Efficacy of aprepitant for the prevention of chemotherapy-induced nausea and vomiting with a moderately emetogenic chemotherapy regimen: a multicenter, placebo-controlled, double-blind, randomized study in patients with gynecologic cancer receiving paclitaxel and carboplatin
PubMed | Red Cross, Kyushu Hospital, National Kyushu Medical Center, Miyazaki Prefectural Hospital and 6 more.
Type: Journal Article | Journal: International journal of clinical oncology | Year: 2016
Substance P contributes to the hypersensitivity reaction (HSR) to paclitaxel in a rat model. Aprepitant acts as an inhibitor of the binding of substance P to the neurokinin-1 receptor and, consequently, may reduce the frequency of paclitaxel-induced HSR. While aprepitant has a prophylactic effect against vomiting caused by high-dose cisplatin, the benefits of aprepitant have not been clearly demonstrated in patients receiving paclitaxel and carboplatin (TC) combination chemotherapy.We conducted a multicenter, placebo-controlled, double-blind, randomized study in Japanese patients with gynecologic cancer who received TC combination chemotherapy. Patients received aprepitant or placebo together with both a 5-HT3 receptor antagonist and dexamethasone prior to chemotherapy. The primary endpoint was the proportion of patients with HSR, and the secondary endpoints were the proportion of patients with no vomiting, no significant nausea, and complete response, respectively.Of the 324 randomized patients, 297 (151 in the aprepitant group; 146 in the placebo group) were evaluated. The percentage of patients with HSR (9.2 vs. 7.5%, respectively; P=0.339) was not significantly different between the groups. The percentage of no vomiting patients (78.2 vs. 54.8%; P<0.0001), no significant nausea patients (85.4 vs. 74.7%; P=0.014), and patients showing complete response (61.6 vs. 47.3%, P=0.0073) was significantly higher in the aprepitant group than in the placebo group.The administration of aprepitant did not have a prophylactic effect on the HSR but was effective in reducing nausea and vomiting in gynecologic cancer patients receiving TC combination chemotherapy.
Uemura N.,Kohnodai Hospital |
Sugano K.,Jichi Medical University |
Hiraishi H.,Dokkyo Medical University |
Shimada K.,Jichi Medical University |
And 5 more authors.
Journal of Gastroenterology | Year: 2014
Background: Low-dose aspirin is widely used for the prevention of cardiovascular events. The prevalence of gastroduodenal injuries and the risk factor profile including gastroprotective drug therapy needs to be clarified in Japanese patients taking daily aspirin for cardioprotection. Methods: This Management of Aspirin-induced Gastro-Intestinal Complications (MAGIC) study was conducted with a prospective nationwide, multicenter, real-world registry of Japanese patients at high-risk of cardiovascular diseases who were taking regular aspirin (75-325 mg) for 1 month or more. All patients underwent endoscopic examination for detection of gastroduodenal ulcer and mucosal erosion. The risk factor profiles including the concurrent drug therapy were compared for those patients with gastroduodenal problems and those without. Results: Gastroduodenal ulcer and erosion were detected in 6.5, and 29.2 % of the 1,454 patients receiving aspirin, respectively. H. pylori infection was associated with an increased risk for ulcer: OR 1.83 (1.18-2.88 p = 0.0082). Risk of erosion was lower with enteric-coated aspirin than with buffered aspirin: odds ratio (OR) 0.47 (0.32-0.70, p = 0.0002). Patients receiving proton pump inhibitors had lower risks for both gastroduodenal ulcer and erosion: OR 0.34 (0.15-0.68, p = 0.0050) and 0.32 (0.22-0.46, p < 0.0001), respectively. However, those receiving histamine 2-receptor antagonists had reduced risks for erosion but not for ulcer: OR 0.49 (0.36-0.68, p < 0.0001). Conclusion: Gastroduodenal ulcer and erosion are common in Japanese patients taking low dose aspirin for cardioprotection. Proton pump inhibitors reduce the risk of gastroduodenal mucosal injury. © 2013 The Author(s).
PubMed | Gunma Prefectural College of Health Sciences, Red Cross, National Kyushu Medical Center and Gunma Cardiovascular Center
Type: Journal Article | Journal: Asia Oceania journal of nuclear medicine & biology | Year: 2016
Use of a positron emission tomography (PET)/single-photon emission computed tomography (SPECT) system facilitates the simultaneous acquisition of images with fluorine-18 fluorodeoxyglucose ((18)F-FDG) and technetium ((99m)Tc)-tetrofosmin. However, (18)F has a short half-life, and 511 keV Compton-scattered photons are detected in the (99m)Tc energy window. Therefore, in this study, we aimed to investigate the consequences of these facts.The crosstalk correction for images in the (99m)Tc energy window involved the dual energy window (DEW) subtraction method. In phantom studies, changes in the count of uniform parts in a phantom (due to attenuation from decay), signal detectability in the hot-rod part of the phantom, and the defect contrast ratio in a cardiac phantom were examined.For (18)F-FDG in the step-and-shoot mode, nearly a 9% difference was observed in the count of projection data between the start and end positions of acquisition in the uniform part of the phantom. Based on the findings, the detectability of 12 mm hot rods was relatively poor. In the continuous acquisition mode, the count difference was corrected, and detectability of the hot rods was improved. The crosstalk from (18)F to the (99m)Tc energy window was approximately 13%. In the cardiac phantom, the defect contrast in (99m)Tc images from simultaneous dual-radionuclide acquisition was improved by approximately 9% after DEW correction; the contrast after correction was similar to acquisition with (99m)Tc alone.Based on the findings, the continuous mode is useful for (18)F-FDG acquisition, and DEW crosstalk correction is necessary for (99m)Tc-tetrofosmin imaging.
PubMed | Kurume University, National Kyushu Medical Center, Hamanomachi Hospital, Harasanshin Hospital and Kyushu University
Type: Journal Article | Journal: International journal of hematology | Year: 2016
Umbilical cord blood transplantation with a reduced-intensity conditioning regimen (RIC-UCBT) is used increasingly in patients who have comorbid organ functions and lack human leukocyte antigen-identical donors. We compared the outcomes in 35 patients who received mycophenolate mofetil plus cyclosporine (MMF/CSP, n=17) or MMF plus tacrolimus (MMF/TAC, n=18) for graft-versus-host disease (GVHD) prophylaxis after RIC-UCBT. Cumulative incidence of neutrophil engraftment was 94 and 89% in MMF/CSP and MMF/TAC groups, respectively (p=0.34). The incidence of pre-engraftment immune reaction did not differ between the MMF/CSP (41%) and MMF/TAC (39%, p=1.00) groups; however, patients in the MMF/TAC group tended to have a lower incidence of grade II-IV acute GVHD than those in MMF/CSP group (28 vs 53%, p=0.11). Overall survival (OS) at 1year was 43 and 60% in MMF/CSP and MMF/TAC groups, respectively (p=0.39). Progression-free survival, non-relapse mortality, and relapse rate were comparable between the two groups (p=0.76, 0.59, and 0.88, respectively). In multivariate analyses, MMF/TAC GVHD prophylaxis was closely associated with improved OS, but not with incidence of engraftment and acute GVHD. These results suggest that more intensive GVHD prophylaxis with MMF/TAC decreased acute GVHD without affecting other clinical outcomes, resulting in improved OS after RIC-UCBT.
PubMed | Haradoi Hospital, National Kyushu Medical Center, Kyushu University Hospital and Kyushu University
Type: Journal Article | Journal: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy | Year: 2016
Klebsiella pneumoniae often causes pneumonia and other infections in heavy drinkers and patients with diabetes. Pneumonia caused by Klebsiella rhinoscleromatis, a subspecies of K.pneumoniae, has not been previously reported. We report a case of pneumonia caused by K.rhinoscleromatis. A 68-year-old man with type 2 diabetes visited our department complaining fever and fatigue for 10 days and cough and bloody sputum for two days. His Japan Coma Scale score was I-1, body temperature 38.3C, blood pressure 85/51mmHg, pulse 135 bpm, and peripheral capillary oxygen saturation level 92% (room air). He had no abnormal breathing sounds. His white blood cell count had decreased to 2600/L, and his C-reactive protein level was high, at 35.9mg/dL. Chest computed tomography revealed lobar pneumonia in the right upper lobe and pneumonia in the left upper division. Klebsiella was suspected based on the result of a sputum smear examination. He was diagnosed with septic shock due to pneumonia and was immediately admitted. Intravenous antibacterial (levofloxacin) treatment was initiated, however, he died 13h after presenting at the hospital. Subsequently, K.rhinoscleromatis was detected in sputum and blood culture. Additional testing determined the bacteria to be a highly pathogenic hypermucoviscosity phenotype and the cause of the fatal lobar pneumonia. Although cases of rhinoscleroma and bacteremia caused by K.rhinoscleromatis infection have been reported, this is the first report of a case with sepsis caused by fulminant pneumonia.
Tsuchihashi T.,National Kyushu Medical Center
Nihon rinsho. Japanese journal of clinical medicine | Year: 2011
Hypertension is the most common lifestyle related disease in Japan. Among the lifestyle modifications, salt restriction is most important especially in Japanese hypertensive patients. Although Japanese as well as international guidelines recommend the restriction of salt intake less than 6 g/day, very few Japanese hypertensive patients are able to achieve this goal. Other lifestyle modifications include the increased intake of vegetables and fruits, maintenance of appropriate body weight, regular exercise, the restriction of alcohol intake and cessation of smoking. It is emphasized that comprehensive lifestyle modification is more effective. Since the long-term compliance of lifestyle modification is difficult, a strategy to promote lifestyle modification by encouraging individual subject should be established.
Akahoshi T.,National Kyushu Medical Center |
Tomikawa M.,National Kyushu Medical Center |
Korenaga D.,National Kyushu Medical Center |
Ikejiri K.,National Kyushu Medical Center |
And 2 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2010
Background This study aimed to evaluate whether laparoscopic splenectomy (Lap-Sp) contributes to the completion and curability of combined peginterferon and ribavirin (peg-IFN + RIB) therapy for cirrhotic patients with pancytopenia due to hypersplenism. Methods From December 2004 to September 2007, 21 patients underwent Lap-Sp before treatment with peg-IFN + RIB. All the patients were Child-Pugh class A or B with a mean platelet count of 5.7 × 10 4/mm3 and a mean leukocyte count of 2,830/mm3. The hepatitis C virus (HCV) genotype was 1b for 18 patients and 2b for 3 patients. Of the 21 patients, 17 had a viral load exceeding 100 KIU/ml, and 4 had a load of less than 100 KIU/ml. Results All the patients underwent Lap-Sp without severe complications. The average hospital stay was 12.7 days (range, 6-23 days). Platelet counts increased from a mean of 5.7 ± 2.2 × 104/mm3 preoperatively to 19.6 ± 7.6 × 104/mm3 postoperatively and remained above 7.0 × 104/ mm3 during the subsequent peg-IFN + RIB therapy. The full course of therapy was completed for nine patients, with five obtaining a sustained virologic response and one obtaining a biologic response. The five patients who obtained a sustained virologic response had either HCV type 2b or 1b with a low viral load (<100 KIU). At this writing, treatment is ongoing for the remaining 12 patients. Conclusions Laparoscopic splenectomy allows patients with HCV cirrhosis and hypersplenism to receive full-dose peg-IFN + RIB therapy. Patients with HCV, genotype 2 or 1b and a low viral load, and hypersplenism may be good candidates for Lap-Sp. Copyright © 2009 Springer Science+Business Media, LLC.
PubMed | National Kyushu Cancer Center and National Kyushu Medical Center
Type: Journal Article | Journal: Annals of surgical oncology | Year: 2016
S-1 adjuvant chemotherapy is commonly administered postoperatively for stage II and III advanced gastric cancer.This study included 113 patients treated with S-1 adjuvant chemotherapy after surgery for stage II and III advanced gastric cancer. These patients were divided into 4 groups: group A (n = 63), who had a longer duration (6 months) and earlier S-1 administration (6 weeks) after surgery; group B (n = 16), who had a longer and later S-1 administration (>6 weeks) after surgery; group C (n = 27), who had a shorter duration (<6 months) and earlier S-1 administration after surgery; and group D (n = 7), who had a shorter and later S-1 administration after surgery.The recurrence rates in groups A, B, C, and D were 15.7, 43.8, 44.4, and 57.1 %, respectively (A vs. B, p < 0.05, A vs. C and D, p < 0.01). The survival time of group A was significantly longer than that of other groups (p < 0.005). In addition, the survival time of patients with severe complications was significantly shorter than that of patients with non-severe complications (p < 0.05). An earlier S-1 administration after surgery was the only independent prognostic factor in the multivariate analysis.The prognosis of advanced gastric cancer was significantly related to the start of S-1 adjuvant treatment within 6 weeks after surgery.
Nakamura M.,National Kyushu Medical Center
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011
A 34-year-old woman developed polydipsia, polyuria, amenorrhea and loss of pubic hair in 2001, but did not seek medical advice. On September 7th, 2009, she was admitted to our hospital complaining of acute exacerbation of dyspnea on exertion. Chest computed tomography (CT) showed multiple cystic lesions, predominantly in bilateral lower lung fields. Non-segmental, diffuse ground-glass attenuated areas and thickened bronchovascular bundles were also seen in bilateral lung fields. Pathological findings of lung specimens from a surgical lung biopsy (right S6 and S8) 14 years previously showed infiltration of S100 protein-positive histiocytoid cells in the bronchiolar wall. As a result, pulmonary Langerhans cell histiocytosis (PLCH) was diagnosed. Moreover, panhypopituitarism due to LCH was identified on endocrine testing. Dyspnea on exertion, reduction of carbon-monoxide diffusing capacity (D(LCO)) and ground-glass attenuation areas on CT were improved by smoking cessation alone, and she was discharged. However, similar acute deterioration of PLCH recurred 4 months after first admission. Her dyspnea on exertion, reduction of D(LCO) and ground-glass attenuation areas on CT were improved again by 500 mg/day methylprednisolone pulse therapy for 3 days. This case was a unique combination of panhypopituitarism and the appearance and disappearance of ground-glass attenuation areas on CT, paralleling PLCH disease activity.
PubMed | National Kyushu Medical Center and Kyushu University
Type: | Journal: International journal of clinical oncology | Year: 2017
The role of induction chemotherapy (IC) in the treatment of resectable advanced head and neck squamous cell carcinoma has not been elucidated, and the most effective IC regimen for chemoselection is still unknown. At our institute we have not used the triple combination of docetaxel, cisplatin, fluorouracil (TPF) for chemoselection, but rather the double combination of docetaxel + cisplatin (TP). The aim of this study is to report the outcome of patients with advanced hypopharyngeal cancer treated by single cycle of IC with TP followed by chemoradiation (CRT) or surgery.A total of 29 patients with resectable advanced hypopharyngeal cancer who were treated with a single cycle of IC were entered into the study. Responders were treated by CRT while nonresponders underwent surgery. Outcomes were analyzed using the Kaplan-Meier method.A single cycle of IC with TP achieved response in 21 of the 29 patients. The major side effect was neutropenia which could be managed without delaying the sequential treatment. The 2-year overall survival and disease-specific survival were both 74.0% (stage III 100%, stage IVA 69.1%). The cumulative 2-year laryngeal preservation rate was 100% for stage III and 53.6% for stage IVA.A single cycle of IC with the combination of docetaxel + cisplatin may be sufficient to select advanced hypopharyngeal cancer patients with radio-sensitivity. IC intended for organ preservation strategies should be low toxic. Our strategy may be a useful for providing the benefits of IC and the opportunity for curative surgery without delay.