepatitis C patients with normal alanine aminotransferase treated with pegylated interferon and ribavirin. J Viral Hepat 2014; 21:357-65. [PMID: 24716638 DOI: 10.1111/jvh.12151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/20/2013] [Indexed: 12/09/2022]
Abstract
Pegylated interferon (Peg-IFN) plus ribavirin combination therapy is effective in patients with hepatitis C virus (HCV) infection and normal alanine aminotransferase levels (NALT). However, it remains unclear whether the risk of hepatocellular carcinoma (HCC) incidence is actually reduced in virological responders. In this study, HCC incidence was examined for 809 patients with NALT (ALT ≤ 40 IU/mL) treated with Peg-IFN alpha-2b and ribavirin for a mean observation period of 36.2 ± 16.5 months. The risk factors for HCC incidence were analysed by Kaplan-Meier method and Cox proportional hazards model. On multivariate analysis among NALT patients, the risk of HCC incidence was significantly reduced in patients with sustained virological response (SVR) or relapse compared with those showing nonresponse (NR) (SVR vs NR, hazard ratio (HR): 0.16, P = 0.009, relapse vs NR, HR: 0.11, P = 0.037). Other risk factors were older age (≥65 years vs <60 years, HR: 6.0, P = 0.032, 60-64 vs <60 years, HR: 3.2, P = 0.212) and male gender (HR: 3.9, P = 0.031). Among 176 patients with PNALT (ALT ≤ 30 IU/mL), only one patient developed HCC and no significant risk factors associated with HCC development were found. In conclusion, antiviral therapy for NALT patients with HCV infection can lower the HCC incidence in responders, particularly for aged and male patients. The indication of antiviral therapy for PNALT (ALT ≤ 30 IU/mL) patients should be carefully determined.
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Affiliation(s)
- N Harada
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
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Hirashima T, Suzuki H, Okamoto N, Morishita N, Yamadori T, Tamiya M, Shiroyama T, Kurata K, Kawase I. Important factors for achieving survival of five years or more in non-small cell lung cancer patients with distant metastasis. Oncol Lett 2014; 8:327-334. [PMID: 24959271 PMCID: PMC4063572 DOI: 10.3892/ol.2014.2107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 04/01/2014] [Indexed: 11/12/2022] Open
Abstract
In order to examine which factors were important for achieving a ≥5 year survival time in non-small cell lung cancer (NSCLC) patients with distant metastasis, 268 NSCLC patients who received first-line chemotherapy between January 2004 and December 2007 were retrospectively examined. The median survival time of the patients was 14 months, with 22 surviving for ≥5 years, 48 for ≥2 years, but <5 years, and 198 surviving <2 years. Multivariate analysis determined that never having smoked, a good performance status, relapse following thoracic surgery and intra-thoracic metastasis were significantly favorable prognostic factors, while abdominal metastasis was a significantly poor prognostic factor. The ≥5 years and ≥2–5 years groups had significantly more favorable prognostic factors than the <2 years group. The never-smoked status was a particularly important factor for ≥5 years of survival. The ≥5 years and ≥2–5 years groups achieved a significantly more favorable response to first-line chemotherapy, and a greater number of regimens, total months of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) treatment and cytotoxic agent treatment cycles compared with the <2 years group. In total, ~50% of the patients received palliative radiotherapy. In the ≥5 years group, patients with EGFR drug-sensitive mutations achieved ≥5 years of survival mainly by EGFR-TKI therapy, while those without EGFR mutations achieved ≥5 years of survival by continuing effective cytotoxic agents. Achievement of >5 years of survival was found to correlate with the presence of favorable prognostic factors, response to first-line chemotherapy, provision of appropriate EGFR-TKI therapy according to genetic testing results, continuing effective cytotoxic regimens and the use of radiotherapy as local therapy.
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Affiliation(s)
- Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino-shi, Osaka 583-8588, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino-shi, Osaka 583-8588, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino-shi, Osaka 583-8588, Japan
| | - Naoko Morishita
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino-shi, Osaka 583-8588, Japan
| | - Tadahiro Yamadori
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino-shi, Osaka 583-8588, Japan
| | - Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino-shi, Osaka 583-8588, Japan
| | - Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino-shi, Osaka 583-8588, Japan
| | - Kanako Kurata
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino-shi, Osaka 583-8588, Japan
| | - Ichiro Kawase
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino-shi, Osaka 583-8588, Japan
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Tamiya M, Okamoto N, Sasada S, Shiroyama T, Morishita N, Suzuki H, Yoshida E, Hirashima T, Kawahara K, Kawase I. Diagnostic yield of combined bronchoscopy and endobronchial ultrasonography, under LungPoint guidance for small peripheral pulmonary lesions. Respirology 2014; 18:834-9. [PMID: 23586738 DOI: 10.1111/resp.12095] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 12/26/2012] [Accepted: 12/31/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVE The yield of biopsy performed during bronchoscopy is reduced if the lesion is smaller than 30 mm. We evaluated the performance of a new diagnostic technique combining endobronchial ultrasonography with a guide sheath (EBUS-GS) and a virtual bronchoscopic navigation system, LungPoint (Broncus Technologies, Inc., Mountain View, CA, USA), for the diagnosis of small (≤30 mm) peripheral pulmonary lesions (PPL). METHODS Between May 2011 and December 2011, we recruited 68 consecutive patients presenting with a PPL 30 mm or less in diameter determined by chest computed tomography. We used the LungPoint system before bronchoscopy to identify the bronchus into which the bronchoscope should be advanced. We used a thin bronchoscope. EBUS-GS was performed using an endoscope ultrasonography system equipped with a 20-MHz mechanical radial-type probe. We used a guide sheath with an external diameter of 1.95 mm, thin forceps and brushing. RESULTS The diagnostic yield of the 68 PPL was 77.9%; it was 83.7% and 68.0% for the malignant and benign lesions, respectively. Notably, three cases were diagnosed by transbronchial needle-aspiration cytology alone. Univariate and multivariate analyses showed that the EBUS probe localization was the most significant contributor to successful diagnosis (diagnostic yield: within vs adjacent to the lesion = 92.1% vs 60.0%, respectively; P = 0.004 and P = 0.003, respectively). CONCLUSIONS The combination of EBUS-GS and LungPoint was useful for diagnosing small PPL.
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Affiliation(s)
- Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
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Hirashima T, Shigeoka H, Suzuki H, Yoshifuji T, Shinzaki W, Morishita N, Yamadori T, Tamiya M, Shiroyama T, Okamoto N. Clinical Course and Treatment Outcomes of Metastatic Colon Cancer Patients At a Medical Center for Respiratory Diseases. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt459.156] [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: 11/12/2022] Open
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49
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Suzuki H, Asami K, Hirashima T, Okamoto N, Yamadori T, Tamiya M, Morishita N, Shiroyama T, Takeoka S, Osa A, Azuma Y, Okishio K, Kawaguchi T, Atagi S, Kawase I. Stratification of malignant pleural mesothelioma prognosis using recursive partitioning analysis. Lung 2013; 192:191-5. [PMID: 24141556 DOI: 10.1007/s00408-013-9516-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/02/2013] [Indexed: 12/29/2022]
Abstract
PURPOSE Prognostic factors and complicated prognostic models have been proposed for malignant pleural mesothelioma (MPM). This study was designed to stratify MPM prognosis by using a simple model. METHODS Patients diagnosed with MPM in the past 10 years (n = 122) were examined retrospectively. Data on the presence of chest pain, performance status (PS), asbestos exposure, smoking status, white blood cell count (WBC), haemoglobin (Hb) concentration, platelet count (PLT), lactate dehydronate (LD), histology, stage, and date of death or censored status were collected. After the factors were examined in the univariate analysis, recursive partitioning analysis was performed. RESULTS Statistically significant factors related to survival were the type of histology, stage, PS, WBC, PLT, Hb concentration, and LD. Histology, stage, PS, and Hb concentration were used in multivariate analysis. Stage and Hb concentration showed good statistical significance, whereas PS was borderline significant. The survival analyses were stratified into five groups by PS, stage, Hb concentration, and chest pain using recursive partitioning analysis. Group A comprised patients showing the most favourable prognoses (PS 0-2 and Hb concentration >12.1 g dL(-1) or PS 0-2 and Hb concentration ≤12.1 g dL(-1) without pain), and group B comprised the remaining patients. The median overall survival in groups A and B was 563 days (95 % confidence interval [CI] 502-779) and 157 days (95 % CI 115-224), respectively (hazard ratio of 5.44 [3.46-8.53, P < 0.0001]). CONCLUSIONS The MPM patients with PS 0-2 and Hb concentration >12.1 or ≤12.1 g dL(-1) without chest pain had favourable prognoses.
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Affiliation(s)
- Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1 Habikino Habikino-shi, Osaka, 583-8588, Japan,
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Tamiya M, Tamiya A, Yamadori T, Nakao K, Asami K, Yasue T, Otsuka T, Shiroyama T, Morishita N, Suzuki H, Okamoto N, Okishio K, Kawaguchi T, Atagi S, Kawase I, Hirashima T. Phase2 study of bevacizumab with carboplatin-paclitaxel for non-small cell lung cancer with malignant pleural effusion. Med Oncol 2013; 30:676. [PMID: 23925664 DOI: 10.1007/s12032-013-0676-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 07/21/2013] [Indexed: 10/26/2022]
Abstract
Vascular endothelial growth factor (VEGF) is involved in non-small cell lung cancer (NSCLC) with malignant pleural effusion (MPE), but little is known regarding the efficacy of bevacizumab (Bev) with carboplatin-paclitaxel (CP) for NSCLC with MPE. Chemotherapy-naive non-SQ NSCLC patients with MPE were eligible to participate. Pleurodesis before chemotherapy was not allowed. In the first cycle, the treated patients received only CP to prevent Bev-induced wound healing delayed after chest drainage. Subsequently, they received 2-6 cycles of CP with Bev. Patients who completed more than 4 cycles of CP and Bev without disease progression or severe toxicities continued to receive Bev alone as a maintenance therapy. The primary end point was overall response, although an increase in MPE was allowed in the first cycle. The VEGF levels in plasma and MPE were measured at baseline, and the VEGF levels in plasma were measured after 3 cycles of chemotherapy. Between September 2010 and June 2012, 23 patients were enrolled. The overall response rate was 60.8 %; the disease control rate was 87.0 %. Sixteen patients received maintenance therapy, following a median of 3 cycles. Median progression-free and overall survival times were 7.1 months (95 % confidence interval [CI], 5.6-9.4 months) and 11.7 months (95 % CI, 7.4-16.8 months), respectively. Most patients experienced severe hematological toxicities, including ≥grade 3 neutropenia; none experienced severe bleeding events. The MPE control rate improved on combining CP with Bev (CP, 78.3 %; CP with Bev, 91.3 %; P = 0.08). The median baseline VEGF level in MPE was 1798.6 (range 223.4-35,633.4) pg/mL. Plasma VEGF levels significantly decreased after 3 chemotherapy cycles (baseline, 513.6 ± 326.4 pg/mL, post-chemotherapy, 25.1 ± 14.1 pg/mL, P < 0.01). CP plus Bev was effective and tolerable in chemotherapy-naïve non-squamous NSCLC patients with MPE.
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Affiliation(s)
- Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino 3-7-1, Habikino City, Osaka 583-8588, Japan.
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