s-1-(combination) and Adenocarcinoma--Papillary

A 68-year-old woman was referred to our hospital with an abnormal shadow on her chest CT, which showed a mass lesion 3.5 cm in diameter at segment 7 in the right lung. At thoracotomy, a curative operation could not be performed because of pleural dissemination, so a partial resection was done for the histopathological examination. It showed papillary adenocarcinoma and clinical Stage IIIB. Her family hoped not to inform her that a curative operation was impossible. We explained the necessity of adjuvant chemotherapy to her, and she consented to UFT. However, the level of CEA gradually elevated, and pleural effusion on the right side appeared 2 years after operation. We converted UFT into TS-1. The level of CEA gradually reduced, and pleural effusion disappeared. We conclude that oral administration of UFT or TS-1 is useful as palliative chemotherapy for advanced non-small cell lung cancer without serious adverse events and worsening of quality of life.

Topics: Adenocarcinoma, Papillary; Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Administration Schedule; Drug Combinations; Female; Humans; Lung Neoplasms; Oxonic Acid; Pleural Effusion, Malignant; Pyridines; Quality of Life; Tegafur; Uracil

A 70-year-old man presented with dizziness, headache and hearing loss. He was admitted to our hospital because of increasing unsteadiness of gait. Magnetic resonance imaging of the brain revealed meningeal thickening with enhancement. The lumbar puncture revealed high opening pressure. The cerebrospinal fluid showed pleocytosis, high carcinoembryonic antigen (CEA) concentration, and presence of neoplastic cells, leading to the diagnosis of leptomeningeal carcinomatosis. Systemic investigation for primary neoplasm identified a Bormman type 3 gastric cancer (papillary adenocarcinoma with micropapillary pattern). Except for the meninges, no metastatic lesions could be detected. A ventriculoperitoneal shunt (Codman Hakim Programmable Valve) was placed for management of intracranial hypertension and intrathecal chemotheray. He was started on oral S-1 (TS-1) combined with intrathecal methotrexate injection using the VP shunt reservoir. In two weeks, headache and hearing loss completely disappeared and gait disturbances started to improve. CSF findings also improved remarkably with disappearance of neoplastic cells and almost normalization of CEA. For the next five months, he was well on oral S-1 and monthly intrathecal chemotherapy, being able to walk using a walker and to stay at home. He subsequently developed posterior cortical symptoms such as prosopagnosia and cortical blindness and gradually lapsed into coma. He died from pneumonia one year after the onset of neurological symptoms. At autopsy, primary gastric cancer was found but much reduced in size. No peritoneal metastasis could be found. In the brain, leptomeningeal carcinomatosis involved the occipital lobes, the base of the temporal lobe, and the cerebellum. We suggest that intrathecal chemotherapy using ventriculoperitoneal shunt with programmable valve system could be an effective method for the treatment of meningeal carcinomatosis.

Topics: Adenocarcinoma, Papillary; Administration, Oral; Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Fatal Outcome; Humans; Injections, Spinal; Intracranial Hypertension; Male; Meningeal Neoplasms; Methotrexate; Oxonic Acid; Stomach Neoplasms; Tegafur; Treatment Outcome; Ventriculoperitoneal Shunt

A 49-year old man underwent distal gastrectomy (D3) for circumferential type 3 cancer at the gastric antrum and cholecystectomy in September 2002. During the surgery, multiple metastases were observed predominantly in the left lobe of the liver, and lateral segmentectomy was performed as non-curative (curability-C) resection leaving the small metastases in the right lobe of the liver. Based on the results of chemo-sensitivity tests (5-FU 15.0%, CDDP 34.0%, MMC 35.3%, TXT 0.0%), we started to administer TS-1 (100 mg/day for 4 weeks followed by a 2-week rest interval) and MMC (10 mg/body on day 1). Due to leukocytopenia, the regimen was changed to TS-1 (100 mg/day for 4 weeks followed by a 2-week rest interval) and MMC (4 mg/body every other week [day 1, 14]) from the second course. Levels of tumor markers dropped and liver metastatic lesions remarkably decreased in size by CT after the third course. In conclusion, a combination of TS-1/MMC may be regarded as one option for postoperative adjuvant chemotherapy for outpatients.

Topics: Adenocarcinoma, Papillary; Administration, Oral; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Drug Administration Schedule; Drug Combinations; Humans; Injections, Intravenous; Liver Neoplasms; Male; Middle Aged; Mitomycin; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

We report the case of a 58-year-old male with Stage IV gastric cancer accompanied by multiple liver metastases, which responded to chemotherapy using TS-1. The patient was treated with daily oral administration of 120 mg TS-1 for 4 weeks followed by 2 weeks rest as 1 cycle. After 4 cycles, most of the liver metastases had disappeared and serum CEA level was reduced from 140 to 53.9. The patient received chemotherapy at our outpatient clinic for 9 months during which time there was no regrowth after the first treatment. The current case suggests that TS-1 may have a potent therapeutic efficacy in cases of advanced gastric cancer.

Topics: Adenocarcinoma, Papillary; Administration, Oral; Antineoplastic Combined Chemotherapy Protocols; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

TS-1 is a new, oral anticancer agent composed of two modulators, gimeracil (CDHP) and oteracil potassium (Oxo) are mixed with tegafur in a ratio of 1:0.4:1. We report one case of advanced gastric cancer with lung and lymph node metastases that completely responded to TS-1. A 71-year-old woman was admitted to our hospital because of breathlessness. A diagnosis of advanced gastric cancer with extensive lymph node metastases and multiple pulmonary metastases was made. One hundred mg/body/day of TS-1 was orally administrated for 4 weeks. A partial response (PR) was obtained after the first course with regression of multiple pulmonary metastases. After 1 drug-free week, the second course was administered with 120 mg/body/day of TS-1 for 4 weeks. After two courses, the primary tumor was reduced to an ulcer scar with pathological confirmation of a complete disappearance of the cancer tissue. Moreover, computed tomography (CT) showed a complete regression of the extensive lymph node and diffuse lung metastases, for a complete response (CR). The serum level of CEA was reduced from 172.7 ng/ml to 8.1 ng/ml after TS-1 treatment. As for adverse events, only pigmentation of the skin and Grade 2 oral aphta were observed.

Topics: Adenocarcinoma, Papillary; Administration, Oral; Aged; Antineoplastic Agents; Carcinoembryonic Antigen; Drug Combinations; Female; Humans; Lung Neoplasms; Lymphatic Metastasis; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur