Senoo Y.,Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
[Rinsho ketsueki] The Japanese journal of clinical hematology | Year: 2016
We describe herein the clinical outcomes of 16 patients with chronic myeloid leukemia in the chronic phase who stopped the administration of tyrosine kinase inhibitors (TKI) after maintaining undetectable levels of major BCR-ABL1, based on real-time quantitative polymerase chain reaction, for prolonged periods (undetectable MR for a median of 2,100 days (822-4,068). The reasons for discontinuing TKI were enrollments in a clinical trial testing discontinuation of these agents (n=9), adverse effects (n=2) or financial problems (n=5). After TKI discontinuation, patients were followed for a median of 551 days (154-2,446). A total of 8 patients (50%) experienced molecular relapse after a median of 119 days (28-171). Among them, 6 patients who lost major molecular response (MMR) were treated with imatinib (n=2) or dasatinib (n=4), while 2 patients who lost undetectable MR after discontinuing TKI (1 each had taken bostinib and imatinib) but maintained MMR were carefully monitored without re-administration of TKI. Of 6 patients who re-started TKI, 4 (67%) achieved undetectable MR but the other 2 achieved only MMR. The results of this small, retrospective study may support the current understanding of treatment discontinuation, possibly leading to a sustained deep molecular response in some patients.
Okuma Y.,Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital |
Okuma Y.,Jikei University School of Medicine |
Saito M.,Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital |
Hosomi Y.,Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital |
And 2 more authors.
Journal of Cancer Research and Clinical Oncology | Year: 2014
Purpose: Thymic malignancies, comprising thymoma and thymic carcinoma, are rare. Consequently, optimal chemotherapy for advanced thymic malignancies remains controversial. Platinum-based chemotherapy is currently the consensus treatment based on the results of single-arm phase II trials and retrospective investigations. However, comparison of cisplatin-based and carboplatin-based chemotherapy has yet to be undertaken; the effectiveness of the addition of anthracycline also remains uncertain.Methods: In the present study, clinical trials and retrospective data regarding platinum-based chemotherapy were analyzed. The endpoint was the response rate to each chemotherapy. For advanced thymoma, we compared platinum with anthracycline-based chemotherapy and platinum with non-anthracycline-based chemotherapy. For advanced thymic carcinoma, anthracycline-based versus non-anthracycline-based chemotherapy and carboplatin-based versus cisplatin-based chemotherapy were compared. This analysis included a retrospective study of response of advanced thymic carcinoma to irinotecan and cisplatin in our institution.Results: The response rate for the 314 patients from 15 studies with advanced thymoma, including both prospective and retrospective data, was 69.4 % [95 % confidence interval (CI) 63.1–75.0 %] for platinum with anthracycline-based chemotherapy and 37.8 % (95 % CI 28.1–48.6 %; p < 0.0001) for platinum with non-anthracycline-based chemotherapy. The response rates after anthracycline-based and non-anthracycline-based chemotherapy for advanced thymic carcinoma were similar (41.8 vs. 40.9 %; p < 0.91), whereas the response rates after cisplatin-based and carboplatin-based chemotherapy for advanced thymic carcinoma differed significantly (53.6 vs. 32.8 %; p = 0.0029) in 206 patients from 10 studies.Conclusions: Platinum with anthracycline-based chemotherapy is an optimal combination for advanced thymoma. For advanced thymic carcinoma, cisplatin-based chemotherapy may be superior to carboplatin-based chemotherapy. © 2014, The Author(s).
Okuda Y.,Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital
Asian journal of endoscopic surgery | Year: 2013
While the amount of blood loss during laparoscopic hepatectomy tends to be smaller than that during open hepatectomy, intermittent vascular occlusion to control hepatic inflow can diminish blood loss during laparoscopic hepatectomy. Described herein is a useful and convenient method for intermittent vascular occlusion, which was standardized for laparoscopic hepatectomy. A tourniquet system consisting of cloth tape and a 20-cm catheter was used for intermittent vascular occlusion. This was placed through a hole in the abdominal wall from which a 5-mm trocar had been extracted. By operating this tourniquet system outside the patient's body, we were easily able to repeat intermittent vascular occlusion. Twenty-three patients underwent laparoscopic hepatectomy using this system. The mean time of operation and vascular occlusion were 311.6 and 83.6 min, respectively. The mean blood loss was 215.0 mL. There were no intraoperative blood transfusions or critical postoperative complications. The average length of postoperative hospital stay was 6.5 days. The mean time to place this system was 354 s, and there were no complications caused by this system. During totally laparoscopic hepatectomy, surgeons can perform intermittent vascular occlusion safely by using this method. © 2012 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
Okuma Y.,Tokyo Metropolitan Cancer and infectious diseases Center Komagome Hospital |
Hosomi Y.,Tokyo Metropolitan Cancer and infectious diseases Center Komagome Hospital |
Imamura A.,Tokyo Metropolitan Cancer and infectious diseases Center Komagome Hospital
OncoTargets and Therapy | Year: 2014
With the advent of antiretroviral therapy, lung cancer has become a crucial health problem among individuals living with human immunodefciency virus (HIV). In East Asian populations, the frequency of lung cancer patients harboring epidermal growth factor receptor (EGFR) mutations is greater than in other populations. Herein, we present two cases of advanced non-small cell lung cancer with EGFR mutations in patients treated with EGFR-tyrosine kinase inhibitors. Both patients were male, 67 and 59 years of age, with known HIV infection and immunologically stable disease with antiretroviral therapy. Case 1 was treated with erlotinib for recurrent adenocarcinoma metastasizing to the liver and brain harboring EGFR mutation in exon 21 L858R. The duration of treatment effcacy was 9.7 months. Case 2 had an EGFR mutation exon 19 in-frame deletion with bone metastasis and was treated with geftinib for 22.1 months in combination with antiretroviral therapy. These advanced lung cancer patients living with HIV with EGFR mutations demonstrate the promising effectiveness and safety of EGFR-tyrosine kinase inhibitors concomitant with antiretroviral therapy for an extended period. © 2015 Okuma et al.
Koizumi F.,Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital
British Journal of Cancer | Year: 2016
Background:We aimed to analyse clinical and gene expression profiles to predict pathologic complete response and disease-free survival using two consecutive, prospective, preoperative chemotherapy trial cohorts.Methods:Clinicopathological and gene expression data were evaluated in a cohort from two consecutive phase II preoperative studies that included patients with stage IIA–IIIC breast cancer of all subtypes. Analysed specimens were obtained before preoperative chemotherapy, and cDNA microarray analyses were performed using the Affymetrix Gene Chip U133 plus 2.0.Results:Between December 2005 and December 2010, 122 patients were analysed. The pathologic complete response rate was significantly higher in HER2+ and HR−/HER2− cancers. Age, pathologic complete response, HR−/HER2− status, and lymph node positivity (⩾4) were significant poor prognostic factors for disease-free survival. For the cDNA microarray analyses, sufficient tumour samples were available from 78 of the 107 patients (73%). An 8-gene signature predictive of pathologic complete response and a 17-gene signature predictive of prognosis were identified. Patients were categorised into low-risk (n=45) and high-risk groups (n=33) (HR 70.0, P=0.004).Conclusions:This study yielded preliminary data on the expression of specific genes predicting pathologic complete response and disease-free survival in a cohort of chemonaïve breast cancer patients. Further validation may distinguish those who would benefit most from perioperative chemotherapy as well as those needing further intervention.British Journal of Cancer advance online publication 14 July 2016; doi:10.1038/bjc.2016.184 www.bjcancer.com. © 2016 Cancer Research UK
Tsuda H.,Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital |
Tanaka K.,Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
Internal Medicine | Year: 2012
We report two cases of isolated unilateral pupil-sparing partial fascicular oculomotor paresis. Patient 1 was a 72-year-old man who developed left-sided palsy of the inferior rectus muscle (IR), medial rectus muscle (MR), superior rectus muscle (SR), inferior oblique muscle (IO), and levator palpebrae superioris (LP) due to infarction of the left paramedian thalamic artery. Patient 2 was a 70-year-old woman who developed rightsided palsy of MR, SR, IO and LP due to infarction of the right superior paramedian mesencephalic artery. These results suggest that the fibers to IR may be located in the most rostral portion of the oculomotor fascicles. © 2012 The Japanese Society of Internal Medicine.
Koga F.,Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital |
Yokoyama M.,Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital |
Fukushima H.,Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital
Expert Review of Anticancer Therapy | Year: 2013
Small cell carcinoma of the urinary bladder (SCCUB) is a rare and aggressive disease. To date, no standard treatment has been proposed due to the lack of prospective studies resulting from the rarity of this disease. Recently published studies of relatively large patient cohorts, however, have shed some light on the management of SCCUB patients. In this article, the authors review the epidemiology, pathogenesis, diagnosis and treatment (based on disease stage), and they then discuss the optimal therapeutic strategy for SCCUB patients, particularly for those with limited, locoregional disease. The authors conclude that multidisciplinary approaches are needed for the optimal management of this aggressive disease. The authors also discuss bladder-sparing approaches for SCCUB patients, compared to those for conventional bladder urothelial carcinoma patients. © 2013 Informa UK Ltd.
Honda G.,Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital |
Kurata M.,Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital |
Okuda Y.,Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital |
Kobayashi S.,Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital |
And 2 more authors.
Journal of Gastrointestinal Surgery | Year: 2014
Laparoscopic hepatectomy has rapidly evolved recently; 1-5 however, laparoscopic anatomical hepatectomy has yet to become widely used, although anatomical hepatectomy is ideal, especially for curative treatment of hepatocellular carcinoma, and is widely accepted via open approach. 6-10 This is because good-experienced skills, for example, exposing Glissonean pedicles and hepatic veins on the cutting plane, are required in order to perform anatomical hepatectomy via a pure laparoscopic approach. We obtained good results for various totally laparoscopic anatomical hepatectomies using the standardized techniques. We exposed the major hepatic veins from the root side by utilizing the unique view from the caudal side in the laparoscopic approach, and moved CUSA from the root side toward the peripheral side to avoid splitting the bifurcation of the hepatic vein. 11-13 We performed totally laparoscopic anatomical hepatectomy for 47 patients from August, 2008, to December, 2012 (Table 1). In most types of anatomical hepatectomy, the mean blood loss was <500 ml. Conversion to open surgery was required in two patients. Postoperative complications were prolonged ascites in two, peroneal palsy in two, and biloma in one. Mortality was zero. The embedded video demonstrates totally laparoscopic right anterior sectorectomy. In conclusion, our standardized techniques make laparoscopic anatomical hepatectomy more feasible. © 2014 The Author(s).
Onoyama H.,Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011
A 74-year-old man, whose chief complaint was epigastralgia, was referred to our hospital and diagnosed gastric cancer with liver metastasis. Gastrointestinal endoscopy showed a tumor on the lesser curvature of cardia of stomach. He was diagnosed as neuroendocrine cell carcinoma by biopsy specimens. He was treated by combined chemotherapy of CPT-11 and CDDP. After 11 courses, endoscopic examination revealed a complete disappearance of the primary tumor. CT-scan and MRI showed that the liver metastasis had been disappeared. We diagnosed as clinical CR and performed total gastrectomy with lymph node dissection and partial hepatectomy. Histological findings revealed a few cells in stomach and no cancer cells in the liver. He was treated with adjuvant chemotherapy of S-1. After 3-course, he suffered from anemia of grade 3, thus we interrupted chemotherapy. The patient remains alive for 28 months without recurrence. We conclude that chemotherapy was effective for neuroendocrine cell carcinoma of the stomach, which was to be considered of poor prognosis, and that liver resectomy was often effective.
Takahashi K.,Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013
We report a rare case of fibrosing mediastinitis diagnosed by thoracoscopic biopsy. A 56-year-old female visited our hospital with an abnormal mediastinal shadow on chest X ray. Chest computed tomography revealed a paravertebral tumor from Th9 to Th11. Pathological examination of thoracoscopic biopsy specimen showed fibrous tissue with mild inflammation and no malignant feature. Final diagnosis was idiopathic fibrosing mediastinitis. The paravertebral lesion shrinked spontaneously 5 months later after biopsy.