s-1-(combination) and Hemorrhage

A57 years old man with gastric cancer underwent distal gastrectomy (pT3N1M0, pStage II B). Three months after gastric resection, he was admitted to our hospital because of acute right dorsal pain. Abdominal computed tomography showed multiple liver tumors with subcapsular hemorrhage. He was diagnosed as multiple liver metastases from gastric cancer. We judged liver tumors to be unresectable and decided to start systemic chemotherapy with S-1 and cisplatin (CDDP) because he was hemodynamically stable. After 8 courses of chemotherapy, the liver tumors were markedly reduced and judged as clinical partial response. Left hepatectomy and S5, S6, S7 partial hepatectomy for liver metastasis was performed. Histopathological examination of the resected specimen revealed no cancer cell in the liver, suggesting a pathologically complete response. We consider that systemic chemotherapy is one of the effective treatments for unresectable liver metastasis with subcapsular hemorrhage from gastric metastasis.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Drug Combinations; Fatal Outcome; Gastrectomy; Hemorrhage; Hepatectomy; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Salvage Therapy; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

A 82-year-old male patient had suffered from a cancer of the papilla of Vater. After the operation, he received 4 courses of gemcitabine(GEM)adjuvant chemotherapy and warfarin(WF)administration because of thrombosis in the left internal jugular vein. Since the tumors re-grew, GEM was discontinued, and chemotherapy including S-1 and GEM was examined. However, the chemotherapy could not be continued because of edema in both lower legs and tassel midway in the 2nd course. Because of a bleeding tendency(non-measurable INR(international normalized ratio of prothrombin time)), WF administration was discontinued on the 11th day after S-1/GEM combined therapy was suspended. On the following day, although the INR value recovered to 1.7, it gradually worsened and the symptoms of pulmonary embolism developed on the 13th day. Then, INR was controlled by continuous infusion of heparin. Since the INR level decreased after that, in addition to heparin, re-medication of WF was performed. We tried to analyze the genotype of a patient, who had a tendency to bleed by coadministration of WF with S-1, in terms of hepatic cytochrome P-450(CYP)2C9 and vitamin K epoxide reductase complex subunit 1(VKORC1). We also measured the plasma concentration of S-and R-WF by HPLC after obtaining informed consent from the patient. We found that he is homozygous for CYP2C9 1/1 and for A/A of VKORC1(-1639G>A). The obtained data did not show the abnormalities of blood coagulation. Because the genotype of a patient with a tendency to bleed was a major type in a Japanese population, fine monitoring of INR is required in order to prevent side effects of blood coagulation by S-1 and WF coadministration, regardless of patient genotypes.

Topics: Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Duodenal Neoplasms; Hemorrhage; Humans; Male; Oxonic Acid; Stereoisomerism; Tegafur; Thrombosis; Treatment Failure; Warfarin

In the management of inoperable patients who have advanced gastric cancer, it is important to control an active tumor bleeding for the purpose of keeping the patient's quality of life well. We treated two patients: embolization with coil to aneurysm in the gastric tumor in one case, and embolization and chemoradiationtherapy with S-1 in the other. In results, we have never seen an active tumor bleeding and anemic state requiring a blood transfusion after the treatment. Both patients died from other diseases. We think these treatments are useful for patients with active bleeding in advanced gastric cancer.

Topics: Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Drug Combinations; Embolization, Therapeutic; Gastroscopy; Hemorrhage; Humans; Male; Neoplasm Staging; Oxonic Acid; Stomach Neoplasms; Tegafur