s-1-(combination) and Disseminated-Intravascular-Coagulation

Our patient was a 58-year-old man who was diagnosed with a large bowel obstruction caused by ascending colon cancer, together with multiple liver metastases for which a right hemicolectomy was performed. After the operation, he developed disseminated intravascular coagulation(DIC)and severe anemia. Bone marrow biopsy findings led to a diagnosis of disseminated carcinomatosis of the bone marrow caused by colon cancer. We administered S-1+oxaliplatin(SOX) and bevacizumab( BV)chemotherapy, which improved the DIC. The patient was discharged from the hospital. After a total of six courses of chemotherapy, the carcinoma became resistant. We changed the drug regimen and his clinical condition improved. He survived for 292 days from the onset of disease.

Topics: Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Bone Marrow Neoplasms; Chemotherapy, Adjuvant; Colonic Neoplasms; Disseminated Intravascular Coagulation; Drug Combinations; Fatal Outcome; Humans; Male; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Tegafur

We report an 87-year-old woman who was admitted to our hospital due to anemia and extremely elevated serum alkaline phosphatase (ALP) levels. We diagnosed advanced gastric cancer with disseminated carcinomatosis of the bone marrow and multiple bone metastasis. She was immediately treated with low-dose S-1 (50mg/body, p.o., days 1-14) and zoledronic acid hydrate (4mg/body, i.v., day 1) to avoid disseminated intravascular coagulation (DIC). After 1 course of the treatment, she could completely avoid DIC and we found the primary lesion and the metastasis had decreased. Now she is an outpatient and continues treatment without relapse for about 6 months. We consider low-dose S-1 and zoledronic acid hydrate combination therapy to be an effective strategy against advanced gastric cancer with disseminated carcinomatosis of the bone marrow and multiple bone metastasis in very elderly cases.

Topics: Aged, 80 and over; Alkaline Phosphatase; Antimetabolites, Antineoplastic; Bone Marrow Neoplasms; Bone Neoplasms; Carcinoma; Diphosphonates; Disseminated Intravascular Coagulation; Drug Combinations; Female; Humans; Imidazoles; Oxonic Acid; Stomach Neoplasms; Tegafur; Zoledronic Acid

We report the case of a 36‒year‒old man who was treated with S‒1 plus oxaliplatin(SOX)therapy for gastric cancer with disseminated intravascular coagulation(DIC). The patient visited our hospital for the treatment of an unresectable type 4 advanced gastric cancer. He had respiratory distress at the first visit. A chest CT scan revealed ground‒glass shadows as well as interstitial and septal thickening diffusely located in both the lungs, which suggested cancerous lymphangiopathy. Moreover, based on blood test results, DIC was diagnosed. After the administration of SOX in combination with recombinant human soluble thrombomodulin, the patient recovered from DIC, and the values of the tumor markers(CEA and CA19‒9) were normalized. After more than 14 months post treatment, the patient has survived without relapse. There are several reports that chemotherapy for gastric cancer is effective for DIC; however, there are no reports on regimens using oxaliplatin. Regimens using this drug may improve the prognosis of gastric cancer complicated by disseminated myelocarcinomatosis and DIC.

Topics: Adult; Disseminated Intravascular Coagulation; Drug Combinations; Humans; Male; Neoplasm Recurrence, Local; Oxaliplatin; Oxonic Acid; Stomach Neoplasms; Tegafur; Thrombomodulin

Disseminated intravascular coagulation (DIC) is a rare complication of advanced gastric cancer (AGC). Despite reports of the efficacy of chemotherapy for AGC with DIC, little is known of platinum-based doublet therapy.. We conducted a single-institute, retrospective chart review of 500 consecutive chemotherapy-naïve patients with advanced gastric adenocarcinoma (recurrent or metastatic) from November 2010 to November 2015.. Six patients were diagnosed with AGC with DIC (1.2%); five (1.0%; 3 men, 2 women) received platinum-based doublet chemotherapy. All patients exhibited improved DIC and thrombocytopenia and survived for >100 days (range=114-313) with no therapy-related mortality. Grade ≥3 adverse effects included neutropenia, anemia, hyponatremia, catheter-related infection and diarrhea (maximum: 2 patients each).. Fluoropyrimidine plus platinum combination therapy was effective against DIC and yielded acceptable survival outcomes. Combination chemotherapy should be considered as a primary therapy for AGC with DIC.

Topics: Adenocarcinoma; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Disseminated Intravascular Coagulation; Drug Combinations; Female; Fluorouracil; Humans; Leucovorin; Male; Middle Aged; Organoplatinum Compounds; Oxonic Acid; Paclitaxel; Stomach Neoplasms; Tegafur; Treatment Outcome

Trastuzumab, a humanized monoclonal antibody against human epidermal growth factor receptor 2 (HER2), has been proven to result in a survival benefit for the treatment of patients with HER2-positive advanced gastric cancer (AGC). However, data are lacking for the treatment of those with disseminated intravascular coagulation (DIC) and diffuse bone marrow carcinomatosis. A 77-year-old woman presented with back pain and fatigue since 2 months. Esophagogastroduodenoscopy showed a scirrhous lesion in the gastric corpus, which was biopsied and identified as signet-ring cell carcinoma with HER2 overexpression on immunohistochemistry. Laboratory testing, bone scintigraphy, and bone marrow biopsy were conducted, and she was diagnosed with HER2-positive AGC with DIC and diffuse bone marrow carcinomatosis. She underwent chemotherapy with the following regimen: oral administration of 80 mg/m2 S-1 for 2 weeks and 6 mg/kg trastuzumab infusion on day 6 every 3 weeks, which significantly improved the DIC. She was discharged from the hospital 73 days after admission and survived for 438 days after diagnosis. To the best of our knowledge, this is the first case report in which HER2-positive AGC complicated by DIC with diffuse bone marrow carcinomatosis was successfully treated with combined chemotherapy consisting of S-1 plus trastuzumab.

Topics: Aged; Anticoagulants; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Bone Marrow Neoplasms; Bone Neoplasms; Carcinoma, Signet Ring Cell; Disseminated Intravascular Coagulation; Drug Combinations; Fatal Outcome; Female; Humans; Oxonic Acid; Receptor, ErbB-2; Stomach Neoplasms; Tegafur; Trastuzumab

A 78-year-old woman was admitted to our hospital complaining of anorexia and purpura of the extremities. She presented with prominent peripheral eosinophilia and disseminated intravascular coagulation (DIC). Despite receiving intensive therapy for DIC, her illness worsened. Esophagogastroduodenoscopy revealed advanced gastric cancer (AGC), and a bone marrow biopsy led to a diagnosis of disseminated carcinomatosis of the bone marrow caused by AGC. We initiated combination chemotherapy with S-1 and cisplatin, which lead to a significant improvement of the DIC and eosinophilia, and the patient was finally discharged. The primary symptoms of DIC and eosinophilia were both considered to be caused by AGC, and we successfully treated the patient's critical condition.

Topics: Aged; Anorexia; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Bone Marrow; Bone Marrow Neoplasms; Cisplatin; Disseminated Intravascular Coagulation; Drug Combinations; Eosinophilia; Female; Humans; Oxonic Acid; Purpura; Stomach Neoplasms; Tegafur; Treatment Outcome

A 63-year-old- female was admitted to our hospital complaining of cough. Based on CT, bone centigram and peripheral blood findings, a diagnosis of gastric carcinoma accompanied by bone marrow metastasis was made. As DIC developed following hospital admission, S-1 and docetaxel(DOC)therapy was initiated(daily oral administration of 80 mg/m(2) S-1 for 14 days and DOC at 40 mg/m(2) on day 1, q3w). Recovery from DIC was achieved. S-1 and DOC therapy is considered to be effective for DIC due to bone marrow metastasis of gastric carcinoma. S-1/DOC is thought to be an effective chemotherapy against progressive gastric carcinoma accompanied by disseminated carcinomatosis bone marrow with DIC.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Neoplasms; Bone Neoplasms; Disease Progression; Disseminated Intravascular Coagulation; Docetaxel; Drug Combinations; Female; Humans; Middle Aged; Oxonic Acid; Stomach Neoplasms; Taxoids; Tegafur

We report a case of gastric cancer accompanied by disseminated carcinomatosis of the bone marrow treated with S-1 and cisplatin( CDDP) combination chemotherapy. The patient was a 68-year-old woman who was detected as having disseminated intravascular coagulation( DIC) during an examination for gastric cancer and she was diagnosed as having disseminated carcinomatosis of the bone marrow by lumbar puncture. She was immediately treated with S-1 and CDDP combination chemotherapy( S-1, 80 mg/body orally administered[ po] on days 1-21 and CDDP, 60 mg/body intravenously [iv] administered on day 8) and her DIC improved on the fourth day. Subsequently, the patient was treated with 3 courses of combination chemotherapy and she survived for 184 days from the initiation of the treatment. Although disseminated carcinomatosis of the bone marrow is associated with a poor prognosis, we believe that the duration of survival of our patient was extended due to initiation of chemotherapy at an early stage.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Neoplasms; Carcinoma; Cisplatin; Disseminated Intravascular Coagulation; Drug Combinations; Fatal Outcome; Female; Humans; Oxonic Acid; Stomach Neoplasms; Tegafur

Patients with bone metastasis originating from gastric cancer experience complications from DIC. They are treated with anticoagulation therapy or platelet transfusion, but their prognosis is poor. Our case was a 50-year-old male who had undergone distal gastrectomy for early gastric cancer[pT1a(M)N0M0, pStage I a]ten years previously. He was admitted to our hospital complaining of backache. As a result of his examination, he was diagnosed with disseminated carcinosis of bone marrow with DIC as a postoperative recurrence of gastric cancer. The patient was treated with combination chemotherapy of S-1 and cisplatin(S-1 80 mg/body, po, day 1-21 and cisplatin 50mg/body, iv, day 8). After one course of treatment, DIC was resolved and his pain was relieved. He survived for about nine months. S-1 and cisplatin are considered to be effective for disseminated carcinosis of bone marrow.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Neoplasms; Carcinoma; Cisplatin; Disseminated Intravascular Coagulation; Drug Combinations; Fatal Outcome; Gastrectomy; Humans; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Stomach Neoplasms; Tegafur

Advanced gastric cancer (AGC) accompanied by disseminated intravascular coagulation(DIC)has a poor prognosis, and has no established therapy. Here, we report a case of a 69-year-old woman referred to our hospital due to severe anemia and thrombocytopenia. Esophagogastroduodenoscopy demonstrated an AGC in the cardiac part of the stomach, which was histologically diagnosed as poorly-differentiated adenocarcinoma. Bone scintigraphy showed multiple metastases to the bone marrow. Her diagnosis was DIC resulting from AGC, with multiple bone metastases. She underwent chemotherapy with the following regimen: 60mg/m2 docetaxel(DOC)infusion on day 1 and daily oral administration of 100 mg/m2 S-1 for two weeks every three weeks. DIC subsided rapidly after initiation of the therapy and resolved in 12 days. She was discharged from the hospital 56 days after admission and survived 303 days. To our knowledge, this is the first case of AGC reported in the Japanese and English literature to obtain long-term survival in this setting. Combined chemotherapy of S-1 plus DOC may play an important role in the treatment of AGC developing DIC.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Disseminated Intravascular Coagulation; Docetaxel; Drug Combinations; Fatal Outcome; Female; Humans; Oxonic Acid; Stomach Neoplasms; Taxoids; Tegafur

A 61-year-old man exhibiting epigastric malaise on hunger was diagnosed with early gastric cancer by upper gastrointestinal endoscopy. Since no obvious metastasis was recognized by abdominal computed tomography(CT), he underwent distal gastrectomy with D1+ lymphadenectomy. Histopathological examination revealed a pStage IA lesion[pT1a (m), pN0]. He received no adjuvant chemotherapy, and he remained alive and in good health without recurrence for more than 5 years. At 5 years and 7 months after gastrectomy, he noticed cervical lymph node swelling and underwent further examination. He was diagnosed with recurrent gastric cancer in cervical lymph nodes, and treatment with S-1 (120 mg/ day) was initiated. He remained alive and free of progression for approximately 1 year on S-1 therapy, but he suddenly died from disseminated intravascular coagulation without an obvious cause. We report a rare case of late recurrence after curative resection in a patient treated for early gastric cancer.

Topics: Biopsy; Combined Modality Therapy; Disseminated Intravascular Coagulation; Drug Combinations; Fatal Outcome; Gastrectomy; Humans; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Oxonic Acid; Recurrence; Stomach Neoplasms; Tegafur; Time Factors

The patient was a 50-year-old man who underwent total gastrectomy twelve years ago. Ahigh level of ALP was found in the patient in April 2008. Based on various examinations, the diagnosis of multiple bone metastasis of gastric carcinoma accompanying disseminated intravascular coagulation(DIC)was made. The patient was treated with S-1/CDDP. S-1(80mg/ m / / 2day)was administered for 14 days followed by a 7-day rest period, and a CDDP(20mg/m2)infusion was administered on days 1 and 8. After one course of treatment, the DIC was controlled, and the patient was given a one-year prognosis. The combination of S-1 and low-dose CDDP may be considered effective even for multiple bone metastases of gastric carcinoma with DIC.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Cisplatin; Disseminated Intravascular Coagulation; Drug Combinations; Fatal Outcome; Humans; Male; Middle Aged; Oxonic Acid; Prognosis; Stomach Neoplasms; Tegafur

A 49-year-old female with advanced gastric cancer complicated with peritoneal dissemination underwent distal gastrectomy, and thereafter she was treated with a combined chemotherapy of S-1 and paclitaxel for 5 months, followed by treatment with S-1 alone. A year after the gastrectomy, she developed disseminated intravascular coagulation (DIC) with multiple bone metastases despite the continuous treatment with S-1, indicating that S-1 was no longer effective. She was then effectively treated by a combined chemotherapy with cisplatin(CDDP)and irinotecan hydrochloride (CPT-11), and DIC subsided within 7 days after the treatment. These findings suggest that combined chemotherapy with CDDP and CPT-11 is a useful regimen for the treatment of certain patients with DIC associated with S-1-resistant advanced gastric cancer.

Topics: Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Camptothecin; Cisplatin; Disseminated Intravascular Coagulation; Drug Combinations; Drug Resistance, Neoplasm; Female; Humans; Irinotecan; Middle Aged; Oxonic Acid; Stomach Neoplasms; Tegafur

Bone marrow carcinosis due to gastric cancer with disseminated intravascular coagulation(DIC)occurs suddenly, progresses rapidly, and has a very poor prognosis. In addition, physical status tends to be bad at the time of the episode, and palliative care is generally selected as the treatment method. The case was a 70-year-old woman who underwent total gastrectomy for scirrhous stomach cancer five years previously. She recently noticed gingival hemorrhage, and was referred to our hospital by a nearby doctor. As a result of her examination, she was diagnosed with disseminated bone marrow carcinosis as a postoperative recurrence of gastric cancer that resulted in DIC. We transfused blood platelets and fresh frozen plasma into her, and controlled the bleeding tendency temporarily. She was started on oral administration of S-1 for improvement of DIC, and the therapy was successful without loss of QOL. It is easy to continue S-1 therapy as chemotherapy in the outpatient department, because it is a matter of internal medicine.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Biopsy; Bone Marrow Neoplasms; Disseminated Intravascular Coagulation; Drug Combinations; Female; Gastrectomy; Humans; Oxonic Acid; Radionuclide Imaging; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

A 71-year-old woman was admitted for anorexia. Endoscopic findings revealed type 3 gastric cancer. Histological examination of the endoscopic biopsy revealed poorly-differentiated adenocarcinoma. We performed total gastrectomy. However, 18 days after surgery, DIC due to multiple bone metastases occurred. The patient was treated with TS-1 chemotherapy in addition to anti-DIC therapy. TS-1(100 mg/day) was administered on days 1 to 5, 8 to 12, and 15 to 19 . The DIC was resolved. She was discharged after 2 courses of this regimen. This chemotherapy can be applied for the management of DIC caused by multiple bone metastases.

Topics: Adenocarcinoma; Aged; Antimetabolites, Antineoplastic; Bone Neoplasms; Combined Modality Therapy; Disseminated Intravascular Coagulation; Drug Administration Schedule; Drug Combinations; Female; Gastrectomy; Humans; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

A 41-year-old man was found to have advanced gastric cancer with simultaneous multiple bone metastases when pyloric stenosis was being diagnosed in our hospital. We performed gastrojejunostomy from the lower third of the stomach to the upper third of the duodenum to relieve the obstruction. However, at 8 days after surgery, disseminated intra-vascular coagulation (DIC) occurred. Therefore, the patient was administered combined chemotherapy with TS-1 plus low-dose cisplatin in addition to anti-DIC therapy. TS-1 (150 mg/day) and cisplatin (10 mg/body intravenously over the course of 30 minutes) were administered on days 1 to 5, 8 to 12, and 15 to 19 (weekday-on/weekend-off schedule). There was remarkable response to this chemotherapy, and the patient was shifted from inpatient to outpatient treatment. The treatment course was repeated for 4 cycles until remission was observed. Because of hematologic relapse due to DIC at 6 months after the first treatment, he was readmitted for administration of combined chemotherapy. Fortunately, DIC once again responded to the same chemotherapy regimen. In this pathologic condition, combined chemotherapy is unavoidable when DIC occurs with cancer. Accordingly, it is necessary that an effective combined chemotherapy with mild bone marrow suppression be chosen. A companion drug should be chosen in consideration of delayed homo-toxicity and of the possibility of relapse into DIC in the drug withdrawal period. In addition, it is indispensable that careful consideration be given to the most favorable dose and regimen.

Topics: Adenocarcinoma; Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Cisplatin; Combined Modality Therapy; Disseminated Intravascular Coagulation; Drug Administration Schedule; Drug Combinations; Gastrectomy; Humans; Male; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

We report a 48-year-old male with gastric cancer who was suffering from acute onset of DIC due to multiple bone metastases. Treatment with TS-1 + CDDP was started with the following regimen: daily oral administration of 80 mg/m2 TS-1 for 21 days, followed by a 14-day rest and CDDP 60 mg/m2 infusion on day 8. The DIC was suddenly resolved and bone metastases were well controlled after the chemotherapy combined with anticoagulant therapy and bisphosphonate. The combination of TS-1 and CDDP can be applied for the management of DIC caused by multiple bone metastases.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Cisplatin; Clodronic Acid; Disseminated Intravascular Coagulation; Drug Combinations; Humans; Male; Middle Aged; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

The patient was a 71-year-old man whose chief complaints were staggering and fatigue. As a result of various examinations, he was diagnosed with advanced gastric cancer, Borrmann 3, with disseminated intravascular coagulation (DIC) and bone metastases. The DIC was treated with oral administration of TS-1 (120 mg/day). Furthermore, both the primary gastric tumor and metastatic bone lesions were reduced in size by the treatment with TS-1. TS-1 appears to be an effective therapeutic agent for advanced gastric cancer with DIC or bone metastases.

Topics: Administration, Oral; Aged; Antimetabolites, Antineoplastic; Bone Neoplasms; Carcinoma, Signet Ring Cell; Disseminated Intravascular Coagulation; Drug Administration Schedule; Drug Combinations; Humans; Male; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur