s-1-(combination) and Carcinoma--Ductal

We report a case of metastatic brain tumor originated from pancreatic cancer, which might be clinically considered as rare and has been reported as a remarkably poor-prognostic disease. A 64-year-old male underwent pancreas tail resection for pancreatic cancer (R0 resection). Histological study revealed an invasive ductal carcinoma (T4N2M0, fStage IVb). Following a short term of GEM administration, S-1 (80 mg/m2,day 1-28/42 days) was administered as the second-line. After 7 courses of S-1 chemotherapy, a follow-up CT demonstrated lymph node recurrence in cervical and mediastinum region. S-1 administration was stopped and irradiation to these sites (60 Gy) resulted in PR. Two months after irradiation, dizziness and speech disturbance appeared, and MRI examination demonstrated a solitary brain metastasis, which was removed because of rapid worseness of neurological symptoms. Postoperatively, hemicereberal irradiation (30 Gy) was performed. After the brain surgery, no brain metastasis was appeared. The patient was alive with abdominal lymph node recurrence for 22 months after distal pancreatectomy. It was concluded from these findings that irradiation to systemic recurrence originated from pancreatic cancer might be effective as well as chemotherapy.

Topics: Antimetabolites, Antineoplastic; Brain Neoplasms; Carcinoma, Ductal; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Gemcitabine; Humans; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Tegafur

Although adjuvant chemotherapy with gemcitabine is standard care for resected pancreatic cancer, S-1 has shown non-inferiority to gemcitabine for advanced disease. We aimed to investigate the non-inferiority of S-1 to gemcitabine as adjuvant chemotherapy for pancreatic cancer in terms of overall survival.. We did a randomised, open-label, multicentre, non-inferiority phase 3 trial undertaken at 33 hospitals in Japan. Patients who had histologically proven invasive ductal carcinoma of the pancreas, pathologically documented stage I-III, and no local residual or microscopic residual tumour, and were aged 20 years or older were eligible. Patients with resected pancreatic cancer were randomly assigned (in a 1:1 ratio) to receive gemcitabine (1000 mg/m(2), intravenously administered on days 1, 8, and 15, every 4 weeks [one cycle], for up to six cycles) or S-1 (40 mg, 50 mg, or 60 mg according to body-surface area, orally administered twice a day for 28 days followed by a 14 day rest, every 6 weeks [one cycle], for up to four cycles) at the data centre by a modified minimisation method, balancing residual tumour status, nodal status, and institutions. The primary outcome was overall survival in the two treatment groups, assessed in the per-protocol population, excluding ineligible patients and those not receiving the allocated treatment. The protocol prespecified that the superiority of S-1 with respect to overall survival was also to be assessed in the per-protocol population by a log-rank test, if the non-inferiority of S-1 was verified. We estimated overall and relapse-free survival using the Kaplan-Meier methods, and assessed non-inferiority of S-1 to gemcitabine using the Cox proportional hazard model. The expected hazard ratio (HR) for mortality was 0.87 with a non-inferiority margin of 1.25 (power 80%; one-sided type I error 2.5%). This trial is registered at UMIN CTR (UMIN000000655).. 385 patients were randomly assigned to treatment between April 11, 2007, and June 29, 2010 (193 to the gemcitabine group and 192 to the S-1 group). Of these, three were exlcuded because of ineligibility and five did not receive chemotherapy. The per-protocol population therefore consisted of 190 patients in the gemcitabine group and 187 patients in the S-1 group. On Sept 15, 2012, following the recommendation from the independent data and safety monitoring committee, this study was discontinued because the prespecified criteria for early discontinuation were met at the interim analysis for efficacy, when all the protocol treatments had been finished. Analysis with the follow-up data on Jan 15, 2016, showed HR of mortality was 0.57 (95% CI 0.44-0.72, pnon-inferiority<0.0001, p<0.0001 for superiority), associated with 5-year overall survival of 24.4% (18.6-30.8) in the gemcitabine group and 44.1% (36.9-51.1) in the S-1 group. Grade 3 or 4 leucopenia, neutropenia, aspartate aminotransferase, and alanine aminotransferase were observed more frequently in the gemcitabine group, whereas stomatitis and diarrhoea were more frequently experienced in the S-1 group.. Adjuvant chemotherapy with S-1 can be a new standard care for resected pancreatic cancer in Japanese patients. These results should be assessed in non-Asian patients.. Pharma Valley Center, Shizuoka Industrial Foundation, Taiho Pharmaceutical.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Ductal; Chemotherapy, Adjuvant; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Injections, Intravenous; Kaplan-Meier Estimate; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Pancreatectomy; Pancreatic Neoplasms; Proportional Hazards Models; Tegafur

A randomized controlled trial has begun in Japan to compare orally administered S-1 with intravenous gemcitabine (GEM) as adjuvant chemotherapy for patients with curatively resected pancreatic cancer. Patients are enrolled within 10 weeks after pancreatectomy to be treated for six months after assignment to either S-1 (80 mg/m(2)/day for four weeks, repeated similarly every six weeks for a total of four courses) or GEM (1000 mg/m(2) on days 1, 8 and 15, repeated similarly every four weeks for a total of six courses). The primary endpoint is overall survival; secondary endpoints include relapse-free survival, incidence of adverse events and health-related quality of life. Each treatment arm includes 180 patients, providing an expected hazard ratio of 0.87 and an upper margin of 1.25 (two-sided alpha-error, 0.05; power, 0.8). Follow-up abdominal computed tomography is repeated every three months during the first two years, then every six months for three years.

Topics: Administration, Oral; Adult; Antimetabolites, Antineoplastic; Carcinoma, Ductal; Chemotherapy, Adjuvant; Deoxycytidine; Disease-Free Survival; Drug Administration Schedule; Drug Combinations; Gemcitabine; Humans; Injections, Intravenous; Japan; Neoplasm Staging; Oxonic Acid; Pancreatectomy; Pancreatic Neoplasms; Prospective Studies; Quality of Life; Survival Rate; Tegafur

Locally advanced breast cancer sometimes results in a large chest wall defect at mastectomy. When closing the wound horizontally, the skin tension is usually severe in the middle of the wound, while the skin of the lateral area tends to make a dog-ear deformity. Triangle technique is a procedure to prevent the dog ear in which the skin and subcutaneous fat of the axilla are cut into an equilateral triangle. Herein, we present a case of breast cancer who underwent a mastectomy and closed the wound with a skin graft by utilizing the skin removed from lateral thoracic area using triangle technique. An 85-year-old female visited our institution complaining about the mass on her right breast. Preoperative images showed a 10 cm-sized mass with suspicious axillary and mediastinal lymph nodes swelling. A biopsy revealed a hormone receptor-negative, HER2-positive invasive ductal carcinoma. A mastectomy and axillary lymph node sampling were performed for a local control as the tumor did not respond to four cycles of triweekly trastuzumab combined with S-1. After a transverse elliptical incision, a skin of the lateral thoracic area was harvested using triangle technique. As the middle of the wound had excessive closing tension, the skin was grafted on the defect. After 10 day fixation by a tie-over dressing, the wound healed without complications. This procedure is a simple method for closing a large defect after mastectomy preventing both the dog-ear deformity and a new wound scarring of a donor site.

Topics: Aged, 80 and over; Antimetabolites, Antineoplastic; Antineoplastic Agents, Immunological; Axilla; Biopsy; Breast Neoplasms; Carcinoma, Ductal; Drug Combinations; Female; Follow-Up Studies; Humans; Lymph Nodes; Mammaplasty; Mastectomy; Oxonic Acid; Skin Transplantation; Surgical Flaps; Tegafur; Thoracic Wall; Trastuzumab; Treatment Outcome

In November 2005, a 34-year-old female presented to our department with a bleeding tumor on her right breast. She noticed the tumor approximately two years ago but she left it untreated. An exposed tumor was observed with a diameter of approximately 8 cm located in the right breast. It was diagnosed as invasive ductal carcinoma by biopsy (ER (+), PgR (+), and HERS2: 1 +). The imaging showed multiple metastases to the bilateral lungs, right axillary lymph node, mediastinal lymph node and sternal. The diagnosis was made as right breast cancer (T4c, N3c, M1, and stage IV). The patient received 4 courses of FEC therapy and 4 courses of PTX therapy. The patient had a partial response (PR). However, tumor markers were elevated in September 2006. Thus, an administration of S-1 was initiated. The size of the tumor shown in the imaging was reduced, and the patient had a PR. Since December 2008, tumor markers have been elevated again. However, the patient has had SD in the imaging and S-1 administrations have been continued. A total of 24 courses have been performed to the present time, and the patient's conditions have not been aggravated in approximately 3 years and 5 months. She has maintained a good QOL and is being followed up on an outpatient basis. S-1 administrations can be an effective treatment for advanced breast cancer resistant to anthracycline and taxane when considering a satisfactory QOL of patients.

Topics: Adult; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Carcinoma, Ductal; Cyclophosphamide; Drug Combinations; Epirubicin; Female; Fluorouracil; Humans; Oxonic Acid; Paclitaxel; Pentoxifylline; Quality of Life; Tegafur; Treatment Outcome