s-1-(combination) and Liver-Neoplasms

The most common sites of recurrence after liver transplantation for hepatocellular carcinoma (HCC) have been reported to be the liver, lung, bone, and adrenal glands, but there have also been many reports of cases of multiple recurrence. The prognosis after recurrence is poor, with reported median survival after recurrence of HCC ranging from 9 to 19 months. Here, we report a case of long-term survival after recurrence of pharyngeal metastasis following living-donor liver transplantation (LDLT) for HCC within the Milan criteria, by resection of the metastatic region and cervical lymph node dissection.. A 47-year-old man with a Model End-stage Liver Disease (MELD) score of 11 underwent LDLT for HCC within the Milan criteria for liver cirrhosis associated with hepatitis B virus infection, with his 48-year-old elder brother as the living donor. One year and 10 months after liver transplantation, he visited a nearby hospital with a chief complaint of discomfort on swallowing. A pedunculated polyp was found in the hypopharynx, and biopsy revealed HCC metastasis. We performed pharyngeal polypectomy. Two years later, cervical lymph node metastasis appeared, and neck lymph node dissection was performed. Although recurrence subsequently occurred three times in the grafted liver, the patient is still alive 12 years and 10 months after recurrence of pharyngeal metastasis. He is now a tumor-free outpatient taking sorafenib.. It is necessary to recognize that the nasopharyngeal region is a potential site of HCC metastasis. Prognostic improvement can be expected with close follow-up, early detection, and multidisciplinary treatment, including radical resection.

Topics: Allografts; Biopsy; Carcinoma, Hepatocellular; Catheter Ablation; Chemotherapy, Adjuvant; Drug Combinations; End Stage Liver Disease; Hepatectomy; Humans; Liver; Liver Neoplasms; Liver Transplantation; Living Donors; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Pharyngeal Neoplasms; Pharynx; Positron Emission Tomography Computed Tomography; Sorafenib; Tegafur; Treatment Outcome

A 70-year-old man with distal bile duct carcinoma underwent a subtotal stomach-preserving pancreaticoduodenectomy without adjuvant chemotherapy. One and a half years after the surgery, elevated levels of serum SPan-1(38.1 U/mL)were observed and CT scans demonstrated a solitary metastasis, 25mm in size, in segment 8 of the liver. The patient received 2 courses of gemcitabine-cisplatin combination chemotherapy. No new lesions were detected after chemotherapy and the patient underwent a partial liver resection of segment 8. The pathological examination revealed a metachronous distant metastasis originating from the bile duct carcinoma. Subsequently, the patient received S-1 adjuvant chemotherapy for 6 months. Following completion of all therapies, the patient survived without tumor recurrence for 3 years and 10 months after the initial operation. Thus, surgical interventions might be effective in improving prognosis among selected patients with postoperative liver metastasis of bile duct carcinoma.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Bile Duct Neoplasms; Cisplatin; Deoxycytidine; Drug Combinations; Gemcitabine; Hepatectomy; Humans; Liver Neoplasms; Male; Oxonic Acid; Pancreaticoduodenectomy; Tegafur

We report a case of rhabdomyolysis related to S-1 plus oxaliplatin(SOX)therapy for liver metastasis of gastric cancer. A 76- year-old man who had received SOX therapy for metastatic gastric cancer was admitted to our hospital for a chief complaint of fatigue and weakness. He diagnosed with rhabdomyolysis related to SOX therapy because of his symptoms and because his laboratory studies showed significant elevation of his serum creatine kinase(CK)level. The symptoms disappeared and the CK level normalized following large-volume transfusions. Rhabdomyolysis following SOX therapy is a very rare, but severe adverse event. This is the first detailed case report of rhabdomyolysis related to SOX therapy.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Hepatectomy; Humans; Liver Neoplasms; Male; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Rhabdomyolysis; Stomach Neoplasms; Tegafur

A 77-year-old man underwent endoscopic submucosal dissection (ESD) of a type 0-IIc tumor located in the cardiac part of the stomach. The pathological diagnosis of the tumor was poorly differentiated tubular adenocarcinoma with submucosal invasion depth;therefore, radical gastrectomy was also performed. After 1 year and 10 months, liver metastasis was detected because of which partial liver resection was performed. The pathological diagnosis of the tumor was neuroendocrine carcinoma (NEC). The pathology of the ESD specimen was re-examined, and a diagnosis of gastric NEC was made;furthermore, the liver tumor was regarded as metachronous metastasis. Despite the radical excision of the stage IA tumor, metastasis occurred. Chemotherapy with S-1 alone was successfully performed after the liver resection while considering the advanced age of the patient. Follow-up revealed no signs of recurrence at 1 year and 4 months after the treatment, indicating that the S-1 therapy may be considered for treating NEC in elderly and medically compromised patients owing to its mild side effects.

Topics: Adenocarcinoma; Aged; Antimetabolites, Antineoplastic; Carcinoma, Neuroendocrine; Chemotherapy, Adjuvant; Drug Combinations; Endoscopic Mucosal Resection; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Oxonic Acid; Stomach Neoplasms; Tegafur; Time Factors

Gemcitabine-based chemotherapy is widely used for unresectable advanced pancreatic cancer which contains locally advanced and metastatic pancreatic cancer. We performed meta-analysis to examine whether gemcitabine plus S-1 could improve treatment efficacy as first-line chemotherapy for those patients when compared with gemcitabine alone.. STATA was used to estimate the summary hazard ratios or odds ratios and their 95% confidence intervals. Heterogeneity among trials was examined by Cochran's χ(2) test. Publication bias was evaluated by Begg's and Egger's tests. Subgroup analysis based on the extent of disease was performed.. Four randomized controlled trials including 878 Asian patients were analyzed. In total meta-analysis, gemcitabine plus S-1 significantly improved overall survival (hazard ratio, 0.82; 95% confidence interval, 0.70-0.96; P = 0.015), progression-free survival (hazard ratio, 0.64; 95% confidence interval, 0.55-0.74; P < 0.001), overall response rate (odds ratio, 3.00; 95% confidence interval, 2.04-4.41; P < 0.001) and disease control rate (odds ratio, 1.78; 95% confidence interval, 1.32 to 2.39; P < 0.001), and was associated with more but manageable hematologic (leukocytopenia, neutropenia, thrombocytopenia) and non-hematologic (diarrhea, stomatitis, nausea, rash) adverse events. In subgroup analysis, gemcitabine plus S-1, comparing with gemcitabine, significantly improved overall survival in locally advanced patients (hazard ratio, 0.69; 95% confidence interval, 0.48 to 0.99; P = 0.022) but not in metastatic patients (hazard ratio, 0.75; 95% confidence interval, 0.46-1.23; P = 0.256).. This meta-analysis confirmed the survival benefits of gemcitabine plus S-1 as first-line treatment for unresectable advanced pancreatic cancer at least in Asia, while good Eastern Cooperative Oncology group performance status was warranted. Importantly, we highlighted the significant overall survival benefit of gemcitabine plus S-1 in locally advanced patients but not in metastatic patients.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Asian People; Deoxycytidine; Disease-Free Survival; Drug Administration Schedule; Drug Combinations; Female; Gemcitabine; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Odds Ratio; Oxonic Acid; Pancreatic Neoplasms; Peritoneal Neoplasms; Randomized Controlled Trials as Topic; Research Report; Tegafur; Treatment Outcome

The patient was a 70-year-old woman with sigmoid colon cancer and metastases in the liver and the paraaortic lymph nodes. We performed sigmoidectomy along with lymph node dissection. The solitary hepatic metastasis was 3 cm in diameter; however, hepatectomy was not performed because metastases in the paraaortic lymph nodes persisted. The serum carcino embryonic antigen(CEA)level was above 200 ng/mL, both preoperatively and postoperatively. After surgery, chemo- therapy was initiated. Initially, weekly 5-fluorouracil and l / -Leucovorin(5-FU/l-LV)therapy was administered 4 times. Subsequently, 5-FU/folinic acid plus oxaliplatin(FOLFOX4)therapy was administered 12 times every 2 weeks. Thereafter, S-1 therapy(orally, 40 mg twice a day, 28 days, followed by 14 days of rest)was initiated. After 3 months of chemotherapy, serum CEA levels decreased rapidly to within the normal limit. Paraaortic lymph node metastases and the hepatic metastasis disappeared after 3 months and 11 months, respectively. S-1 therapy was continued for over 7 years. Currently, it has been over 1 year since the discontinuation of S-1 therapy, and complete response has been maintained for over 9 years since the surgery.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Female; Fluorouracil; Humans; Leucovorin; Liver Neoplasms; Lymphatic Metastasis; Organoplatinum Compounds; Oxonic Acid; Sigmoid Neoplasms; Tegafur

A 79-year-old man presented with a history of vomiting. Laboratory data indicated leukocytosis (26360/μl), and elevated granulocyte-colony stimulating factor (G-CSF) level (155 pg/ml). Upper gastrointestinal endoscopy revealed a type 3 gastric cancer, and subsequent G-CSF immunohistochemical staining of a biopsy specimen was positive. He was therefore diagnosed with a G-CSF-producing gastric cancer. Computed tomography revealed multiple liver metastases. Chemotherapy was initiated, resulting in a partial response for 5 months. G-CSF-producing gastric cancer is rare; thus, we take this opportunity to report our case and to summarize the G-CSF-producing gastric cancer cases reported in Japan.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cisplatin; Drug Combinations; Fatal Outcome; Gastroscopy; Granulocyte Colony-Stimulating Factor; Humans; Irinotecan; Liver Neoplasms; Male; Oxonic Acid; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

An 80-year-old man was diagnosed with advanced gastric cancer and underwent distal gastrectomy. Although the pathological Stage of the cancer was III A, he refused adjuvant chemotherapy. One year later, CT revealed multiple liver metastases. Therefore, he was started with S-1 administration and a complete response was obtained at 10 months after starting S-1 administration. He has maintained a complete response for 22 months after S-1 discontinuation.

Topics: Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Oxonic Acid; Remission Induction; Stomach Neoplasms; Tegafur; Time Factors

A 67-year-old woman presented with anemia. Computed tomography and upper gastrointestinal endoscopy revealed a primary gastric cancer with tumor embolus in the portal vein, liver metastasis, lymph node metastasis, and pancreatic involvement. Because curative surgery was deemed impossible, we started chemotherapy using S-1 (120 mg/m(2)/day for 3 weeks, followed by discontinuation for 2 weeks) plus cisplatin (80 mg/m(2)/day on days 1 and 8). After 4 courses of chemotherapy, the tumor embolus in the portal vein, liver metastasis, lymph node metastasis, and pancreatic involvement had resolved. Therefore, we performed distal gastrectomy. Histological examination revealed ypT1a, ly0, v0, ypN0 (0/49), ypCY0, ypStage IA, with a two-grade histological change in the main tumor after chemotherapy. Postoperatively, she underwent adjuvant chemotherapy with S-1 for 1 year (120 mg/m(2)/day for 4 weeks, followed by discontinuation for 2 weeks). At the 30-month follow-up after the adjuvant chemotherapy, she had no recurrence.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Female; Gastrectomy; Humans; Liver Neoplasms; Neoadjuvant Therapy; Neoplastic Cells, Circulating; Oxonic Acid; Portal Vein; Stomach Neoplasms; Tegafur

Gastric cancer is the fourth most common cancer worldwide and the leading cause of tumor-related death in China. Gastric cancer is a heterogeneous disease and therefore requires different treatments based on the subtype. We describe a patient who had gastric cancer with liver metastases. Biopsy and tumor analysis using the HercepTest revealed a human epidermal growth factor receptor 2 (HER2)-positive adenocarcinoma as confirmed by fluorescence in situ hybridization. The patient was treated with a regimen of trastuzumab, oxaliplatin, and S-1 (six cycles). When positron emission tomography findings suggested that the metastases had resolved, the patient underwent surgery. Histopathologically, no cancer cells were observed in the resected hepatic tissue. The patient underwent tumor resection surgery, during which the tumor and gastric lymph nodes with lesions were removed. The patient has remained disease-free for 3 months. Therefore, trastuzumab may be an effective agent in the chemotherapeutic treatment of liver metastases in patients with HER2-positive gastric adenocarcinoma.

Topics: Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Female; Humans; Liver Neoplasms; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Receptor, ErbB-2; Stomach Neoplasms; Tegafur; Trastuzumab; Treatment Outcome

A 58-year-old man presented with anorexia and weight loss in April 2010. Endoscopic examination revealed a type 3 tumor extending from the gastric cardia to the antrum. Preoperative imaging showed liver metastasis (S8; 2 cm) and direct invasion of the cancer into the pancreas. We administered 4 courses of chemotherapy (DCS) for the unresectable tumor; the impact of the therapy was partial response (PR). We performed total gastrectomy, D2 dissection, splenectomy, distal pancreatectomy, and partial hepatectomy (S8) in April 2011. The patient was treated with 8 courses of adjuvant chemotherapy with S-1. In April 2012, abdominal computed tomography (CT) revealed a solitary recurrent lesion in the liver (S2). After 7 courses of chemotherapy(weekly paclitaxel), abdominal CT and magnetic resonance imaging (MRI) revealed a tumor thrombus in the portal vein extending from P2 to the umbilical portion (UP). We performed left hepatectomy and cholecystectomy due to the absence of new lesions. Histopathological findings revealed that the poorly differentiated adenocarcinoma had metastasized to the liver. Abdominal CT revealed the presence of multiple recurrent metastases in the liver, 4 months after the surgery. The patient died 27 months after the initial surgery and 7 months after the last operation.

Topics: Combined Modality Therapy; Drug Combinations; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Paclitaxel; Portal Vein; Stomach Neoplasms; Tegafur; Venous Thrombosis

The patient was a 70-year-old man with a chief complaint of cough.After careful examination, he was diagnosed with pancreatic body cancer with metastasis to the liver and right pleura and with early gastric cancer.He was treated with S-1 and gemcitabine combination chemotherapy.After completing 3 courses, the distant metastasis could no longer be observed. After completing 4 courses, the tumor marker level in the serum was normalized.The pancreatic lesion was restricted by the end of 10 courses, and the pancreas body and tail were resected.After additional chemotherapy with S-1, he was switched to weekly paclitaxel therapy because of peritoneal dissemination.The patient survived for 15 months after surgery.In cases of unresectable pancreatic cancer with distant metastasis, it may be possible to consider the surgical option when chemotherapy is effective.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Combinations; Gemcitabine; Humans; Liver Neoplasms; Male; Neoadjuvant Therapy; Neoplasms, Multiple Primary; Oxonic Acid; Pancreatic Neoplasms; Pleural Neoplasms; Stomach Neoplasms; Tegafur

We report a case of gastric carcinoma with metastasis to the liver responding to surgery and chemotherapy.The patient was a 74-year-old man with gastric cancer, clinically diagnosed as P0H0M0T3N0.We initially planned to perform an open distal gastrectomy.However, intraoperative findings revealed metastatic tumors in the liver.Therefore, the patient underwent a D1 distal gastrectomy.After surgery, the patient received the following chemotherapy regimens: 1 course of S-1 and 8 courses of a S-1 and cisplatin (CDDP) combination.After 8 courses of S-1 plus CDDP treatment, liver metastases could not be detected by computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET). The patient was assessed to have a clinical complete response.Fifty months after surgery, the patient is alive without recurrence.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Drug Combinations; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Multimodal Imaging; Oxonic Acid; Positron-Emission Tomography; Remission Induction; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

A 68-year-old man was introduced to our hospital with right lower abdominal pain. Endoscopic examination and abdominal CT revealed gastric cancer with liver metastasis. We started chemotherapy using S-1(120 mg/body/day), orally administered for 2 weeks followed by a 2-week rest period, and docetaxel(35 mg/m(2)), administered intravenously on day 1 and 15 as 1 course. After 4 courses of chemotherapy, the liver tumor reduced markedly and no new cancerous region was found by examination; therefore total gastrectomy and partial hepatectomy were performed. Histological examination showed an undifferentiated adenocarcinoma remaining as Grade 1b in the resected stomach. A resected specimen of the liver showed necrotic tissue without any cancer cells. This case suggests that S-1/docetaxel chemotherapy may reduce the stage of unresectable liver metastasis from gastric cancer and make a curative operation possible.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Docetaxel; Drug Combinations; Gastrectomy; Hepatectomy; Humans; Liver Neoplasms; Male; Oxonic Acid; Stomach Neoplasms; Taxoids; Tegafur

A 67-year-old man with bladder cancer who was treated with transurethral resection of bladder tumour(TUR-Bt)and chemotherapy at the age of 59 years was diagnosed as having urothelial cancer by biopsy 8 years later. Detailed examination revealed the presence of synchronous triple cancer, with hepatocellular cancer and gastric cancer. Subsequently, semi-total gastrectomy, partial hepatectomy(S6), radio frequency ablation(S5, S7), and cholecystectomy were performed. Histologically, the gastric tumor was a moderately differentiated tubular adenocarcinoma, the hepatic tumor was a moderately differentiated hepatocellular carcinoma, the bladder tumor was a transitional cell carcinoma, and the ureteral tumor was an urothelial carcinoma.

Topics: Aged; Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Drug Combinations; Humans; Liver Neoplasms; Male; Neoplasms, Multiple Primary; Oxonic Acid; Stomach Neoplasms; Tegafur; Treatment Outcome; Urinary Bladder Neoplasms; Urologic Neoplasms

The patient was a 39-year-old man with type 3 gastric cancer with synchronous multiple liver and lung metastases, who was diagnosed as cStage IV(cT4aN1M1H1). He received induction chemotherapy with S-1 and CDDP. After chemotherapy, the liver and lung metastases had disappeared completely. He underwent total gastrectomy and splenectomy, with D2 nodal dissection. Anastomotic leakage occurred on postoperative day 6, and substantial inflammatory conditions continued for 2 weeks. He died 6 weeks after surgery with multiple liver metastases. This case suggests that elevated inflammatory conditions may cause tumor progression.

Topics: Adult; Anastomotic Leak; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Disease Progression; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Lung Neoplasms; Male; Medical Errors; Neoplasm Staging; Oxonic Acid; Splenectomy; Stomach Neoplasms; Tegafur; Treatment Failure

A 57-year-old man was admitted to our hospital for hepatocellular carcinoma (HCC). He underwent right hepatectomy with preoperative adjuvant transcatheter arterial chemoembolization. A follow-up computed tomography scan revealed a single pulmonary metastasis. After 2 courses of S-1 administration, he underwent left lower lobectomy, and a pathological specimen taken at the time was diagnosed as pulmonary metastasis of HCC. Although adjuvant chemotherapy with S-1 resulted in relapse-free survival for 2 years after pulmonary resection, he was found to have recurrence of liver cancer and underwent partial hepatectomy. This case report suggests that surgical resection and S-1 administration would be a useful treatment option for hepatocellular carcinoma with distant metastasis.

Topics: Antimetabolites, Antineoplastic; Carcinoma, Hepatocellular; Combined Modality Therapy; Drug Combinations; Hepatectomy; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Oxonic Acid; Tegafur

The prognosis for hepatocellular carcinoma with extrahepatic metastasis or vascular invasion is very poor. We treated a case successfully by combining chemotherapy and liver resection for hepatocellular carcinoma with multiple pulmonary metastases and vascular invasion. A 56-year-old man who complained of abdominal pain in his right side was transported to the hospital by ambulance. Because CT scan revealed the rupture of hepatocellular carcinoma, he underwent emergency transcatheter arterial embolization (TAE). A close examination revealed tumor thrombus in the inferior vena cava and posterior segment of the portal vein branch, with multiple pulmonary metastases. We conducted right hepatic lobectomy and removal of the inferior vena cava tumor thrombus. After the operation, pulmonary metastatic lesions gradually grew larger, so the oral administration of S-1 at 120 mg per day was started. At the end of the first course, the CT scan revealed that multiple pulmonary metastases were significantly reduced, and treatment was maintained until the end of 4 courses. A prolongation of survival could be expected by combining systemic chemotherapy and liver resection for advanced hepatocellular carcinoma such as the present case.

Topics: Antimetabolites, Antineoplastic; Carcinoma, Hepatocellular; Combined Modality Therapy; Drug Combinations; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Neovascularization, Pathologic; Oxonic Acid; Prognosis; Tegafur

We encountered a case of gastric cancer accompanied with liver metastasis, which had a good response to chemotherapy of S-1. A 68-year-old female was admitted to our hospital due to further examination of gastric tumor detected by an outpatient physician. She was found to have a type-3 gastric cancer in upper gastrointestinal endoscopy and a metastatic tumor of the liver in abdominal CT. Although chemotherapy of S-1 was inducted for the lesions, both the primary and liver tumors were dramatically reduced. We subsequently performed total gastrectomy and partial hepatectomy. Abdominal CT scan at 11 months after the initial operation revealed metachronous liver metastasis. She received combination chemotherapy of S-1 and CDDP. After 5 courses of the combination chemotherapy, the liver tumor disappeared. She has survived for 8 years without a recurrence after the initial operation. There was negative findings of immunostaining with thymidylate synthetase (TS), which was target enzyme for 5-FU at a biopsy sample of the primary gastric tumor before chemotherapy of S-1. TS immunostaining may be a useful marker for S-1 combined therapy for gastric cancer associated with liver metastases.

Topics: Aged; Antimetabolites, Antineoplastic; Drug Combinations; Female; Humans; Liver Neoplasms; Neoadjuvant Therapy; Oxonic Acid; Remission Induction; Stomach Neoplasms; Tegafur; Time Factors; Tomography, X-Ray Computed

A 62-year-old Japanese man presented with a 1-month history of inter-digestive epigastralgia. His family history included a sister with gastric cancer. Gastroendoscopy and gastrography demonstrated a type-2 tumor in the upper region of the stomach. CT scan and fluorodeoxyglucose-positron emission tomography (FDG-PET) scan demonstrated gastric cancer and its metastatic lymph nodes. The patient underwent total gastrectomy with splenectomy and extended lymph node dissection. Although postoperative adjuvant chemotherapy by S-1 was started, the deteriorating condition of the patient prevented drug administration and even eating meals. On the 19th postoperative day (POD), FDG-PET scan of the body demonstrated new uptake in the liver and lymph node around the aorta. Without any sign of infection, leukocytosis developed around the 30th POD. On the 49th POD, remarkable uptake in the whole upper abdomen was detected on FDG-PET scan. Finally, leukocyte count increased to 125,200 and granulocyte colony stimulating factor (G-CSF) was elevated to 28 pg/ml on the 54th POD. The patient died of multiple liver metastases and carcinomatous peritonitis only 56 days after surgery. G-CSF-producing tumor is a rare but aggressive disease, particularly as recurrent tumor. If leukocytosis is detected in relation to a non-lympho hematopoietic malignant tumor, G-CSF-producing tumor should be considered and FDG-PET scan is recommended for early detection. Chemotherapy for G-CSF-producing tumor must be conducted as soon as possible.

Topics: Adenocarcinoma; Antimetabolites, Antineoplastic; Biopsy; Chemotherapy, Adjuvant; Drug Combinations; Fatal Outcome; Fluorodeoxyglucose F18; Gastrectomy; Gastroscopy; Granulocyte Colony-Stimulating Factor; Humans; Leukocytosis; Liver Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Peritoneal Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Splenectomy; Stomach Neoplasms; Tegafur; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

We experienced a case with multiple liver metastases of gastric cancer that disappeared by S-1 alone. The patient has survived without recurrence after the disappearance of liver metastases.

Topics: Aged; Antimetabolites, Antineoplastic; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Remission Induction; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

Hepatic arterial infusion chemotherapy (HAIC) for liver metastases from digestive cancer has passed through a long history. In spite of its significant high tumor reduction rate, this therapeutic modality has been rejected as the first-line therapy for liver metastases from colorectal cancer because of the negative results of RCTs compared to systemic chemotherapy. However, recently some excellent results have been reported by the combination with systemic chemotherapy,and a positive result of RCT using a satisfactory study design has been reported. Thus, the combination with systemic chemotherapy and RCT in comparison with modern standard systemic chemotherapy as the first-line therapy remains an important problem to be solved. On the other hand, the highly-developed technology for HAIC using techniques of interventional radiology has been standardized in Japan. Thus, we now have become the closest in the world to performing good-quality clinical trials of HAIC supported by high-quality technology. We should therefore consider our very important role in resolving such problems and deciding the future of HAIC.

Topics: Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cisplatin; Colorectal Neoplasms; Drug Administration Schedule; Drug Combinations; Hepatic Artery; Humans; Infusions, Intra-Arterial; Irinotecan; Liver Neoplasms; Oxonic Acid; Tegafur

We report the case of a 79-year-old female with gastric cancer accompanied by liver metastasis that was successfully treated by TS-1, a novel oral fluoropyrimidine derivative. Abdominal CT scan showed a low-density area in the lateral segment of the liver and lymph node swelling in the right side of the abdominal aorta. One treatment course consisted of 4 weeks of TS-1 administration (100 mg daily) followed by a 2-week break. After 2 courses of this treatment, an abdominal CT scan showed no evidence of liver metastasis and a reduction of lymph nodes metastasis. The serum level of CA19-9 was reduced from 780 U/ml to within a normal range. Grade 1-2 toxicity (nausea and diarrhea) was seen after 2 courses. We conclude that TS-1 may be beneficial in the treatment of the liver metastasis of gastric cancer.

Topics: Administration, Oral; Aged; Antimetabolites, Antineoplastic; Biomarkers, Tumor; CA-19-9 Antigen; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

Purpose Our previous phase I trial suggested feasibility of addition of leucovorin (LV) to S-1 and gemcitabine therapy in advanced pancreatic cancer. The aim of this phase II trial was to assess the efficacy and toxicity of gemcitabine, S-1 and LV (GSL) combination therapy for advanced pancreatic cancer. Methods Chemotherapy-naïve patients with histologically or cytologically proven advanced pancreatic cancer were enrolled. Gemcitabine was administered at a dose of 1000 mg/m2 by 30 min infusion on days 1, S-1 40 mg/m2 orally twice daily and LV 25 mg orally twice daily on days 1 to 7 every 2 weeks. Primary end point was progression free survival (PFS). Results A total of 49 patients with advanced pancreatic cancer (19 locally advanced and 30 metastatic) were enrolled. Overall response rate and disease control rate were 32.7% and 87.8%. The median PFS and overall survival (OS) were 10.8 (95% confidence interval [CI], 7.4-13.5) and 20.7 (95% CI 13.0-NA) months with 1-year survival rate of 73.4%. Major Grade 3-4 toxicities were neutropenia (22.4%) and stomatitis (14.3%). No toxicity related death was observed. Conclusions In this single center, phase II trial, gemcitabine, S-1 and LV combination therapy was tolerable and can potentially be a treatment option for advanced pancreatic cancer.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Combinations; Female; Follow-Up Studies; Gemcitabine; Humans; Leucovorin; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Peritoneal Neoplasms; Prognosis; Survival Rate; Tegafur

Background Optimal maintenance therapy for lung squamous cell carcinoma (SCC) has not been established. The aim of this study was to evaluate the efficacy and safety of switch maintenance therapy with S-1, an oral fluoropyrimidine, after induction therapy with carboplatin and nanoparticle albumin-bound paclitaxel (nab-paclitaxel) in chemotherapy-naïve patients with advanced SCC. Methods Chemotherapy-naïve patients with advanced SCC received induction therapy with four cycles of carboplatin (at an area under the curve of 6, day 1 of a 28-day cycle) and nab-paclitaxel (100 mg/kg, days 1, 8, and 15). Patients who achieved disease control after induction therapy received maintenance therapy with S-1 (80 mg/m

Topics: Adult; Aged; Aged, 80 and over; Albumins; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Brain Neoplasms; Carboplatin; Carcinoma, Non-Small-Cell Lung; Carcinoma, Squamous Cell; Drug Combinations; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Maintenance Chemotherapy; Male; Middle Aged; Nanoparticles; Oxonic Acid; Paclitaxel; Prognosis; Survival Rate; Tegafur

Recent gastric cancer clinical trials have aimed to establish the efficacy of combination therapy over monotherapy, however, the role for genomic biomarkers in these trials has remained largely unexplored. Here, using the NanoString expression platform, we analyzed 105 gastric tumors from a randomized phase III Japanese clinical trial (GC0301/TOP002) testing the efficacy of irinotecan plus S-1(IRI-S) versus S-1 therapy. We found that previously established proliferative subtype signatures, were associated with older patients (>65 years) and liver metastasis while mesenchymal subtype signatures were associated with younger patients (≤65 years) and peritoneal metastasis. Genes associated with tumor microenvironment (CD4, CD14, ADAMTS1, CCL5, CXCL12, CCL19), therapeutic implications (DPYD) and oncogenic signaling (Wnt5A, PTRF) were significantly associated with patient age, histology, tumor status, measurable lesions and metastasis. We identified Wnt5A downregulation as a candidate predictor of improved progression free survival (>8 weeks) in S-1 but not in IRI-S treatment. Although statistical significance was not achieved, mesenchymal subtype showed a trend for treatment interaction with IRI-S for efficacy. These findings highlight promising genomic markers that could be useful predictors of chemotherapy efficacy for better prognosis and survival outcome in gastric cancer.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Drug Combinations; Female; Humans; Irinotecan; Liver Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Stomach Neoplasms; Tegafur; Wnt-5a Protein

Endostar is a new vascular epithelial inhibitor, which is reported to be effective in treating liver metastasis from gastric cancer. However, the optimal therapeutic regimen of Endostar remains unclear. Thus, our study aimed to examine the efficacy and safety of Endostar continuous intravenous infusion combined with S-1 and oxaliplatin (SOX) chemotherapy in treating such patients.. A total of sixty patients with liver metastasis from gastric cancer admitted in our department were enrolled. The experimental group (n = 30) was treated with Endostar continuous intravenous infusion combined with SOX regimen chemotherapy, and the control group (n = 30) received SOX regimen chemotherapy alone. All patients received at least two cycles of treatment. The objective effective rate (ORR), disease control rate (DCR), progression-free survival (PFS), and adverse reactions were recorded and compared.. The ORR of the experimental group and control group was 63.3% and 43.3% (P = 0.046), respectively. The DCR of the experimental group and the control group was 86.7% and 73.3% (P = 0.034). The median PFS in the experimental group was longer than that in the control group (15.3 months vs. 12 months). There was no significant difference in the incidence of common adverse reactions such as gastrointestinal reaction, bone marrow suppression, and cardiac toxicity between the two groups. No death was observed in the study period.. Continuous infusion of Endostar combined with SOX chemotherapy could be recommended for the treatment of liver metastasis from gastric cancer due to its high effective rate, and Endostar did not increase the incidence of adverse reactions.

Topics: Adult; Aged; Angiogenesis Inhibitors; Antineoplastic Combined Chemotherapy Protocols; Disease-Free Survival; Drug Combinations; Endostatins; Female; Humans; Infusions, Intravenous; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Oxaliplatin; Oxonic Acid; Recombinant Proteins; Stomach Neoplasms; Tegafur; Treatment Outcome

This Phase II trial evaluated the safety and efficacy of neoadjuvant chemotherapy (NAC) with S-1 and oxaliplatin (SOX) plus bevacizumab (Bev) in patients with colorectal liver metastasis (CRLM).. Patients with initially resectable CRLM received four cycles of SOX plus Bev as NAC. We adopted the R0 resection rate as the primary endpoint, and the threshold R0 resection rate was set at 80%.. Between December 2010 and August 2014, 61 patients were enrolled in this study and all started NAC. The completion rate of NAC was 82.0%. Three patients (4.9%) developed severe liver dysfunction caused by NAC and one patient finally decided against resection. Three patients (4.9%) were judged as having progressive disease during or after NAC and did not undergo liver resection. Among 57 patients who underwent liver resection after NAC, three patients were diagnosed with CRLM by pre-treatment imaging modalities and received NAC although a final pathological diagnosis was another malignant disease or benign condition. Finally, 47 of the 54 patients (87.0%) with resected CRLM achieved R0 resection. The pathological complete response rate of the 54 patients was 13.0%, and 31.5% were judged as pathological responders. However, the R0 resection rate of 77.0% in the entire cohort did not meet the endpoint.. NAC with SOX plus Bev has an acceptable toxicity profile and achieved a satisfactory pathological response. However, accuracy of pre-operative diagnoses and liver dysfunction caused by NAC were serious problems. Easy introduction of NAC for initially resectable CRLM should not be performed.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Colorectal Neoplasms; Drug Combinations; Female; Humans; Liver Neoplasms; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Metastasis; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Tegafur

Unresectable advanced hepatocellular carcinoma is a heterogeneous disease, for which sorafenib is the first targeted agent approved for first-line therapy, and treatment options for patients with sorafenib-refractory advanced hepatocellular carcinoma are limited. We assessed the efficacy and safety of S-1, a chemotherapeutic agent based on fluorouracil, in patients with sorafenib-refractory advanced hepatocellular carcinoma.. We did a randomised, double-blind, placebo-controlled, phase 3 study done at 57 sites in Japan. Patients with advanced hepatocellular carcinoma who were ineligible for surgical or local-regional therapy and judged refractory to sorafenib (ie, had progressed on sorafenib or had discontinued sorafenib because of adverse events) were randomly assigned (2:1) to receive oral S-1 (weight-banded 80 mg/m. Between Oct 26, 2009, and Aug 22, 2012, we screened 399 patients. 65 patients were excluded due to not meeting criteria (n=61), declining to participate (n=3), or other reasons (n=1). 334 patients were randomly assigned to receive either S-1 (n=223) or placebo (n=111). One patient in the S-1 group did not receive treatment, and was thus excluded from analyses. At data cutoff, median follow-up was 32·4 months (IQR 24·0-34·7) in the S-1 group and 32·9 months (23·7-39·5) in the placebo group. Median overall survival was 11·1 months (95% CI 9·7-13·1) in the S-1 group and 11·2 months (9·2-12·8) in the placebo group (hazard ratio 0·86, 95% CI 0·67-1·10; p=0·220). The most frequently reported adverse events were skin hyperpigmentation (123 [55%] of 222 patients in the S-1 group vs nine [8%] of 111 patients in the placebo group), decreased appetite (104 [47%] vs 21 [19%]), fatigue (102 [46%] vs 20 [18%]), diarrhoea (77 [35%] vs 14 [13%]), and increased blood bilirubin (77 [35%] vs 14 [13%]). Serious adverse events were reported in 90 (41%) of 222 patients in the S-1 group and 24 (22%) of 111 patients in the placebo group. Five treatment-related deaths were reported in the S-1 group.. S-1 did not prolong overall survival in patients with sorafenib-refractory advanced hepatocellular carcinoma. Further research is needed to identify subgroups of patients who might benefit from S-1.. Taiho Pharmaceuticals.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Hepatocellular; Diarrhea; Double-Blind Method; Drug Combinations; Fatigue; Feeding and Eating Disorders; Female; Humans; Hyperbilirubinemia; Hyperpigmentation; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Survival Analysis; Tegafur

A randomized phase III study of Japanese patients with advanced gastric cancer, the G-SOX trial, revealed that S-1 and oxaliplatin (SOX) combination therapy was noninferior to S-1 and cisplatin (CS) combination therapy. However, it is unclear whether the efficacy and safety in elderly patients were different between the two regimens.. A total of 685 patients registered in the G-SOX trial were classified as elderly (70 years or older) or not elderly (younger than 70 years), and 663 patients (SOX therapy, elderly 113 of 333 patients, 34 %; CS therapy, elderly 99 of 330 patients, 30 %) and 673 patients (SOX therapy, elderly 114 of 338 patients, 34 %; CS therapy, elderly 101 of 335 patients, 30 %) were analyzed for efficacy and safety, respectively. Treatment delivery of SOX was also compared between elderly and nonelderly groups.. No differences in efficacy were identified between the elderly and nonelderly groups for either regimen. In the elderly groups, SOX therapy showed better trends in progression-free survival (hazard ratio 0.805, 95 % confidence interval 0.588-1.102) and overall survival (hazard ratio 0.857, 95 % confidence interval 0.629-1.167) compared with CS therapy, although there were no significant differences. Grade 3 or worse adverse events were less frequent in the elderly group receiving SOX than in the elderly group receiving CS except for the low incidence of sensory neuropathy (5.3 % vs 0 %), neutropenia (25.4 % vs 42.6 %), anemia (21.1 % vs 42.6 %), febrile neutropenia (1.8 % vs 10.9 %), increased creatinine level (0.9 % vs 3.0 %), and hyponatremia (7.9 % vs 18.8 %).. SOX is an effective and feasible therapy in both nonelderly and elderly patients with advanced gastric cancer. In elderly patients, SOX demonstrated favorable efficacy and safety compared with CS.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Peritoneal Neoplasms; Prognosis; Safety; Stomach Neoplasms; Survival Rate; Tegafur

Oral fluoropyrimidines are used for the first-line treatment of metastatic breast cancer to avoid severe adverse effects, although firm supporting evidence is lacking. We aimed to establish whether S-1 is non-inferior to taxanes in this setting.. We did an open-label, non-inferiority, phase 3 trial at 154 hospitals in Japan. We enrolled individuals who had HER2-negative metastatic breast cancer who had received no chemotherapy for advanced disease, and who were resistant to endocrine treatment. Patients were randomly assigned (1:1) either to taxane (docetaxel 60-75 mg/m(2) at intervals of 3-4 weeks; paclitaxel 80-100 mg/m(2) weekly for 3 of 4 weeks; or paclitaxel 175 mg/m(2) at intervals of 3-4 weeks) or to S-1 (40-60 mg twice daily for 28 consecutive days, followed by a 14-day break). Randomisation was done centrally with the minimisation method, with stratification by institution, liver metastasis, oestrogen and progesterone receptor status, previous treatment with taxanes or oral fluorouracil, and time from surgery to recurrence. The primary endpoint was overall survival, with a prespecified non-inferiority margin of 1·333 for the hazard ratio (HR). The primary efficacy analysis was done in the full analysis set, which consisted of all patients who took at least one study treatment and who had all data after randomisation. This trial is registered with the University Hospital Medical Information Network, Japan (protocol ID C000000416).. Between Oct 27, 2006, and July 30, 2010, we enrolled 618 patients (309 assigned to taxane; 309 assigned to S-1). The full analysis set consisted of 286 patients in the taxane group and 306 in the S-1 group. Median follow-up was 34·6 months (IQR 17·9-44·4). Median overall survival was 35·0 months (95% CI 31·1-39·0) in the S-1 group and 37·2 months (33·0-40·1) in the taxane group (HR 1·05 [95% CI 0·86-1·27]; pnon-inferiority=0·015). The most common grade 3 or worse adverse events were neutropenia (20 [7%] of 307 patients in the S-1 group vs nine [3%] of 290 patients in the taxane group), fatigue (ten [3%] vs 12 [4%]), and oedema (one [<1%] vs 12 [4%]). Treatment-related deaths were reported in two patients in the taxane group.. S-1 is non-inferior to taxane with respect to overall survival as a first-line treatment for metastatic breast cancer. S-1 should be considered a new option for first-line chemotherapy for patients with HER2-negative metastatic breast cancer.. Comprehensive Support Project for Oncology Research of the Public Health Research Foundation, Japan; Taiho.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Breast Neoplasms; Disease Progression; Disease-Free Survival; Docetaxel; Drug Combinations; Edema; Fatigue; Female; Follow-Up Studies; Health Status; Humans; Liver Neoplasms; Middle Aged; Neutropenia; Oxonic Acid; Paclitaxel; Receptor, ErbB-2; Receptors, Estrogen; Receptors, Progesterone; Survival Rate; Taxoids; Tegafur

of Background Data The effectiveness of adjuvant chemotherapy in patients with stage II/III colorectal cancer has been confirmed in various studies. However, no adjuvant chemotherapy for colorectal liver metastasis (CLM) classified to stage IV has been established. Objectives We conducted a phase 1 study of S-1 and oxaliplatin to determine the recommended dose (RD) in patients with CLM as adjuvant therapy in two institutes. Methods S-1 and oxaliplatin were administered from day 1 to day 14 of a 3-week cycle as a 2-h infusion every 3 weeks, respectively. The initial doses of S-1 and oxaliplatin were fixed to 80 mg/m(2) and 100 mg/m(2), respectively (level 1). We scheduled in the protocol a dose change of S-1 and oxaliplatin to level 2 (S-1: 80 mg/m(2) and oxaliplatin: 130 mg/m(2)) or level 0 (S-1: 65 mg/m(2) and oxaliplatin: 100 mg/m(2)) depending on the incidence of dose-limiting toxicity (DLT) at level 1 in six patients. Results Because DLT occurred in one among the initial six patients at level 1, the doses were increased to level 2 in the next six patients. At level 2, grade 3 leukopenia and neutropenia occurred in one (16.7 %) and two (33.3 %) patients, respectively, in the absence of non-hematological event. Because no DLT occurred at level 2, we suggest that the RD can be set to the level 2 dose. The median number of cycles delivered at RD was 8. The mean relative dose intensity of S-1 and oxaliplatin at RD was 0.90 and 0.63, respectively. Conclusion In a patient undergoing hepatectomy for CLM, 80 mg/m(2) of S-1 and 130 mg/m(2) of oxaliplatin are recommended as adjuvant therapy. A further study is required to confirm the efficacy and safety of this regimen on a larger scale.

Topics: Aged; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Colorectal Neoplasms; Drug Combinations; Female; Hepatectomy; Humans; Liver Neoplasms; Male; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Tegafur

We previously showed that S-1 after curative resection of colorectal liver metastasis had acceptable toxicity and a high rate of completion of therapy in a prospective phase II trial. We here reported the primary endpoint of disease-free survival (DFS).. Between October 2008 and August 2010, 60 patients were eligible for this study and received S-1 for 28 days followed by a 2-week rest period. Treatment was started within 8 weeks after surgery and repeated for eight cycles.. Median follow-up was 41 months. Among 60 patients, 45 had solitary metastasis, and the median maximum tumor diameter was 2.6 cm. The 3-year DFS and overall survival were 47.4 and 80.0 %, respectively. Recurrences developed in 31 patients, with the remnant liver the most common site (19 patients). Multivariate analysis showed that positive lymph node metastasis around the primary site (p = 0.013) and early liver metastasis (synchronous disease or metachronous disease within 12 months) (p = 0.041) were independent poor prognostic factors for DFS. Patients having both risk factors had a significantly worse DFS than those without these risk factors (p < 0.001). Early liver metastasis was an independent indicator of early recurrence within 1 year.. S-1 after curative liver resection yielded promising survival in patients with a low tumor burden. Outcome in patients having both positive lymph node metastasis around the primary site and early liver metastasis was much worse than in patients without these conditions; therefore, they might warrant more aggressive therapy.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Colorectal Neoplasms; Disease-Free Survival; Drug Combinations; Female; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Prognosis; Prospective Studies; Survival Analysis; Tegafur

The Kyushu Study Group of Clinical Cancer (KSCC) conducted phase II trials of KSCC1002 (UMIN000001308) concerning liver resectability after first-line treatment of initially unresectable or not optimally resectable colorectal liver metastases in a prospective, multicenter study.. Patients with wild-type KRAS received 4-6 cycles of S-1 and oxaliplatin (SOX) plus cetuximab. Liver resectability was evaluated subsequently with the liver resection rate as the primary endpoint.. Of the 33 patients enrolled between March 2010 and July 2013, the median number of administration cycles was 4 (range 0-10). The overall response rate was 63.6 % (95 % confidence interval [CI] 45.1-79.6 %). Liver resection was possible in 16 of 33 (48.5 %) patients, and there were 13 R0 cases (39.4 %). We conducted a central review of liver resectability evaluated by five liver surgeons, and the resectability increased from 18.2 to 66.7 % after chemotherapy, based on imaging. The median overall survival for all 33 cases was 31.6 months (95 % CI 14.8-not reached). The median progression-free survival was 9.7 months (95 % CI 6.2-11.8).. SOX plus cetuximab is safe and effective for advanced colorectal cancer with limited liver metastasis, and may lead to high liver resectability.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cetuximab; Colorectal Neoplasms; Drug Combinations; Follow-Up Studies; Humans; Liver Neoplasms; Neoplasm Staging; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Prognosis; Survival Rate; Tegafur

Sorafenib is the sole molecular-targeted agent showing a survival benefit in patients with advanced hepatocellular carcinoma (HCC). We evaluated the tolerability and effectiveness of a combination of S-1 with sorafenib in patients with advanced HCC.. S-1 was administered during days 1-14 and sorafenib was administered every day. This treatment was repeated every 21 days. In phase I, we determined the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs). The dose of each drug was planned as follows: cohort 1: S-1 48 mg/m(2)/day and sorafenib 400 mg/day, cohort 2a: S-1 48 mg/m(2)/day and sorafenib 800 mg/day, cohort 2b: S-1 64 mg/m(2)/day and sorafenib 400 mg/day, cohort 3: S-1 64 mg/m(2)/day and sorafenib 800 mg/day, and cohort 4: S-1 80 mg/m(2)/day and sorafenib 800 mg/day. In phase II, the patients were treated at the MTD to evaluate safety and efficacy.. Nineteen patients were enrolled in phase I. One of the six patients in cohort 1 and one of the six patients in cohort 3 experienced DLT. None of the three patients in cohort 2a experienced DLT and three of the four patients in cohort 4 experienced DLT. Therefore, cohort 3 was considered the MTD. Subsequently, 26 patients were enrolled in phase II. The most common grade 3/4 toxicities were an increase of aspartate aminotransferase (38.5 %), thrombocytopenia (23.1 %), neutropenia (19.2 %), hyperbilirubinemia (15.4 %), an increase of alanine aminotransferase (15.4 %), hyponatremia (11.5 %), rash (11.5 %), and hypophosphatemia (11.5 %). Sudden death occurred in one patient (3.8 %). A patient (3.8 %) had a partial response, 15 (57.7 %) had stable disease, and 10 (38.5 %) had progressive disease. The median times to progression and overall survival were 2.4 and 10.5 months, respectively.. The MTD of S-1 and sorafenib in patients with advanced HCC was 64 mg/m(2)/day and 800 mg/day, respectively. This dose/regimen demonstrated substantial clinical activity among patients with advanced HCC.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Drug Combinations; Female; Humans; Liver Neoplasms; Male; Maximum Tolerated Dose; Middle Aged; Niacinamide; Oxonic Acid; Phenylurea Compounds; Prospective Studies; Sorafenib; Tegafur

In Japan, transarterial infusion chemotherapy using cisplatin (CDDP-TAI) is frequently used for advanced hepatocellular carcinoma (HCC). Moreover, oral chemotherapy with S-1, an oral fluoropyrimidine derivative, has also elicited promising responses in HCC patients. We determined the recommended dosage for CDDP-TAI plus S-1 combination therapy for advanced HCC.. Twelve Child-Pugh class A or B patients with advanced HCC who met the eligibility criteria were enrolled in this phase I trial. Patients received CDDP-TAI (infusion, day 1) plus S-1 (oral administration, days 1-21) every 5 weeks until disease progression.. Cisplatin (65 mg/m(2)) was administered with S-1 at 50 mg · m(-2) day-1 (level 1, 3 patients), 60 mg · m(-2) day-1 (level 2, 3 patients), or 80 mg · m(-2) day-1 (level 3, 6 patients). The total number of treatment courses was 25 (median, 2 courses/patient; range, 1-6 courses). Dose-limiting toxicity was not observed in any patient at any level; therefore, the recommended dosage for cisplatin and S-1 in combination was level 3. Grade 3 adverse events were elevated alanine aminotransferase levels (2 patients), elevated aspartate aminotransferase levels (2 patients), anemia (1 patient), and decreased platelet counts (1 patient). Median progression-free survival and overall survival were 73 days and 328 days, respectively. The disease control rate was 58% (7/12); 17% (2/12) of patients achieved partial response and 42% (5/12) achieved stable disease. CDDP-TAI plus S-1 is safe for the treatment of HCC.. The recommended dosage for further evaluation of this combination therapy in phase II studies is 65 mg/m(2) CDDP and 80 mg/m(2) S-1.. UMIN; number: UMIN000003113.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Cisplatin; Disease-Free Survival; Drug Combinations; Female; Humans; Japan; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Tegafur; Treatment Outcome

We aimed to investigate the recommended dose for the combination of TSU-68, a multiple-receptor tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor-2 and platelet-derived growth factor receptor-β, and S-1, an oral fluoropyrimidine, in patients with advanced hepatocellular carcinoma (HCC) based on its associated dose-limiting toxicity (DLT) frequency. We also determined the safety, tolerability, pharmacokinetics (PK), and efficacy of the combination treatment.. Patients without any prior systemic therapy received 400 mg/day TSU-68 orally and 80 mg/day (level 1) or 100 mg/day (level 2) S-1 for 4 or 2 weeks followed by a 2- or 1-week rest period (groups A and B, respectively). According to the treatment, patients progressed from level 1B to level 2A, then level 2B. Safety and response rates were assessed.. Eighteen patients were enrolled. Two patients at levels 1B and 2A but none at level 2B showed DLTs. The common adverse drug reactions were a decrease in hemoglobin levels, hypoalbuminemia, and anorexia, which were mild in severity (grades 1-2). PK data from levels 1B and 2A indicated that the area under the curve for TSU-68 and 5-fluorouracil was unlikely to be affected by the combination treatment. Response rate, disease control rate, median time to progression, and median overall survival were 27.8 %, 61.1 %, 5.3 months, and 12.8 months, respectively.. The recommended dose for advanced HCC should be 400 mg/day TSU-68 and 100 mg/day S-1 for 4 weeks followed by 2-week rest.

Topics: Administration, Oral; Aged; Aged, 80 and over; Angiogenesis Inhibitors; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Drug Combinations; Female; Humans; Indoles; Liver Neoplasms; Male; Middle Aged; Oxindoles; Oxonic Acid; Propionates; Pyrroles; Tegafur; Treatment Outcome

This phase II trial was designed to evaluate the safety and efficacy of adjuvant chemotherapy with S-1 in patients with curatively resected liver metastasis from colorectal cancer. Results of an interim analysis of safety and short-term outcomes are reported.. Patients who underwent curative resection of liver metastasis from colorectal cancer received S-1 monotherapy (on days 1-28, followed by 14 days' rest, 8 cycles) as adjuvant chemotherapy.. Among 62 patients enrolled between October 2008 and August 2010, a total of 60 patients were eligible for analysis. The most frequent grade 3 or higher hematologic toxicity involved neutropenia in three patients (5.0 %). Nonhematologic toxicities of grade 3 or higher were fatigue in 6.7 % of patients. Grade 4 enteritis occurred in one patient, but resolved promptly after withdrawal of S-1 therapy. The completion rate of the eight scheduled cycles of chemotherapy was 58.3 %. The most common reasons for withdrawal of treatment was the detection of early relapse in 16 patients (64 %). When the 16 patients who had recurrence during adjuvant treatment were excluded from analysis, 79.5 % of the remaining 44 patients completed the scheduled treatment. Early recurrence within 1 year after curative liver resection occurred in 21 patients (35 %). The most common site was the remnant liver in 14 patients.. Orally administered S-1 after curative liver resection has an acceptable toxicity profile and a high rate of completion of the therapy. S-1 can be safely used and might be a viable treatment option in an adjuvant setting.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Colorectal Neoplasms; Drug Combinations; Feasibility Studies; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Oxonic Acid; Prognosis; Salvage Therapy; Tegafur; Young Adult

This randomized phase II study was conducted to compare the efficacy and safety of paclitaxel with S-1 (PS) vs. S-1 in patients with advanced gastric cancer (AGC).. Eighty-two (82) patients were 1:1 randomly assigned to oral S-1 (daily for 2 weeks, every 4 weeks' cycle) or S-1 (daily for 2 weeks, every 4 weeks' cycle) plus paclitaxel (on day 1, 8 and 15 of a 4 weeks' cycle). S-1 was orally administered with a fixed quantity according to body surface area (BSA), while paclitaxel was given 60 mg/m(2) i.v. daily through an implanted catheter. The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), overall responsible rates and safety.. The median OS with PS versus S-1 monotherapy was 14.0 versus 11.0 months (P = 0.02), survival at 12 months was 61.0 % in the PS group and 46.3 % in the S-1 group. Median PFS was also significantly longer in the PS group (6.0 months) than in the S-1 group (4.0 months). The overall response rate was determined in 82 evaluable patients, and was significantly higher (P = 0.04) with PS (19 patients, 46.3 %) than with S-1 monotherapy (10 patients, 24.4 %). PS was well tolerated with no treatment-related deaths, all were grade 3-4 gastrointestinal toxicities, including anorexia, nausea, and diarrhea developed in less than 10 % of the patients.. Combination chemotherapy of paclitaxel with S-1 is well tolerated and active in AGC patients. Further investigation with comparative trials is needed for confirmation.

Topics: Adenocarcinoma; Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Feasibility Studies; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Prognosis; Stomach Neoplasms; Survival Rate; Tegafur; Young Adult

S-1, an oral fluoropyrimidine derivative, has previously demonstrated anticancer efficacy in pancreatic cancer (PC), predominantly in Asian populations. This study evaluated the antitumor effect and safety of S-1 in Caucasian patients with metastatic PC.. Chemotherapy-naïve patients received S-1 orally at 30 mg/m(2) twice daily (BID) for 2 weeks, repeated every 3 weeks. Primary endpoint was ORR. Secondary endpoints included PFS, OS and safety assessment. The trial had a Simon's two-stage design with 22 patients evaluable for efficacy in stage 1 and an additional 18 patients in stage 2, if ≥3/22 patients had a confirmed response at the first stage.. Three out of 27 patients showed PR, however, detection of asymptomatic brain metastases in one of them prevented this study from proceeding to stage 2. The median PFS and OS for all patients was 3.5 and 9.1 months, respectively. The median duration of disease control for patients with SD or PR (n = 17) was 4.3 months. S-1 was well tolerated; fatigue was the most frequent grade 3/4 adverse event.. Efficacy data of PFS and OS are at least comparable to gemcitabine, the current standard of care. S-1 is active in Caucasian patients with metastatic PC.

Topics: Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic; Bone Neoplasms; Drug Combinations; Female; Humans; Liver Neoplasms; Lung Neoplasms; Lymph Nodes; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Tegafur

Sorafenib is a multi-kinase inhibitor, which was approved as first-line treatment for patients with advanced hepatocellular carcinoma (HCC). We conducted a phase 1 study of sorafenib plus S-1 in patients with advanced HCC.. We designed to escalate S-1 at 4 different dose levels with fixed dose of sorafenib. Four dose levels were as follows: level 1, D1-14 S-1 50 mg/m(2)/day + D1-21 sorafenib 400 mg bid; level 2, D1-14 S-1 60 mg/m(2)/day + D1-21 sorafenib 400 mg bid; level 3,, D1-14 S-1 70 mg/m(2)/day + D1-21 sorafenib 400 mg bid; level 4, D1-14 S-1 80 mg/m(2)/day + D1-21 sorafenib 400 mg bid. The treatment was repeated every 3 weeks.. From August 2009 to July 2010, 20 patients with advanced HCC were enrolled. The median age was 48 years (range, 29-74). Eighteen (90%) patients had hepatitis B viral infection and 19 (95%) patients were rated as Child-Pugh class A. The dose-limiting toxicities were grade 4 infection and thrombocytopenia. After a median follow-up duration of 8.6 months (range, 3.7-14.2 months), median PFS was 3.9 months (95% CI, 0.8-7.0 months) and median OS was 10.4 months (95% CI, 0-22.4 months). In pharmacokinetic analysis, there was no statistically significant drug interaction between sorafenib and S-1.. The combination of sorafenib and S-1 showed tolerable toxicity profile and modest clinical efficacy in patients with advanced HCC. The recommended dose of sorafenib and S-1 was 400 mg twice daily and 40 mg/m(2) twice daily, respectively.

Topics: Adult; Aged; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Benzenesulfonates; Carcinoma, Hepatocellular; Drug Combinations; Female; Fluorouracil; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Male; Maximum Tolerated Dose; Middle Aged; Neoplasm Staging; Niacinamide; Oxonic Acid; Phenylurea Compounds; Pyridines; Sorafenib; Tegafur; Treatment Outcome

Doses and schedules of the combination of S-1 and cisplatin for the treatment of advanced gastric cancer (AGC) have not been standardized. We therefore evaluated the efficacy and feasibility of a 3-week schedule of S-1 and cisplatin in patients with AGC, as well as assessing factors prognostic of patient outcomes.. A total of 159 patients with AGC were treated with S-1 (40 mg/m(2) bid on days 1-14) and cisplatin (60 mg/m(2) IV on day 1) between January 2004 and December 2008.. Median follow-up duration was 20.0 months (range, 11.4-48.5 months), during which time 129 patients (81.1%) died. Patients received a median 6 cycles of chemotherapy (range, 1-19 cycles). Among the 59 patients with measurable disease, 1 achieved a complete response (1.7%) and 24 (40.7%) had partial responses, giving an overall response rate of 42.4% (95% CI, 23.0-61.8%). The median progression-free survival (PFS) was 5.8 months (95% CI, 4.8-6.9 months), and the median overall survival (OS) was 11.3 months (95% CI, 9.6-13.0 months). Multivariate analysis showed that initial metastasis, bone metastasis, and liver metastasis were independent prognostic factors for reduced PFS, whereas poor performance status, initial metastasis, and bone metastasis were prognostic for reduced OS. Application of a previous prognostic model showed that observed PFS and OS survival curves for patients in various risk groups differed significantly (P < 0.001 each).. A 3-week regimen of S-1 plus cisplatin was active and well tolerated as first-line treatment in patients with AGC. Disease status and bone metastasis were the most important prognostic factors.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Cisplatin; Disease-Free Survival; Drug Administration Schedule; Drug Combinations; Female; Follow-Up Studies; Humans; Liver Neoplasms; Male; Middle Aged; Multivariate Analysis; Oxonic Acid; Prognosis; Retrospective Studies; Stomach Neoplasms; Tegafur; Treatment Outcome

To carry out a phase II multi-center study on the efficacy and safety of triple combination therapy with paclitaxel, S-1, and cisplatin in patients with unresectable/metastatic gastric cancer.. A total of 63 patients from 8 institutions were included in this study. Paclitaxel (160 mg/m²) was administered by infusion for 3 h on the first day. S-1 (70 mg/m²/day) was administered orally for 14 consecutive days from the first day. Cisplatin (60 mg/m²) was administered intravenously over 24 h on day 14 of every 28-day cycle.. All 63 patients were assessed for clinical efficacy and safety. A total of 259 cycles of treatment were administered (median 4, range 1-10). Grade 3-4 toxicities included neutropenia in 30.2%, thrombocytopenia in 12.7%, and anemia in 11.1%. There was no grade 3-4 non-hematological toxicity or treatment-related death. Complete response was observed in 6 patients and partial response in 34 patients. The overall response rate was 63.5%. The median progression-free survival and response duration were 8.0 and 8.8 months, respectively, and median survival time was 15 months.. Triple combination therapy with paclitaxel, S-1, and cisplatin showed promising safety and efficacy profiles with the potential to become a standard regimen for unresectable/metastatic gastric cancer.

Topics: Adult; Aged; Anemia; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Disease-Free Survival; Drug Combinations; Female; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neutropenia; Oxonic Acid; Paclitaxel; Stomach Neoplasms; Survival Rate; Tegafur; Thrombocytopenia; Treatment Outcome

The efficacy and safety of oxaliplatin combined with S-1 (SOX regimen) for unresectable advanced or recurrent gastric cancer were investigated.. Oxaliplatin was administered i.v. (100 mg/m(2)) on day 1, while S-1 was administered orally (80 mg/m(2)/day, b.i.d.) for 14 days followed by a 7-day rest. This schedule was repeated every 3 weeks.. Among 55 patients enrolled, one patient received oxaliplatin for the other study, and three patients were considered unsuitable against the inclusion criteria. Accordingly, 51 patients were assessable for efficacy. The response rate was 59%, and the disease control rate was 84%. The median progression-free survival time was 6.5 months, the 1-year survival rate was 71%, and the median survival time was 16.5 months. In 54 patients assessed for safety, the major grade 3/4 toxic effects were neutropenia (22%), thrombocytopenia (13%), anemia (9%), anorexia (6%), fatigue (6%), and sensory neuropathy (4%).. These findings indicate that SOX regimen with oxaliplatin at a dose of 100 mg/m(2) is feasible and shows promising efficacy against advanced gastric cancer.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Peritoneal Neoplasms; Stomach Neoplasms; Survival Rate; Tegafur; Treatment Outcome

The objectives of this study were to determine the maximum tolerated dose (MTD) and recommended dose (RD) of S-1 plus cisplatin (CDDP) and to evaluate safety and efficacy using the defined RD in advanced/recurrent head and neck cancer (HNC).. S-1 was administered orally at 40 mg/m(2) twice daily for 14 consecutive days, and CDDP was infused on day 8 at a dose of 60 and 70 mg/m(2). Each course was repeated every 4 weeks.. A total of 38 patients were registered, 10 patients for the Phase I study and an additional 28 patients for the Phase II study. Although no dose-limiting toxicity (DLT) was observed in the CDDP 60 mg/m(2) (Level 1) group, two of six patients in the CDDP 70 mg/m(2) (Level 2) group exhibited DLT (fatigue/diarrhea). The MTD was not achieved in the Phase I study. Level 2 was therefore determined as the RD. In the Phase II study, 34 patients, including 6 patients from the Phase I study, were evaluated. At the termination of treatment, the confirmed response rate was 44.1% (15/34, 95% CI: 27.4-60.8). The best response rate without an adequate duration time was 67.6% (95% CI: 51.9-83.4). The median survival period was 16.7 months, and the 1-year survival rate was 60.1%. The main toxicities of Grade 3 or above were anorexia (26.5%), nausea (14.7%), neutropenia/thrombocytopenia (11.8%) and anemia/fatigue (8.8%).. This is considered to be an effective regimen with acceptable toxicities for HNC.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Carcinoma, Squamous Cell; Cisplatin; Drug Combinations; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Infusions, Intravenous; Liver Neoplasms; Lung Neoplasms; Male; Maximum Tolerated Dose; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Oxonic Acid; Prognosis; Survival Rate; Tegafur; Treatment Outcome; Young Adult

S-1 plus cisplatin is standard treatment for advanced gastric cancer in Japan. Triplet therapy with docetaxel, cisplatin and fluoropyrimidine showed a survival benefit over doublet therapy, but was associated with substantial toxicities. We investigated the maximum tolerated dose of combination chemotherapy with divided-dose docetaxel added to standard-dose S-1 plus cisplatin in advanced gastric cancer patients.. Patients with advanced gastric cancer, naive to chemotherapy or not refractory to fluoropyrimidine, were enrolled. Fixed doses of S-1 (40 mg/m(2) twice daily for 3 weeks) and cisplatin (60 mg/m(2) on day 1) were administered with increasing docetaxel dose levels of 20 mg/m(2) (dose level 1), 25 mg/m(2) (dose level 2) and 30 mg/m(2) (dose level 3) on days 1, 8 and 15, or 40 mg/m(2) (dose level 4) on days 1 and 15 of a 5-week cycle. Treatment cycles were repeated until disease progression, patient's refusal or unacceptable toxicity occurred.. Fifteen patients were enrolled. During the first cycle, no dose-limiting toxicity was observed at dose levels 1 and 2. At dose level 3, grade 3 febrile neutropenia was seen in one patient. At dose level 4, grade 3 infection and grade 3 abdominal pain were observed. Thus, dose level 4 was determined to be the maximum tolerated dose. The response rate was 54% (7/13), and median progression-free survival and overall survival were 243 and 383 days, respectively.. The recommended dose of docetaxel added to standard-dose S-1 (80 mg/m(2) days 1-21) plus cisplatin (60 mg/m(2) day 1) was 40 mg/m(2) on days 1 and 15 of a 5-week cycle.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Docetaxel; Drug Combinations; Female; Humans; Japan; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Maximum Tolerated Dose; Middle Aged; Oxonic Acid; Peritoneal Neoplasms; Stomach Neoplasms; Survival Rate; Taxoids; Tegafur; Treatment Outcome

S-1, an oral fluoropyrimidine derivative, has been shown to be clinically effective against various solid tumors, and preclinical studies have demonstrated activity against hepatocellular carcinoma. We conducted a phase I/II study in patients with advanced hepatocellular carcinoma to examine the pharmacokinetics, recommended dose, safety and efficacy of S-1. In phase I, the administered dose of S-1 was approximately 64 mg/m(2) per day in three patients (level 1) and approximately 80 mg/m(2) per day in six patients (level 2). There was no dose-limiting toxicity at level 1, but two patients had dose-limiting toxicity at level 2 (grade 3 anorexia and grade 2 rash requiring eight or more consecutive days of rest). The recommended dose was finally estimated to be 80 mg/m(2) per day. There were no significant differences in the pharmacokinetics of S-1 between patients with Child-Pugh A and those with B. In phase II, five of 23 patients (21.7%) had partial responses. The median progression-free survival and overall survival were 3.7 and 16.6 months, respectively. The most common toxicities of grade 3 or 4 were elevated serum aspartate aminotransferase levels, hypochromia and thrombocytopenia. In conclusion, S-1 showed an acceptable toxicity profile and promising antitumor activity for hepatocellular carcinoma, warranting further evaluation in randomized clinical trials.

Topics: Aged; Antimetabolites, Antineoplastic; Area Under Curve; Carcinoma, Hepatocellular; Disease-Free Survival; Drug Combinations; Female; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Male; Maximum Tolerated Dose; Middle Aged; Neoplasm Staging; Oxonic Acid; Tegafur

It is extremely difficult to bring about a complete cure of metastatic breast cancer: the purpose of treatment is to prolong the patient's survival while maintaining their quality of life (QOL). The current retrospective study was conducted to find whether S-1, an orally administered 5-FU agent, can produce a therapeutic result in patients with recurrent metastatic breast cancer while maintaining their QOL.. Among the patients who were diagnosed at our institution to have recurrent metastatic breast cancer between November 2001 and December 2008, those who were treated with S-1 were selected and their records retrospectively reviewed.. The analysis was conducted on 33 patients. The median number of regimens that these patients underwent was 2 (range 0-6). The overall response rate (ORR), clinical benefit rate (CBR), median time to treatment failure and overall survival were 30%, 42%, 152 days and 338 days, respectively. Among the 11 patients who were treated with S-1 in the first or the second line, ORR and CBR were 45.5 and 63.6%, respectively. Toxicity more than grade 3, leucopenia, neutropenia diarrhea, mucositis, and hand-foot syndrome were found in only 3%.. S-1 is well-tolerated by patients, promising a therapy while maintaining their QOL. When applied in the early stage of a disease in particular, the agent promises a very effective anti-tumor effect.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Bone Neoplasms; Breast Neoplasms; Drug Combinations; Female; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Middle Aged; Oxonic Acid; Retrospective Studies; Survival Rate; Tegafur; Treatment Outcome

We performed preoperative chemotherapy with combined docetaxel, cisplatin and S-1 (DCS therapy) for treatment of advanced gastric cancer with para-aortic lymph node metastases. The aim of this study was to determine the maximum tolerated dose (MTD) and the dose-limiting toxicities. Furthermore, we evaluated the feasibility of DCS therapy in a preoperative setting, and also examined the pathological response. Fifteen patients received intravenous docetaxel and cisplatin (30, 35 or 40 mg/m2, each dose escalation was reciprocal) on days 1 and 15 and oral S-1 (40 mg/m2 twice daily) on days 1-14 every 4 weeks. After one cycle of chemotherapy, toxicities were evaluated and after two cycles of chemotherapy, patients who were judged to be candidates for curative resection underwent gastrectomy with D2 lymphadenectomy plus para-aortic lymph node dissection. The MTD of this combination was presumed to be at dose level 3 (docetaxel 40 mg/m2 and cisplatin 35 mg/m2). The dose-limiting toxicities were grade 4 neutropenia in one patient, grade 3 febrile neutropenia in two patients and grade 3 diarrhoea in two patients. Thirteen of the 15 patients received complete resection and there was no operation-related death. Good pathological responses were observed in 12 cases with lesions in the lymph nodes (complete response, n = 4; partial response, n = 8) and 11 patients with primary stomach lesions (complete response, n = 2; partial response, n = 9). This preoperative DCS therapy was considered feasible and provided a high pathological response rate in gastric cancer patients with para-aortic lymph node metastases.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Cisplatin; Docetaxel; Drug Combinations; Drug Therapy, Combination; Female; Humans; Liver; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Stomach; Stomach Neoplasms; Taxoids; Tegafur; Treatment Outcome

This randomised multicentre phase II study was conducted to investigate the activity and safety of two oral fluoropyrimidines, capecitabine or S-1, in elderly patients with advanced gastric cancer (AGC). Elderly (>or=65 years) chemo-naive patients with AGC were randomly assigned to receive capecitabine 1250 mg m(-2) two times daily on days 1-14 every 3 weeks or S-1 40-60 mg two times daily according to body surface area on days 1-28 every 6 weeks. Ninety-six patients were enrolled and 91 patients were randomised to capecitabine (N=46) or S-1 (N=45). Overall response rate, the primary end point, was 27.2% (95% CI, 14.1-40.4, 12 of 44 assessable patients) with capecitabine and 28.9% (95% CI, 15.6-42.1, 13 of 45) with S-1. Median times to progression and overall survival in the capecitabine arm (4.7 and 9.5 months, respectively) were similar to those in the S-1 arm (4.2 and 8.2 months, respectively). The incidence of grade 3-4 granulocytopenia was 6.8% with capecitabine and 4.8% with S-1. Grade 3-4 nonhaematologic toxicities were: asthenia (9.1% with capecitabine vs 7.1% with S-1), anorexia (6.8 vs 9.5%), diarrhoea (2.3 vs 0%), and hand-foot syndrome (6.8 vs 0%). Both capecitabine and S-1 monotherapies were active and tolerable as first-line treatment for elderly patients with AGC.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic; Bone Neoplasms; Capecitabine; Deoxycytidine; Drug Combinations; Feasibility Studies; Female; Fluorouracil; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Neoplasm Recurrence, Local; Oxonic Acid; Peritoneal Neoplasms; Prognosis; Stomach Neoplasms; Survival Rate; Tegafur; Treatment Outcome

A pre-clinical study demonstrated that paclitaxel induced thymidine phosphorylase in the tumor tissues. The combination of paclitaxel and doxifluridine is expected to exert extra anti-tumor effects. We evaluated the efficacy of this combination in patients with unresectable or recurrent gastric cancer who had been previously treated with S-1.. Registration was started to enroll 35 patients with advanced/recurrent gastric cancer, who were selected among those with measurable lesions fitting to response evaluation criteria in solid tumors, and with resistant to S-1 treatment. This regimen is consisted of paclitaxel, 80 mg/m(2), iv on days 1 and 8; and doxifluridine, 600 mg/m(2), po on days 1-14. The treatment was repeated every three weeks. Primary endpoint was response rate (RR); and secondary endpoints were overall survival (OS), progression free survival (PFS) and onset rate of adverse events.. From September 2003 to March 2005, 35 patients were registered: including 28 men; 7 women; median age of 66 years (range, 49-75 years); and performance status (PS) levels were, zero with 21 and one with 14 patients. In 33 eligible patients, except two, clinical usefulness was evaluated resulting in RR of 18.2% (partial response, 6; stable disease, 15; progressive disease, 10; and not evaluable, 2 patients). Median survival time was 321 days and median PFS was 119 days. Severe adverse events were found in three patients to discontinue the present treatment.. The combination of paclitaxel and doxifluridine might be a treatment of choice as a second line chemotherapy for patient undergone S-1 treatment.

Topics: Adenocarcinoma; Aged; Anemia; Anorexia; Antineoplastic Combined Chemotherapy Protocols; Disease-Free Survival; Drug Combinations; Drug Resistance, Neoplasm; Female; Floxuridine; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Neutropenia; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Stomach Neoplasms; Survival Rate; Tegafur; Thrombocytopenia

We report a patient with gallbladder cancer and multiple liver and lymph node metastases which completely responded to S-1, an oral fluoropyrimidine anticancer drug. The patient was enrolled in the "Late phase II study of S-1 in patients with advanced biliary tract cancer". A partial response was confirmed after the first two courses of S-1 monotherapy, and anti-tumor efficacy was finally evaluated as a complete response after the 5th course. S-1 was discontinued after the 18th course because of long CR, and the patient has been alive and disease-free for more than 3 years. Grade 2 anorexia, diarrhea, hand-foot skin reaction, and tasty disturbance were observed, but no grade 3 or more toxicities were noted. S-1 appeared to be effective against advanced gallbladder cancer and showed excellent tolerability.

Topics: Antimetabolites, Antineoplastic; Drug Combinations; Gallbladder Neoplasms; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Tegafur; Treatment Outcome

Early and late phase II studies of S-1 were conducted for the treatment of metastatic pancreatic cancer. In both trials, S-1 was administered at a dose of 80 mg/m2/day. One course consisted of consecutive administration of S-1 for 28 days, followed by 14 days of rest. This regimen was repeated every 6 weeks until the occurrence of progressive disease or unacceptable toxicities. The early phase II study demonstrated a response rate of 21.1% with a median survival time of 5.6 months in 19 patients. The major drug-related adverse events were gastrointestinal toxicities like nausea, and anorexia, though most of them were tolerable and reversible. Other treatment-related adverse events, like ileus, colitis, and abdominal distension, were less frequent. The late phase II study confirmed favorable responces with a mild toxicity profile in 40 evaluable patients. S-1 is active and well tolerated in patients with metastatic pancreatic cancer. Randomized trials are warranted to determine the effectiveness of S-1 for the treatment of pancreatic cancer.

Topics: Administration, Oral; Aged; Anorexia; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Female; Humans; Liver Neoplasms; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Nausea; Oxonic Acid; Pancreatic Neoplasms; Tegafur

This is the first phase II study of S-1 monotherapy for patients with metastatic colorectal cancer after failure of both irinotecan- and oxaliplatin-containing regimens. The initial dose of S-1 was 35 mg m-2, administered twice daily for 14 days every 3 weeks. Treatment was repeated until the occurrence of disease progression. Twenty-eight patients were enrolled. S-1 was administered to 21 patients as third-line therapy and to the remaining seven patients as fourth-line therapy. Of 26 evaluable patients, the overall response rate was 14.3% (95% CI, 0.4-28.1), and the disease control rate was 42.9% (95% CI, 23.3-62.4). With a median follow-up period of 227 days, median time to progression and overall survival duration were 91 and 414 days, respectively. The 1-year survival rate of all patients was 60.7%. There was no grade 4 toxicity. Grade 3 haematological toxicities were documented only in two patients. In conclusion, S-1 shows potential as a salvage regimen in heavily pretreated colorectal cancer patients. The twice-daily dose of 35 mg m-2 was well tolerated and can be used in designing further combination chemotherapy.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colorectal Neoplasms; Drug Combinations; Female; Humans; Irinotecan; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Salvage Therapy; Survival Rate; Tegafur; Treatment Outcome

Several chemotherapy regimens used against advanced gastric cancer have been studied extensively over the decades in an attempt to further improve the prognosis of patients. To date, no standard chemotherapeutic regimens have been established worldwide. S-1 (TS-1), a combination of ftorafur and two modulators, gimestat (CDHP) and oxonic acid, in a molar ratio of 1:0.4:1, has been widely used in Japan for the treatment of advanced gastric cancer, and much attention has been paid to attempts to increase its antitumor effect by combining it with other chemotherapeutic drugs. We treated 12 patients with advanced gastric cancer with 80 mg/m2 of S-1 for 21 days and 60 mg/m2 of cisplatin (CDDP) on day 8 every 5 weeks. The treatment was continued until disease progression, unacceptable toxicity, or the patient's refusal. Eight out of 12 evaluable patients achieved a partial response (PR), with a response rate of 66.7%. The incidence of grade 3 or 4 adverse effects, including myelosuppression and gastrointestinal toxicities, was 16.6%. None of the patients treated with this regimen died of adverse effects and none required hospitalization for the toxicity. We conclude that the combination of S-1 and CDDP seems to have a high therapeutic index, enhancing the antitumor effect of S-1 while maintaining modest adverse effects, thus suggesting the possible use of this combination based at the outpatient clinic (apart from a short stay in hospital during the infusion of CDDP with hydration). Further study with a large number of patients may be needed to confirm the combination of S-1 and CDDP to be an appropriate first-line chemotherapy for gastric cancer.

Topics: Adenocarcinoma; Adult; Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Digestive System Surgical Procedures; Drug Combinations; Drug Evaluation; Female; Humans; Japan; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Peritoneal Neoplasms; Pyridines; Severity of Illness Index; Stomach Neoplasms; Survival Analysis; Tegafur; Treatment Outcome

A previous phase II study showed that S-1 (TS-1) was effective for advanced gastric cancers and had mild toxicity. The present study aimed to evaluate the efficacy and feasibility of this novel anticancer drug combined with low-dose cisplatin (CDDP).. Fifteen patients with unresectable and recurrent gastric cancer were enrolled. S-1 was administered orally twice daily after meals, at a standard dose of 80 mg/m2 per day according to the late phase II trial protocol. One course consisted of 28 days' consecutive administration followed by 14 days' rest. Five or 10 mg CDDP was infused three times each week (days 1, 3, 5) during S-1 administration on hospitalization, and once each week (day 1) at the outpatient clinic. Patients' backgrounds, response rates, response durations, and time to progression were investigated.. None of the 15 patients had a complete response and 8 had a partial response. Therefore, the overall response rate was 53% (8/15). For site efficacy, the response rate was 50% (5/10) for the primary lesion, 50% (3/6) for liver metastasis, and 39% (5/13) for lymph node metastasis. The median response duration of the 8 responders was 4 months, and the time to progression was 3.3 months. Adverse reactions appeared in 60% (9/15). The incidence of adverse reactions of grades 3 and 4 was 13% (2/15) and 0%, respectively. As for hematological toxicity, grade 3 leukopenia was observed in 2 patients (2/15), but decreased hemoglobin level and thrombocytopenia did not appear. Although gastrointestinal adverse reactions appeared in 40% (6/15), all reactions were grades 1 and 2. Because of the mild toxicity, most patients were treated at the outpatient clinic.. Combination chemotherapy of S-1 and low-dose CDDP is expected to be a useful chemotherapy for advanced gastric cancer.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Digestive System Surgical Procedures; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Female; Follow-Up Studies; Humans; Incidence; Japan; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Peritoneal Neoplasms; Pyridines; Retrospective Studies; Severity of Illness Index; Stomach Neoplasms; Tegafur; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Interventional

This study was designed to investigate the role of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), and thymidine phosphorylase (TP) in tumor progression and sensitivity to 5-fluorouracil (5-FU).. A total of 275 tumor samples from 275 patients with gastric cancer were utilized in this study. TS activity was determined in 130 samples by 5-fluorodeoxyuridine monophosphate binding assay. DPD activity was measured in 140 samples by radioenzymatic assay, and TP protein level was determined in 157 samples by an enzyme-linked immunosorbent assay (ELISA) system. These parameters were compared with several clinicopathologic factors and sensitivity to 5-FU determined by in-vitro ATP assay. The antitumor activities of 5-FU, uracil plus tegafur (UFT), and 1M tegafur--0.4 M 5-chloro-2,4-dihydroxypyridine--1 M potassium oxonate (S-1 [TS-1]) were also compared, using three human gastric cancer xenografts in nude mice.. There was no correlation between either TS or TP and sensitivity to 5-FU. However, a weak inverse correlation was found between DPD activity and sensitivity to 5-FU. High DPD activity in tumor resulted in poor prognosis, especially in patients who received 5-FU-based adjuvant chemotherapy. Although TP was significantly correlated with depth of tumor invasion and with lymphatic and venous invasions, TP alone had no impact on survival. On the other hand, TS, as well as peritoneal, hepatic, and lymph node metastases, was selected as an independent prognostic factor in gastric cancer. In the animal model, there was no significant difference in antitumor activities among the drugs in a tumor with low DPD activity. However, S-1 showed superior antitumor activity to 5-FU or UFT in tumors with high DPD activity.. DPD is considered to be a most important predictive factor of 5-FU sensitivity. The use of DPD inhibitory fluoropyrimidines is strongly recommended for tumors with high DPD activity.

Topics: Adult; Aged; Aged, 80 and over; Animals; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Combined Modality Therapy; Dihydrouracil Dehydrogenase (NADP); Drug Combinations; Female; Fluorouracil; Gastrectomy; Humans; Japan; Liver Neoplasms; Lymphatic Metastasis; Male; Mice; Mice, Inbred BALB C; Middle Aged; Multivariate Analysis; Neoplasm Staging; Oxidoreductases; Oxonic Acid; Peritoneal Neoplasms; Predictive Value of Tests; Pyridines; Retrospective Studies; Statistics as Topic; Stomach Neoplasms; Survival Analysis; Tegafur; Thymidine Phosphorylase; Thymidylate Synthase; Treatment Outcome; Uracil

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Pancreatic Ductal; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Male; Microwaves; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Propensity Score; Radiofrequency Ablation; Retrospective Studies; Survival Rate; Tegafur; Tumor Burden

The purpose of this study was to analyze the safety and feasibility of low-dose apatinib combined with S-1 as a second-line therapy or beyond in Chinese patients with pulmonary and/or hepatic metastases of nasopharyngeal carcinoma (NPC).. Forty-one Chinese NPC patients with pulmonary and hepatic metastases were treated with low-dose apatinib plus S-1. The S-1 dose was determined according to each patient's body surface area (BSA): 40 mg twice a day for BSA <1.25 m. Treatment efficacy was evaluated in all 41 patients after four courses of chemotherapy. The objective response rate was 34.1%, and the disease control rate was 80.4%. The median progression-free survival was 9.7 months (95% confidence interval, 6.2-13.8 months), and the median overall survival was 22.1 months (95% confidence interval, 15.1-28.9 months). The 2-year survival rate was 41.5%. The most common toxicities included loss of appetite in 39.0% of patients, dyslipidemia in 34.1%, hypertension in 31.7%, myelosuppression in 24.4%, fatigue in 21.9%, and hand-foot syndrome in 17.1%. Seven patients received dose adjustment of apatinib due to side effects.. In patients with pulmonary and/or hepatic metastases of NPC, low-dose apatinib plus S-1 yielded an excellent survival benefit, and the toxicities were mild and tolerable.

Topics: Administration, Oral; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Asian People; Carcinoma, Non-Small-Cell Lung; Combined Modality Therapy; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Feasibility Studies; Female; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Oxonic Acid; Pyridines; Survival Rate; Tegafur; Young Adult

An 82-year-old woman presented with a dull feeling in her stomach and anemia. The gastroscopy and abdominal CT scan showed a progressive gastric tumor with multiple liver metastases, and a biopsy specimen revealed moderately differentiated tubular adenocarcinoma. A subtotal gastrectomy with D1 plus lymph node dissection was performed. The final diagnosis was as follows: H1, P0, CY0, M1, pT3, pN2, and fStageⅣ. We considered her age, and postoperative chemotherapy with of an oral anticancer drug, S-1, was initiated at a daily dose of 100 mg, with a 2-week administration and 1-week suspension schedule. The multiple liver metastases obviously reduced in size(PR)by 3 months, and the CT scan revealed complete response(CR)by 8 months after beginning S-1 administration. However, grade 2 anorexia and general malaise developed, so the S-1 administration was changed to a daily dose of 80 mg, with a 2-week administration and 2-week suspension schedule. However, an adverse event of nausea appeared again, and the patient needed a 2-month discontinuation. Therefore, S-1 administration was changed to alternate-day administration, at a daily dose of 100 mg. Subsequently, no side effects were observed, and we continued the S-1 administration for 4 years. She has maintained a complete response(CR) for 10 years, with no obvious cancer recurrence.

Topics: Aged, 80 and over; Antimetabolites, Antineoplastic; Drug Combinations; Female; Gastrectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Neoplasm Recurrence, Local; Oxonic Acid; Stomach Neoplasms; Tegafur

Topics: Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Drug Combinations; Hepatectomy; Humans; Liver Neoplasms; Oxonic Acid; Tegafur

Gastroscopy ofa 79-year-old man complaining ofanemia showed a type 3 tumor at the lesser curvature ofthe gastric body. A biopsy revealed poorly differentiated HER2-negative adenocarcinoma. Abdominal CT showed the tumor at the lesser curvature ofthe gastric body, multiple lymph nodes with a maximum diameter of 25mm at the lesser curvature, and a mass measuring 50mm with ring enhancement on S6 ofthe liver. The clinical diagnosis was cT4aN2M1(Hep), cStage Ⅳ. He was treated with chemotherapy comprising 4 courses ofS -1 plus oxaliplatin. Although the tumor had shrunk remarkably, chemotherapy was discontinued because of anorexia. Therefore, we performed total gastrectomy and hepatic partial resection(S6). The final staging was ypT3N0M0, ypStage ⅡA. We achieved R0 resection, and he has shown no recurrence without adjuvant chemotherapy for 3 years.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Neoplasm Recurrence, Local; Oxaliplatin; Oxonic Acid; Stomach Neoplasms; Tegafur

Adjuvant S-1 monotherapy prolongs the survival of patients with pathological stage II or III gastric cancer undergoing D2 gastrectomy. This therapeutic regimen is standard in Japan. Unfortunately, some patients who undergo this treatment suffer from recurrent disease. However, information regarding the timing and site-specific trends of recurrence is insufficient.. Among 396 patients who underwent D2 gastrectomy followed by adjuvant S-1 monotherapy between 2008 and 2012, 122 experienced a recurrence. We retrospectively determined the timing and sites of recurrence.. The median RFS of the 122 patients was 19.5 months, and their 1-, 3- and 5-year RFS rates were 67.2%, 23.0% and 5.7%, respectively. There were no significant differences in RFS among disease substages. Local recurrence, lymph node involvement and peritoneal and hematogenous metastases were found in 6, 25, 63 and 42 patients, respectively. Approximately 10% of patients presented with contemporaneous sites of recurrence. Local recurrence and lymph node metastasis plateaued 3 years after gastrectomy. Peritoneal and hematogenous metastasis increased within 5 years after surgery. In patients with hematogenous metastasis, the number of liver metastases plateaued but increased in others.. In patients with recurrent disease who underwent D2 gastrectomy followed by adjuvant S-1 monotherapy, 80% of recurrences occur within 3 years after gastrectomy. The timing of recurrence is not significantly different among substages. Although the rates of local recurrence and lymph node and liver metastasis plateau after 3 years, peritoneal and the other hematogenous metastases increase within 5 years.

Topics: Aged; Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Drug Combinations; Female; Gastrectomy; Humans; Japan; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Oxonic Acid; Retrospective Studies; Stomach Neoplasms; Survival Rate; Tegafur; Time Factors

We report a case of recurrent gastric cancer that was successfully treated by S-1 chemotherapy.An 81-year-old woman with advanced gastric cancer[L Less, Type 2, cT4a(SE), cN0H0P0M0, cStageⅡB]underwent distal gastrectomy.Abdominal CT performed 6 months after surgery revealed a low-density area in the liver.She was diagnosed with liver metastasis and started receiving S-1 chemotherapy.The liver metastasis achieved complete response, so S-1 chemotherapy was discontinued 12 months after recurrence.Abdominal CT performed 9 months after the discontinuation of S-1 chemotherapy revealed multiple low-density areas in the liver.She started receiving S-1 chemotherapy again, but S-1 chemotherapy was discontinued because of side effects after 2 courses.The patient died 24 months after receiving S-1 chemotherapy.

Topics: Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Female; Humans; Liver Neoplasms; Neoplasm Recurrence, Local; Oxonic Acid; Stomach Neoplasms; Tegafur

No standard second-line chemotherapy has been yet established for gemcitabine-refractory biliary tract cancer (BTC).. We conducted multivariable Cox regression analysis to examine the prognostic factors for overall survival (OS) in patients who had received gemcitabine-based treatment.. Forty-six patients received second-line chemotherapy. The median serum carbohydrate antigen 19-9 (CA 19-9) value was 487 U/ml. The modified Glasgow prognostic score (mGPS) was: 0 (n=24), 1 (n=10), or 2 (n=10). The second-line chemotherapy included: S-1 in 20 patients, gemcitabine-based in 20, and tyrosine kinase inhibitors in five. The median OS was 8.3 months, and the median progression-free survival was 3.0 months. Multivariate analysis identified serum CA 19-9 ≥500 U/ml, mGPS ≥1, and presence of liver metastasis as significant prognostic factors for OS.. Second-line chemotherapy for gemcitabine-refractory BTC remains inadequate. Randomized trials with appropriate stratification criteria are required.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Biliary Tract Neoplasms; CA-19-9 Antigen; Deoxycytidine; Drug Combinations; Drug Resistance, Neoplasm; Female; Gemcitabine; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Male; Middle Aged; Multivariate Analysis; Oxonic Acid; Prognosis; Protein Kinase Inhibitors; Retrospective Studies; Tegafur; Treatment Outcome

A 55-year-old man underwent distal gastrectomy and D2 lymph node dissection for type 2 gastric cancer of the antrum. One year later, CEA elevation was discovered, and contrast-enhanced abdominal computed tomography(CT)revealed a 40 mm mass in the liver(S8), which was judged to be a metastatic recurrence of the gastric cancer.S -1 plus CDDP was administered in 5 courses, followed by regular treatment with S-1 alone.Two years after the recurrence was diagnosed, the patient's CEA level was found to be normal, and CT revealed almost total scarring.After 2 more years, there was still no sign of recurrence, so, with the patient's consent, we discontinued the chemotherapy.Eight years after the gastrectomy, a 10mm nodular shadow was observed in the left lower lung lobe, and resection was performed.Despite the earlier diagnosis of gastric adenocarcinoma, this mass was considered a primary lung adenocarcinoma, and the patient died of small-cell lung cancer 11 years and 8 months after the gastrectomy.It is notable that the liver metastasis in this case responded to the S-1 plus CDDP and S-1 therapies, and this response is considered in light of the literature.

Topics: Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Recurrence; Stomach Neoplasms; Tegafur

A 49-year-old man was diagnosed with advanced gastric cancer, with a chief complaint of epigastric discomfort. Computed tomography revealed multiple liver metastases. S-1 plus cisplatin therapy was administered as first-line chemotherapy, and after 4courses, the liver metastases markedly reduced. Total gastrectomy with D2 lymphadenectomy and a needle biopsy of segment 2 of the liver were performed. Histopathological examination revealed no viable cancer cells in the resected stomach, lymph nodes, or liver tissue. The primary tumor was defined as Grade 3 by histopathological examination. Adjuvant chemotherapy with S-1 was administered for 1 year. The patient is alive without recurrence more than 6 years after surgery.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Stomach Neoplasms; Tegafur

We report a case of effective S-1 plus oxaliplatin (SOX) treatment for duodenal cancer with liver metastases. The patient was a 70-year-old female diagnosed with duodenal carcinoma that was unresectable because of liver metastasis(cT4N1M1, cStage IV in UICC 7th). She received SOX treatment(100mg/m / 2 of oxaliplatin on day 1 combined with 40 mg/day of S-1 twice daily on days 1-14, was repeated every 3 weeks). After 4 courses, a partial response was confirmed by computed tomography and no severe adverse events were observed. However, during the 5th courses, several new liver metastases were observed, so we changed to weekly paclitaxel treatment. This case suggests that SOX treatment may be an effective chemotherapy for advanced primary duodenal carcinoma.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Duodenal Neoplasms; Female; Humans; Liver Neoplasms; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Tegafur

A57 -year-old man was diagnosed with advanced gastric cancer(adenocarcinoma[tub2/por1])with multiple(S3, S4, S5, S6, S8)liver and para-aortic lymph node metastases. The tumor was classified as cT4a, N3, M1, HEP, cStage IV, and the patient received chemotherapy with S-1 plus CDDP(SP). After 10 courses of SP, a CT scan revealed that the primary tumor and the metastases disappeared. The patient presented with cCR and underwent distal gastrectomy, D2 lymph node dissection, partial hepatic resection, and cholecystectomy. The histological diagnosis was classified as ypT0N0M0,(ypStage 0), pCR, and pathological Grade 3.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Digestive System Surgical Procedures; Drug Combinations; Humans; Liver Neoplasms; Male; Middle Aged; Neoadjuvant Therapy; Oxonic Acid; Stomach Neoplasms; Tegafur

Gallbladder cancer (GBC) is a highly fatal malignancy. Due to its invasiveness and delayed diagnosis, many GBC patients are diagnosed with synchronous liver and hepatoduodenal ligament involvement. In our case, we report a gallbladder cancer with portal vein thrombus.. A 60-year-old woman presented with persistent upper abdominal dull pain for 2 months.. Ultrasound examination showed gallbladder carcinoma invading liver segment IV, and a tumor thrombus in the left and right main portal trunk. Ultrasonography and contrast-enhanced magnetic resonance imaging (MRI) showed gallbladder carcinoma with invasion of adjacent liver, and tumor thrombus in the right branch of the portal vein and intrahepatic bile duct. Abdominal computed tomography angiography (CTA) revealed no hepatic artery invasion.. We made a decision to perform extended right lobectomy. Twenty-six days later, the patient underwent intravenous infusion port implantation for S-1 plus oxaliplatin (SOX) therapy.. After treatment, the patient has been doing very well and no recurrence has been found for 5 months.. The patient with gallbladder cancer and tumor thrombus in the portal vein described in this report provides a reminder for surgeons of the importance of early diagnosis, and adequate surgical and adjuvant treatment. Multi-disciplinary treatment is significantly beneficial for the overall survival of patients with advanced GBC.

Topics: Administration, Intravenous; Antineoplastic Agents; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Drug Combinations; Female; Gallbladder Neoplasms; Hepatectomy; Hepatic Artery; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Neoplasm Invasiveness; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Portal Vein; Tegafur; Thrombosis; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography; Vascular Access Devices; Vascular Neoplasms

A 62-year-old man was diagnosed with liver metastasis of sigmoid colon cancer, which resulted in bowel obstruction. SOX plus bevacizumab therapy was administered to perform hepatectomy, after the artificial anus construction; however, substantial liver dysfunction occurred. Therefore, we only performed primary tumor resection and waited for improvement in liver function. After 2 months, liver function improved and liver metastasis increased. However, another metastasis was not recognized, so hepatectomy was carried out, and R0 resection was performed. The oxaliplatin-induced liver function disorder was reversible; however, preoperative chemotherapy for resectable colorectal liver metastases increases the risk of missing the resection window. It is necessary to carefully examine the tumor type and preoperative liver function.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Drug Combinations; Hepatectomy; Hepatic Veno-Occlusive Disease; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Sigmoid Neoplasms; Tegafur

A 77-year-old man was diagnosed with ascending colon cancer with synchronous liver metastasis. Per our policy we first only performed a right hemicolectomy (pSSN2H2M0, stage IV). We then planned S-1 and oxaliplatin (SOX) plus bevacizumab (Bmab) chemotherapy as a neoadjuvant for the resection of liver metastasis. After 4 courses, enhanced CT and EOB-MRI findings showed the liver tumor had significantly decreased in size with no side effects, and we performed a partial liver resection for the S7 lesion. Postoperatively, histopathological analysis revealed only a fibrotic lesion and no cancerous cells in the resected specimen, indicating that chemotherapy had downgraded the tumor to Grade 3. Adjuvant chemotherapy was not continued owing to the patient's refusal, but no recurrence was noted 18 months after the second operation. SOX plus Bmab chemotherapy is, therefore, effective in terms of its anti-tumor effects, tolerance, and accessibility. We believe SOX plus Bmab chemotherapy can be considered as an effective option for cases with synchronous liver metastasis of colon cancer as neoadjuvant chemotherapy for interval liver resection.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Colon, Ascending; Colonic Neoplasms; Combined Modality Therapy; Drug Combinations; Humans; Liver Neoplasms; Male; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Tegafur

A 79-year-old woman was referred for pancreatic tail cancer with multiple liver metastases. The pancreatic tail tumor was diagnosed as acinar cell carcinoma (ACC) histologically by endoscopic ultrasound-guided fine-needle aspiration. Because of multiple liver metastases, S-1 chemotherapy was administered, resulting in a partial response to chemotherapy one year later. After approximately three years, liver atrophy and esophageal varices developed. We suspected S-1 as the cause of the liver cirrhosis. S-1 cessation minimized ascites and improved the esophageal varices. Although S-1 can potentially treat ACC, we should be watchful for liver cirrhosis caused by its long-term administration.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Acinar Cell; Drug Combinations; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Humans; Liver Neoplasms; Oxonic Acid; Pancreatic Neoplasms; Tegafur

The theory of extravasated platelet aggregation in cancer lesions was recently introduced. We investigated the association of platelet aggregation in gastric cancer stroma with clinicopathological features, chemotherapeutic response, pathological response, and survival.. The study comprised 78 patients with advanced gastric cancer who had undergone gastrectomy with or without combination of docetaxel, cisplatin and S-1 (DCS) as preoperative chemotherapy between 2005 and 2014. The patients were divided into two groups: patients who had received preoperative DCS therapy forming the p-DCS group and patients who had not received preoperative DCS therapy forming the control group. The 39 patients in the control group had received gastrectomy and postoperative chemotherapy of S-1 alone. Platelet aggregation in biopsy specimens before preoperative DCS therapy in the p-DCS group and at the time of diagnosis in the control group were evaluated using CD42b immunohistochemical staining.. Twenty-four patients in the p-DCS group and 19 in the control group were found to have platelet aggregation in their cancer stroma. Patients with histologically confirmed platelet aggregation had significantly higher rates of chemoresistance (58.3%) than those without platelet aggregation (20.0%) (P = 0.019). According to multivariate analysis, CD42b expression (odds ratio: 5.102, 95% confidence interval: 1.039-25.00, P = 0.045) was correlated with chemoresistance. CD42b expression and histological non-responder status were both significantly correlated with poor overall survival (OS) (P = 0.012, P = 0.016); however, RECIST was not correlated with OS. In the control group, CD42b expression was also significantly correlated with poor overall survival (OS) (P = 0.033). In the p-DCS group, according to multivariate analysis, male sex (hazard ratio: 0.281, 95% confidence interval: 0.093-0.846, P = 0.024) was correlated with good prognosis and CD42b expression (hazard ratio: 4.406, 95% confidence interval: 1.325-14.65, P = 0.016) with poor prognosis.. This study suggests that platelets in gastric cancer stroma may create a favorable microenvironment for chemoresistance. CD42b immunohistochemical staining of biopsy specimens is a promising candidate for being a prognostic marker in patients with gastric cancer.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Biomarkers; Cisplatin; Docetaxel; Drug Combinations; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Grading; Oxonic Acid; Platelet Aggregation; Preoperative Care; Prognosis; Retrospective Studies; Stomach Neoplasms; Survival Rate; Taxoids; Tegafur

A 77-year-old man was diagnosed with gastric cancer with synchronous single liver metastasis and portal vein thrombus. His HER2 immunohistochemistry tumor score was 3+; therefore, we administered trastuzumab plus capecitabine plus cisplatin. After 2 courses of chemotherapy, we observed disappearance of the portal vein thrombus and tumor reduction as a partial response, according to the RECIST guidelines. We performed distal gastrectomy and right lobectomy; the therapeutic grades of the primary and metastatic tumors were 1a and 2, respectively. We administered postoperative chemotherapy, and no recurrent lesions have appeared 2 years after surgery. Multidisciplinary treatment for gastric cancer with liver metastasis might be a feasible and useful strategy.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Cisplatin; Combined Modality Therapy; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Oxonic Acid; Portal Vein; Stomach Neoplasms; Tegafur; Time Factors; Trastuzumab; Venous Thrombosis

Although chemotherapy with oral S-1and oxaliplatin (SOX) plus bevacizumab (bev) is safe and\ feasible for patients with advanced or recurrent colorectal cancer, it is difficult to achieve a complete\ response (CR) using only chemotherapy. A 67-year-old man underwent endoscopic mucosal resection\ and additional sigmoidectomy (D2 dissection) for submucosal invasive sigmoid colon cancer. Multiple\ liver metastases were diagnosed 1.5 years later, and chemotherapy with SOX + bev was initiated.\ Computed tomography (CT) after the end of the third course revealed reduced liver recurrence. Liver\ metastases could not be identified using CT after the end of the sixth course. Grade 1peripheral\ neuropathy was the only side effect of this regimen. Subsequently, the chemotherapy regimen was\ changed to oral S-1. CT evaluation revealed that there was no recurrence at 6 months after the\ regimen change.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Colonic Neoplasms; Drug Combinations; Humans; Liver Neoplasms; Male; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Recurrence; Tegafur

A 67-year-old man was admitted to our hospital because of anemia and weight loss, and diagnosed with a type 3 tumor in the upper gastric body. Pathological examination suggested moderately differentiated adenocarcinoma with immunohistochemically negative staining for HER2. Abdominal CT revealed thickening of the gastric wall and multiple liver metastases. The clinical findings suggested Stage IV disease(T4aN0M1). Chemotherapy was administered with a combination of S-1 plus CDDP(SP). However, the level of CEA(ng/mL)increased from 49.2 to 634.6, and the treatment schedule was changed to a combination of S-1 plus oxaliplatin(SOX). After 3 courses of the SOX regimen, abdominal CT showed a reduction of liver metastases and the level of CEA decreased to 8.4 ng/mL. We performed total gastrectomy with D1 lymph node dissection in September 2016. Post-operative pathological findings were ypStage IV (T3N0M1)and chemotherapeutic effect was grade 2. CT scan revealed regrowth of the tumor in S2 3 months after the operation. The patient underwent transcatheter arterial chemoembolization(TACE)followed by a regimen of paclitaxel plus ramucirumab(PTX/RAM). At present, he is being treated with the PTX/RAM regimen in the outpatient department with no signs of tumor growth. Although the prognosis of gastric cancer with synchronous liver metastases is very poor, it is possible for survival to be prolonged with multimodality therapy.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Stomach Neoplasms; Tegafur; Treatment Outcome

A 76-year-old man was referred to our hospital with gastric cancer.Esophagogastroduodenoscopy (EGD)revealed an irregular, nodulated lesion with ulcers in the lower part of the stomach, for which biopsy specimens indicated poorly differentiated adenocarcinoma.Abdominal computed tomography(CT)showed a well-defined mass lesion measuring 5.3 cm in the posterior segment of the liver.Under the clinical diagnosis of advanced gastric cancer with liver metastasis, the patient received chemotherapy using S-1 and oxaliplatin.After 8 courses of chemotherapy, abdominal CT and EGD revealed that the size of liver metastasis was reduced to 2.3 cm. He underwent distal gastrectomy with D2 lymphadenectomy and resection of the liver metastases because there was no evidence of further metastatic lesions in any other organs after 10 courses of chemotherapy.The gross appearance of the surgically resected specimen showed a shrunk gastric tumor measuring 3.5×3.0 cm and a well-circumscribed, solid liver mass.Pathological examination confirmed the diagnosis of solid-type, poorly differentiated adenocarcinoma in the stomach that had invaded the submucosal layer with no lymph node metastasis, and necrotic change of the liver mass.The postoperative course was uneventful, and the patient has been well, receiving maintenance chemotherapy using S-1, without evidence of recurrence for 9 months following the operation.Conversion surgery following chemotherapy might be a proposed treatment for patients with advanced gastric cancer; however, further studies and assessments are needed to establish this treatment strategy.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Gastrectomy; Hepatectomy; Humans; Liver Neoplasms; Male; Neoadjuvant Therapy; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Stomach Neoplasms; Tegafur

A 73-year-old man presented to a clinic complaining of upper abdominal pain with nausea and diarrhea. The patient was subsequently diagnosed with progressive gastric cancer: cT4a(SE), N3M1(H1P1), Stage IV . For first-line therapy, SP: S-1(120 mg, 3 weeks)and CDDP(90 mg, 8 days iv) were selected. Though the patient had Grade 3 thrombocytopenia and renal dysfunction, 13 courses were performed over 1 year 6 months. The primary lesion in the stomach showed complete response, while the metastatic foci in the liver reduced in size. Because of renal dysfunction and thrombocytopenia, 19 courses of SOX: S-1(80 mg, 2 weeks)and oxaliplatin(100 mg, 3 weeks)were administered for 1 year. Thereafter, S-1(80 mg, 4 weeks) was continued for 6 months. Appropriate administration of chemotherapy led to complete radiographic resolution of the gastric tumor, with survival currently approaching 3 years 6 months.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Humans; Liver Neoplasms; Male; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Peritoneal Neoplasms; Stomach Neoplasms; Tegafur

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Docetaxel; Drug Combinations; Fatal Outcome; Humans; Liver Neoplasms; Male; Neoplasm Recurrence, Local; Oxonic Acid; Paget Disease, Extramammary; Prognosis; Spinal Neoplasms; Tegafur

For patients with liver metastases from gastric cancer (LMGC), combination chemotherapy with fluoropyrimidines and platinum agents has been recognized as standard treatment. However, the prognosis of hepatic progression after first-line treatment failure remains poor. When hepatic progression occurs, hepatic arterial infusion (HAI) chemotherapy may be helpful for preventing disease progression.. To retrospectively assess the feasibility and efficacy of HAI chemotherapy using 5-fluorouracil, epirubicin, and mitomycin C (FEM) for patients with LMGC after failure of systemic S-1 plus cisplatin.. We reviewed the records of patients who received HAI chemotherapy using FEM for LMGC that progressed during systemic S-1 plus cisplatin treatment while extrahepatic disease was decreased or did not appear. HAI chemotherapy was given as second-line therapy using 5-fluorouracil (330 mg/m(2) weekly), epirubicin (30 or 40 mg/m(2) every 4 weeks), and mitomycin C (2.7 mg/m(2) biweekly).. Fourteen patients were analyzed. Toxicity of HAI chemotherapy was generally mild. The objective response rate was 42.9%, including a complete response rate of 14.3%. Median times to hepatic and extrahepatic progression were 9.2 and 7.4 months, respectively. Of 12 patients with documented progression after HAI chemotherapy, 10 patients (83.3%) received additional treatment, including irinotecan or taxanes. Overall, median survival was 12.7 months.. Our findings suggest that HAI chemotherapy using FEM is a feasible and effective treatment for patients with LMGC after failure of systemic S-1 plus cisplatin. HAI chemotherapy employed in the second-line setting is useful for achieving long-term disease control of LMGC.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Catheters, Indwelling; Cisplatin; Disease Progression; Drug Combinations; Epirubicin; Female; Fluorouracil; Hepatic Artery; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Male; Middle Aged; Mitomycin; Oxonic Acid; Stomach Neoplasms; Survival Rate; Tegafur; Tomography, X-Ray Computed; Treatment Failure; Treatment Outcome

An 86-year-old woman underwent a cholecystectomy for gallbladder cancer. Seven months later, an abdominal CT scan showed multiple liver and lymph node metastases. Treatment with S-1 was started at a dose of 100 mg/day, but was changed to alternate-day administration because of diarrhea. Metastatic lesions showed a complete response after 7 months of chemotherapy. S-1 alternate-day therapy could be maintained without any severe adverse events. This method can be managed safely and with certainty in an elderly patient and it has demonstrated efficacy in the treatment of recurrent gallbladder cancer.

Topics: Aged, 80 and over; Antimetabolites, Antineoplastic; Drug Combinations; Female; Gallbladder Neoplasms; Humans; Liver Neoplasms; Lymphatic Metastasis; Oxonic Acid; Recurrence; Tegafur; Treatment Outcome

S-1, an oral 5-fluorouracil (5-FU)-based medicine that combines tegafur, gimeracil and oteracil potassium is commonly used as an adjuvant chemotherapeutic drug for the treatment of colorectal cancer.. We enrolled 53 patients who underwent curative resection for colorectal cancer and liver metastasis (synchronous, n=24; metachronous, n=29). The subsequent adjuvant chemotherapy with oral S-1 administration was initiated within 56 days after liver resection. Recurrence was evaluated by imaging studies, that were performed during the first year after liver resection. Of the 53 patients, 25 who did not recur within 1 year were defined as being in the no-recurrence (NREC) group and the remaining 18 patients were defined as being in the early-recurrence (EREC) group. There were no significant differences in gene expression profiling for drug resistance and metabolism between the NREC group and the EREC group.. In synchronous liver metastasis, there was no significant difference in early recurrence between serum carcinoembryonic antigen (CEA) ≤5 ng/ml and serum CEA >5 ng/ml (8/24 vs. 16/24, respectively). In metachronous liver metastasis, the early recurrence rate was significantly higher in patients with CEA >5 ng/ml compared to patients with CEA ≤5 ng/ml (15/29 vs. 14/29, p=0.05). The expression of cytochrome P450 2C19 (CYP2C19) and ATP-binding cassette, sub-family B member 1 (ABCB1) were significantly lower in the EREC group (6/15) compared to the NREC group (9/15) in colorectal cancer with metachronous liver metastasis and with serum CEA >5 ng/ml.. Although the exact reason for down-regulation of these genes in the group with poor prognosis is unknown, the information obtained in this study may be useful in clinical practice for colorectal cancer.

Topics: Adult; Aged; Antineoplastic Agents; Carcinoembryonic Antigen; Colorectal Neoplasms; Drug Combinations; Female; Gene Expression Profiling; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Recurrence; Tegafur

We report curative resection of an advanced intrahepatic cholangiocarcinoma that responded well to combined S-1 and gemcitabine chemotherapy(GS therapy). A 67-year-old woman was admitted to our hospital in July 2011 for upper right abdominal pain. She was diagnosed with intrahepatic cholangiocarcinoma with abdominal para-aortic lymph node metastasis on the basis of the computed tomography (CT) findings. She was treated with GS therapy. One course of S-1(80 mg/m(3)) consisted of the administration of the drug for 14 days, followed by 14 days of rest; GEM(1,000 mg/m(3)) was administered on days 1 and 15 after initiating S-1. After 2 courses of treatment, the sizes of the primary tumor and the lymph node metastasis were observed to be reduced on CT. In September, partial hepatectomy and regional lymph node dissection were performed. The patient subsequently received 22 postoperative courses of GS therapy. The patient's postoperative course was uneventful, and she remains free of recurrence 49 months since diagnosis. Therefore, GS therapy is a possible option for the management of advanced intrahepatic cholangiocarcinoma.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Bile Duct Neoplasms; Cholangiocarcinoma; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Hepatectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Oxonic Acid; Tegafur; Treatment Outcome

The patient was a 59-year-old female. A liver tumor measuring 10 cm was found in the right hepatic lobe by medical examination of August, 2008 and she underwent extended right hepatectomy in September. Microscopically, the tumor was composed of small cuboidal cells possessing oval nuclei and resembling cholangiole. These formed small tubular structures with fibrous stroma. From a result of histopathological features, a diagnosis of a cholangiolocellular carcinoma was made. She received postoperative adjuvant chemotherapy with gemcitabine and S-1. After that, the patient underwent six partial hepatectomies by August, 2013 for recurrent intrahepatic cholangiolocellular carcinoma. The patient is doing well 7 years after the first hepatectomy. Cholangiolocellular carcinoma is a rare tumor accounting for less than 1% of primary liver cancer, and the clinicopathologic features are not fully understood. Aggressive surgical resection may be one of the choices to assure a good outcome.

Topics: Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Cholangiocarcinoma; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Hepatectomy; Humans; Liver Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Reoperation; Survival; Tegafur; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

The patient was a 58-year-old man with advanced gastric cancer with multiple liver metastases. He received TXL/TS-1 therapy during February 2009, but treatment was stopped immediately when he developed anorexia, diarrhea, and numbness in his fingers. Therefore, only TS-1 was administered. Following treatment initiation, tumor marker levels promptly dropped. The gastric lesion disappeared and, to date, only a slight scar remains since April 2010. Similarly, liver metastases have not been detected since August 2011. There has been no lesion progression for 6 years since the start of the chemotherapy.

Topics: Antimetabolites, Antineoplastic; Drug Combinations; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Stomach Neoplasms; Tegafur; Time Factors; Treatment Outcome

A 63-year-old man was admitted to our hospital owing to weight loss and vertigo. Endoscopic examination revealed advanced gastric cancer type 2. Abdominal CT showed a 62mm liver tumor in segment 4 and a 26mm tumor in segment 8. Distal gastrectomy and D2 lymph node dissection were performed. After surgery, he was administered chemotherapy with S- 1. After 2 courses of treatment, the tumors' in segments 4 and 8 were reduced to 52mm and 16mm, respectively. No other metastases were detected. Left lobectomy and partial resection of segment 8 were performed. The pathological therapeutic effects were rated as Grade 1b for the tumor in segment 4 and Grade 3 for the tumor in segment 8. After hepatectomy, he was administered adjuvant chemotherapy with S-1 for 1 year. No recurrence has been detected for 4 years and 6months after hepatectomy.

Topics: Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Drug Combinations; Gastrectomy; Hepatectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Stomach Neoplasms; Tegafur; Treatment Outcome

A 76-year-old woman was referred to our hospital because of an abdominal tumor in September 2009. An irregularly shaped large tumor was detected in the right subcostal abdominal cavity on computed tomography, and was diagnosed as advanced gallbladder cancer without distant metastasis following further examination. We then performed a laparotomy. The tumor had invaded directly into the descending portion of the duodenum and transverse colon. We performed a curative resection of the tumor macroscopically. Pathological findings were moderately differentiated tubular adenocarcinoma derived from gallbladder cancer(T3N0M0, Stage III ). Postoperative antineoplasticc hemotherapy was not administered. At least 4 metastaticregions in the liver(segments 1, 5, 7, and 8)were detected using computed tomography 3 months after the operation, and we then initiated oral administration of S-1. After beginning treatment, we observed partial remission at 3 months and continued treatment. We changed the regimen of chemotherapy to gemcitabine 11 months later because of a drug-induced corneal disorder. One after treatment change also continues advertising, and treatment has ended 5 years after the operation. The patient has not received any treatment for the last 6 years and 7 months, and is now in the follow up period.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Combinations; Female; Gallbladder Neoplasms; Gemcitabine; Humans; Liver Neoplasms; Oxonic Acid; Tegafur; Treatment Outcome

A 78-year-old woman was diagnosed with liver and para-aortic lymph node metastasis of colorectal cancer via abdominal computed tomography (CT) during a post-operative follow-up. She and her family declined intensive chemotherapy. Therefore, reduced S-1 (80 mg/body/day) was administered for 2 weeks followed by a 2 week interval. After 5 courses, CT revealed a complete response for the liver metastasis and a partial response for the para-aorticlymph node metastasis. Twenty-four courses of chemotherapy were completed, and only a follow-up CT examination was performed. The paraaorticlymph node grew larger, but the liver metastasis did not reappear. Herein, we report a case that showed a good response to S-1.

Topics: Aged; Antimetabolites, Antineoplastic; Aorta; Colonic Neoplasms; Drug Combinations; Female; Humans; Liver Neoplasms; Lymphatic Metastasis; Oxonic Acid; Tegafur; Treatment Outcome

We describe a case of liver metastasis of colorectal cancer that became resectable after bevacizumab (Bmab), CPT-11, and S-1 ie Bmab+IRIS combination chemotherapy. A 65-year-old man experienced repeated constipation and diarrhea in August of 2013. Colonoscopy was conducted by a local doctor, and a tumor(diagnosed as adenocarcinoma tub1 by biopsy)was found in the upper rectum. Computed tomography performed at our institution detected synchronous liver metastasis. On September 9, laparoscopic rectal anterior resection was performed to prevent metastasis to the ileus, and on October 9, the patient began receiving Bmab+IRIS combination chemotherapy. Before chemotherapy, 3 metastases with a maximum diameter of 7 cm diameter)were observed in the right lobe of the liver. After 4 courses of chemotherapy, their maximum diameter was 3 cm, which allowed resection. Ultimately, the metastases were completely resected. Conversion of non optimal resection cases of liver metastases to optimal cases by using Bmab+IRIS chemotherapy is extremely rare. We suggest that Bmab+IRIS chemotherapy could be an option for conversion of non optimal liver resection cases to optimal cases. We report this rare case and discuss the implications of adjuvant chemotherapy for this patient.

Topics: Adenocarcinoma; Aged; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Camptothecin; Combined Modality Therapy; Drug Combinations; Humans; Irinotecan; Liver Neoplasms; Male; Oxonic Acid; Sigmoid Neoplasms; Tegafur

The prognosis of Stage IV b pancreatic cancer is extremely poor; the mean survival time is 2-4 months. However, new anticancer agents can improve the outcome of advanced pancreatic cancer. We present the case of a 50-year-old female patient with Stage IV b pancreatic head cancer with invasion to the superior mesenteric vein(SMV)and multiple liver metastases. The patient received S-1 as first-line chemotherapy. Three months later, a further CT scan showed reduction of the pancreatic tumor, disappearance of the liver metastases, and reduction in SMV invasion. Therefore, a subtotal stomach-preserving pancreatoduodenectomy with partial SMV resection was performed. Following surgery, the patient received S-1 chemotherapy again. However, lung metastasis appeared. Despite the initiation of gemcitabine(GEM)treatment, the patient developed metastases in other parts of the lung and the abdominal wall. She died 46 months after surgery, but it is noteworthy that the liver metastases were manageable. The combination of chemotherapy and surgery was effective in prolonging survival in this patient with Stage IV b pancreatic head cancer.

Topics: Antimetabolites, Antineoplastic; Deoxycytidine; Drug Combinations; Fatal Outcome; Female; Gemcitabine; Humans; Liver Neoplasms; Lung Neoplasms; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Oxonic Acid; Pancreatic Neoplasms; Pancreaticoduodenectomy; Tegafur

Recent advances in gastric cancer chemotherapy have made macroscopic complete resection possible in some patients with stage IV disease.. We retrospectively investigated the efficacy of multimodal therapy with combined docetaxel, cisplatin, and S-1 (DCS) and conversion gastrectomy in 57 patients with stage IV gastric cancer.. Of the 57 patients, 15 patients were categorized into potentially resectable case, which is defined as patients with single incurable factor including the upper abdominal para-aortic lymph node metastasis (16a2b1 PAN metastasis) or fewer than three peripheral liver metastases. The other 42 were categorized as initially unresectable. All of patients underwent DCS therapy, and then 34 patients underwent conversion gastrectomy. The 3-year overall survival (OS) rate among the patients who underwent conversion gastrectomy was 50.1% with MST of 29.9 months. They had significantly longer OS than patients who underwent DCS therapy alone (p < 0.01). Univariate analysis among the patents with conversion gastrectomy identified 16a2b1PAN metastasis, peritoneal metastasis, potential resectable case, R0 resection as significant prognostic factors. A 3-year OS in potential resectable cases was 92.9%. Multivariate analysis identified potential resectability as the only independent prognostic factor contributing to OS (HR 0.133, 95%CI 0.024-0. 744, p = 0.021). In contrast, clinical response was selected as the only independent prognostic factor in the subgroup of initially unresectable cases (HR 0.354, 95%CI 0.151-0.783, p = 0.021).. Patients with potentially resectable disease had a remarkably good prognosis among stage IV gastric cancer patients, and might be ideal candidates for conversion gastrectomy following DCS therapy.

Topics: Adenocarcinoma; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Aorta; Cisplatin; Cohort Studies; Docetaxel; Drug Combinations; Female; Gastrectomy; Humans; Liver Neoplasms; Lymph Nodes; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Oxonic Acid; Retrospective Studies; Stomach Neoplasms; Taxoids; Tegafur; Treatment Outcome

We report of a patient with 3-year relapse-free survival after surgical resection for lung and liver metastases of distal cholangiocarcinoma (DCC). A quinquagenarianman was taken to a local hospital in October 2009 for yellow urine. He was diagnosed with DCC and was referred to our hospital for surgery. Pancreaticoduodenectomy was performed, and there was no residual tumor on histological examination. He did not receive any adjuvant therapy. One year 7 months after surgery, an isolated lung metastasis was identified on CT and was surgically removed. Six months after resection of the lung metastasis, a solitary liver metastasis was detected. Although systematic chemotherapy (gemcitabine plus S-1; 2 weeks treatment, 1 week drug free) was administered, the treatment was abandoned because of grade 3 (CTCAE v4.0) of skin disorders during the third course. Partial resection of the liver was performed in April 2012. Alternate-day treatment with S-1 was performed after resection of liver metastasis and is ongoing without adverse events. He has survived for more than 3 years without recurrence after liver resection. In this case of DCC metastasis, prognosis improved with surgical resection.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bile Duct Neoplasms; Cholangiocarcinoma; Deoxycytidine; Drug Combinations; Gemcitabine; Hepatectomy; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Oxonic Acid; Pancreaticoduodenectomy; Recurrence; Tegafur

A 60-year-old male patient underwent curative surgical resection for gastric cancer. After the surgery, the patient was diagnosed with T4b, N3b, ly3, v2, CY0, fStageⅢc gastric cancer, and adjuvant systemic chemotherapy using S-1 and CDDP was administered. However, follow-up computed tomography (CT) scan examination taken 2 months after surgery revealed a pancreatic fistula and retroperitoneal abscess, and percutaneous drainage was performed. After 1 month, the enhanced CT scan detected liver metastasis measuring 25 mm in diameter at segment 7. The CT-guided percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) procedure was performed on the liver metastasis using degradable starch microspheres (DSM). Two months after the RFA, a follow-up CT scan revealed local recurrence of the lesion in the medial side of the ablated area in segment 7. A second CT-guided RFA, which was combined with DSM-TACE, was performed on the recurrent lesion. The patient has since survived more than 2 years after the second treatment without any further recurrences. This case report suggests that RFA treatment combined with DSM-TACE might be a safe and feasible treatment for liver metastasis from gastric cancer.

Topics: Antineoplastic Combined Chemotherapy Protocols; Catheter Ablation; Chemoembolization, Therapeutic; Cisplatin; Combined Modality Therapy; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Starch; Stomach Neoplasms; Tegafur

We encountered a case of pancreatic cancer with multiple liver metastases that developed postoperatively and showed a complete response with S-1 monotherapy for a long time. A pancreaticoduodenectomy was successfully performed on an 80- year-old man. Multiple liver metastases developed 6 months postoperatively. Microscopically, the primary lesion was diagnosed as adenosquamous carcinoma with anaplastic carcinoma component, and the final diagnosis was considered to be Stage Ⅲ disease. S-1monotherapy (80 mg/day, administered for 4 weeks and then stopped for 2-weeks) was effective. A partial response was noted after 3 months, and 9 months after the initial administration of S-1, a complete response was achieved, which persisted for more than 12 months, according to contrast-enhanced CT evaluations.Serum CEA and CA19-9 levels, which became slightly elevated at the time of liver metastasis development, normalized promptly and remained within normal limits. Adverse effects of chemotherapy of more than grade 2 severity were not apparent, and the patient tolerated the 11th course of S-1 administration, consistently. A standard therapeutic strategy and its outcomes in cases of pancreatic cancer recurrence are not clearly outlined in the Japanese Guideline for the Treatment of Pancreatic Cancer. A case of pancreatic cancer with multiple liver metastases that developed postoperatively and showed a complete response with S-1 monotherapy is reported in this paper.

Topics: Aged, 80 and over; Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Drug Combinations; Humans; Liver Neoplasms; Male; Neoplasm Staging; Oxonic Acid; Pancreatic Neoplasms; Pancreaticoduodenectomy; Remission Induction; Tegafur

A 62-year-old man was diagnosed with gastric cancer and underwent distal gastrectomy, and D1+b lymph node dissection. He was diagnosed postoperatively with T1b (sm2) N0M0, StageⅠA gastric adenocarcinoma and did not receive any adjuvant chemotherapy after surgery. One year and 6 months after gastrectomy, blood analysis indicated high levels of carcinoembryonic antigen (CEA 262.1 ng/mL) while abdominal computed tomography (CT) revealed multiple liver tumors (S7: 15 mm, S7/8: 20 mm). The patient was diagnosed with metachronous multiple liver metastases from gastric cancer. Chemotherapy, combined with molecular targeted therapy (S-1 plus cisplatin [CDDP] plus trastuzumab), was administered because of overexpression of the human epidermal growth factor receptor 2 (HER2) protein in the primary tumor as assessed by immunohistochemistry, the CEA levels decreased immediately after 2 cycles of the chemotherapy, and the liver metastases shrank markedly with no evidence of new lesions on abdominal CT. However, after treatment, Grade 3 neutropenia and diarrhea were observed. Chemotherapy was suspended and hepatic resection was performed. After hepatic resection, the liver tumors were histologically evaluated as Grade 2 metastatic gastric adenocarcinoma, and the HER2 expression of remnant carcinoma cells was established. The patient has been in good health and remained free of recurrences in the 2 years and 3 months after the liver resection. Surgery with preoperative chemotherapy (S-1 plus CDDP plus trastuzumab) can be an effective treatment for liver metastasis from HER2-positive gastric cancer.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Gastrectomy; Hepatectomy; Humans; Liver Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Molecular Targeted Therapy; Oxonic Acid; Recurrence; Stomach Neoplasms; Tegafur; Trastuzumab; Treatment Outcome

A 63-year-old woman presented with abnormalities in liver enzyme levels on laboratory studies, which were detected during a routine medical check-up. She was diagnosed with carcinoma of the ampulla of Vater with a synchronous solitary liver metastasis (S7). She was treated with gemcitabine plus S-1. After 2 courses of the chemotherapy, computed tomography revealed that the primary and metastatic tumors had not changed in size, but new lesions had not appeared. A pylorus-preserving pancreaticoduodenectomy and partial resection of the liver (S7) were performed. She received gemcitabine monotherapy for 1 year and she remains alive and well with no evidence of disease 2 year 10 months after resection.

Topics: Ampulla of Vater; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Combinations; Duodenal Neoplasms; Female; Gemcitabine; Hepatectomy; Humans; Liver Neoplasms; Middle Aged; Oxonic Acid; Pancreaticoduodenectomy; Tegafur

The patient, a 76-year-old man, presented to his local doctor's clinic with complaints of fatigue and lightheadedness. Because blood test results indicated anemia, he was referred to our hospital. Upper gastrointestinal endoscopy indicated a type 2 tumor of approximately 5 cm at the top of the gastric corpus. Biopsy results indicated that the lesion was a poorly differentiated adenocarcinoma. Computed tomography showed multiple liver metastases and the patient was diagnosed with stage Ⅳ gastric cancer. After a blood transfusion, chemotherapy with S-1 was started. However, as the patient experienced continued hemorrhage from the primary lesion, treatment was changed to total gastrectomy in order to control the bleeding. The pathologic examination of the resected specimen indicated that the tumor was located in the muscle and subserosal layers. The tumor cells were spindle-shaped, c-kit positive, cytokeratin-negative, and Dog-1 positive. Therefore, a diagnosis of gastrointestinal stromal tumor (GIST) was made. Postoperatively, chemotherapy with imatinib was administered and the patient was alive with no progression of disease 1 year following surgery. Intraductal growth pattern GISTs of the stomach that protrude into the epithelium and exhibit ulceration can be difficult to distinguish from gastric carcinomas. We experienced a case of gastric GIST that was difficult to diagnose preoperatively.

Topics: Aged; Antineoplastic Agents; Biopsy; Drug Combinations; Gastrectomy; Gastrointestinal Stromal Tumors; Humans; Imatinib Mesylate; Liver Neoplasms; Male; Oxonic Acid; Stomach Neoplasms; Tegafur

A 71-year-old man was admitted to our hospital because of abdominal pain. An upper gastrointestinal endoscopy revealed a type 3 tumor in the lesser curvature of the gastric body. A computed tomography (CT) scan showed synchronous liver metastasis in liver S6 and S8, and a large 8a lymph node that could be encased within the common hepatic artery. The patient was diagnosed with gastric cancer with liver metastasis, Stage Ⅳ, and treated with chemotherapy (S-1 plus CDDP). After 3 courses, a CT scan showed that the liver metastasis in S8 was reduced in size.The one in S6 completely disappeared. The 8a lymph node was also reduced in size and revealed to be separated from the common hepatic artery. Total gastrectomy (D2) and radiofrequency ablation (RFA) for the S8 lesion were performed. The postoperative course was favorable and the patient was treated with postoperative adjuvant chemotherapy consisting of S-1. No recurrence has been observed for 17 months after diagnosis. After chemotherapy, if R0 resection is performed, surgical resection and RFA for liver metastasis may be a useful option for gastric cancer with liver metastasis.

Topics: Aged; Antimetabolites, Antineoplastic; Catheter Ablation; Combined Modality Therapy; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Oxonic Acid; Stomach Neoplasms; Tegafur

A 77-year-old man was found to have advanced gastric cancer and underwent total gastrectomy (pT4aN2H0P0M0, Stage ⅢB). Two years after gastrectomy, we found an elevated tumor marker level, and a liver metastasis appeared in segment 5 (20 mm in diameter). He was treated with S-1/CDDP combination chemotherapy. After 2 courses of chemotherapy, the tumor marker level kept rising and a CT scan detected a progressive tumor. S-1/irinotecan combination chemotherapy was administered as second-line chemotherapy. After 6 courses of chemotherapy, the size of the liver metastasis was reduced and the tumor marker level normalized. Because lymph node metastasis or peritoneal recurrence was observed, a partial resection of the liver (S5) was performed. After the operation, he was treated with S-1 chemotherapy again for 1 year and has had no recurrence.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cisplatin; Drug Combinations; Gastrectomy; Hepatectomy; Humans; Irinotecan; Liver Neoplasms; Male; Oxonic Acid; Stomach Neoplasms; Tegafur; Treatment Outcome

A 68-year-old man was admitted to our hospital. He was diagnosed with advanced gastric cancer with multiple liver metastases. The primary tumor was treated with distal gastrectomy with D2 dissection and anti-cancer agents, and then he was scheduled for a 2-stage hepatic resection. After surgery, the liver metastases disappeared, and he was diagnosed with a CR. However he complained of dizziness and was diagnosed with metachronous brain matastasis. Multidisciplinary treatment including resection and radiotherapy was administerd and he survived for 5 years after diagnosis.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Cisplatin; Combined Modality Therapy; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Oxonic Acid; Prognosis; Radiosurgery; Stomach Neoplasms; Tegafur

A 60s male was admitted to our hospital because of appetite loss and nausea. After examination, he was diagnosed with type 3 advanced gastric cancer in the antrum. Abdominal computed tomography showed gastric cancer invasion to the left liver lobe. We initiated neoadjuvant chemotherapy using S-1 plus CDDP after laparoscopic gastrojejunostomy. S-1 was orally administered for 3 weeks followed by a 2-week drug-free period. CDDP was administered intravenously on day 8 of each course. After 5 courses of chemotherapy, the gastric cancer was reduced in size. We therefore performed total gastrectomy with D2-affiliated left liver resection. S-1 plus CDDP is expected to improve outcomes in unresectable or locally advanced gastric cancer.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Neoadjuvant Therapy; Oxonic Acid; Recurrence; Stomach Neoplasms; Tegafur

We performed laparoscopic liver resection in a patient with synchronous liver metastasis from advanced sigmoid colon cancer after induction with S-1 plus oxaliplatin (SOX) plus bevacizumab (BV) chemotherapy. A 61-year-old woman underwent laparoscopy-assisted sigmoidectomy for locally advanced sigmoid colon cancer with synchronous liver metastasis. SOX plus BV chemotherapy was initiated. After 3 courses, the liver tumor was downsized, and metastasectomy was performed laparoscopically with R0 resection. The postoperative course was uneventful and the patient was discharged on the 11th postoperative day. She has been free from recurrence. Induction with SOX plus BV chemotherapy is considered to be not only effective, but also beneficial for maintaining the quality of life (QOL) in patients with advanced colorectal cancer.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Drug Combinations; Female; Hepatectomy; Humans; Laparoscopy; Leucovorin; Liver Neoplasms; Middle Aged; Oxonic Acid; Sigmoid Neoplasms; Tegafur

A 44-year-old woman with subileus was diagnosed with advanced sigmoid colon cancer with a synchronous liver metasta- sis (segmanet 5/8). Laparoscopic anterior resection was performed, and histological diagnosis was sigmoid colon cancer, 55×40 mm, type 2, tub2>por2, pT3, ly2, v2, pN1, M1a, Stage Ⅳ (Japanese Classification of Colorectal Carcinoma, Eighth edition). Four courses of neoadjuvant chemotherapy (FOLFIRI plus panitumumab) shrank the liver metastasis. Laparoscopic partial liver resection was performed for 285 minutes, with 350 g of blood loss. The patient was discharged 9 days after the operation. Two courses of oral adjuvant chemotherapy (S-1) was performed but discontinued owing to side effects. Seven months after the surgery, computed tomography revealed 2 small liver metastasis (segment 8). Although the sizes were 35 and 5 mm, respectively, the larger mass was closed to the middle and right hepatic vein. Therefore, open hepatectomy was performed for 285 minutes, with 525 g of blood loss. The patient was discharged 9 days after the operation without complication. The patient had no recurrence for 1 year after the last surgery.

Topics: Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Drug Combinations; Female; Hepatectomy; Humans; Laparoscopy; Liver Neoplasms; Middle Aged; Oxonic Acid; Recurrence; Sigmoid Neoplasms; Tegafur

Case 1: The patient was a 42-year-old man who was diagnosed with intraductal papillary-mucinous carcinoma with liver metastasis. After S-1+gemcitabine and S-1 chemotherapy, the liver metastasis had disappeared and we performed a pancreaticoduodenectomy( PD). Case 2: The patient was a 70-year-old woman who was diagnosed with pancreatic cancer with liver metastasis. After gemcitabine chemotherapy, the liver metastasis had disappeared and we performed a PD. The prognosis of pancreatic cancer is dismal compared to other types of cancer, and for a Stage Ⅳb cancers, the 5-year survival rate is reported to be approximately 3%. We report 2 cases of liver metastases from pancreatic cancer that disappeared in response to chemotherapy. Both patients underwent primary tumor resection after chemotherapy and experienced long-term survival.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Liver Neoplasms; Male; Oxonic Acid; Pancreatic Neoplasms; Tegafur

A 58-year-old woman with advanced gastric cancer underwent total gastrectomy in May 2012. The histological diagnosis was poorly differentiated adenocarcinoma, cT4a (SE), pN1, cM0; fStage IIIA. Chemotherapy by S-1 was started after surgery. Six months after the operation, two metastatic nodules were noticed on the liver. Therefore, the chemotherapy was switched to S-1 plus cisplatin (CDDP) in November 2012. TS-1 (80 mg/body) was administrated from day 1 to 21 followed by 14 days rest as one course. CDDP (70 mg/body) was infused on day 1. After 3 courses of this combination chemotherapy, remarkable diminution of the metastatic lesions on CT images was observed. Because of the adverse event of Grade 2 nausea, the patient was forced to discontinue chemotherapy. The patient underwent partial resection of the liver (Hr-0: S8, S7) at 1 year after the first operation. The resected specimens showed no sign of malignancy, although uneven fatty deposition was observed more frequently than in the surroundings, and designated as histologically complete response (CR). The patient has been alive 30 months after the second operation without any recurrent sites. Thus, combined use of peroral S-1 and CDDP should be recommended for multiple liver metastases after gastrectomy.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Chemotherapy, Adjuvant; Cisplatin; Drug Combinations; Female; Gastrectomy; Gastroscopy; Hepatectomy; Humans; Liver Neoplasms; Middle Aged; Neoplasm Staging; Oxonic Acid; Remission Induction; Stomach Neoplasms; Tegafur; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

Unresectable metastatic colorectal cancer with very slow tumour growth rate does not necessarily require for strong short-interval chemotherapy. In the present study, we administered monthly chemotherapy and aimed to evaluate the usefulness of the specific treatment schedule in patients with unresectable metastatic colorectal cancer with slow tumour growth rate.. Since 2009, at our Institution, patients' whose serum carcinoembryogenic antigen (CEA) values on the treatment day were not higher than those before initial chemotherapy, and patients who did not wish to undergo intensive chemotherapy, were prospectively scheduled for specific chemotherapy. Between January 2009 and December 2011, 10 patients with unresectable metastatic colorectal cancer who received monthly chemotherapy were enrolled in the current study. During the same period, 14 patients with unresectable metastatic colorectal cancer were administered conventional-interval chemotherapy, oxaliplatin with oral S-1 (SOX) or capecitabine (XELOX), and comprised the control group.. Three patients received first-line, four patients received second-line, and three patients received third-line treatment. All patients were able to receive a single-regimen of chemotherapy for more than a year. The survival of patients who received monthly chemotherapy was significantly better than survival of those who received SOX or XELOX within 30 months after starting chemotherapy (p<0.05).. For patients with very slow tumour growth rates, our monthly chemotherapy may be beneficial.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Colorectal Neoplasms; Deoxycytidine; Drug Combinations; Female; Fluorouracil; Follow-Up Studies; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Peritoneal Neoplasms; Prognosis; Survival Rate; Tegafur

A 73-year-old man was referred to our hospital because of appetite loss and weight loss in January 2009. Endoscopy showed an advanced type II gastric tumor at the middle of the gastric wall, and computed tomography showed multiple liver metastases. Immunohistological examination confirmed a diagnosis of large cell neuroendocrine carcinoma which was chromogranin A(+), CD56(+), and synaptophysin(+). Oral administration of S-1(100mg/body)was given 5 days on and 2 days off, while cisplatin(CDDP 40 mg/body)was administered intravenously once every 2 weeks. The patient achieved a partial response(PR), and no serious adverse effects were observed. This case suggests that S-1/CDDP chemotherapy may be an effective treatment in patients with large cell neuroendocrine carcinoma of the stomach.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Large Cell; Carcinoma, Neuroendocrine; Cisplatin; Drug Combinations; Fatal Outcome; Humans; Liver Neoplasms; Male; Oxonic Acid; Stomach Neoplasms; Tegafur

An 80-year-old man presenting with abdominal distension was admitted to our hospital. He was diagnosed with sigmoid cancer with multiple liver and lung metastases. We first performed a sigmoidectomy to avoid obstruction, and then initiated chemotherapy with S-1(120mg/day). The tumor showed a complete clinical response after 10 courses, but we had to change the regimen after 18 courses because of growth of the lung metastases. After 10 courses of capecitabine(4,200mg/ day)treatment, we again observed growth of the lung metastases; a new nodule, which was also considered to be a metastasis, appeared on the abdominal wall. We then decided to administer mFOLFOX6(5-fluorouracil+Leucovorin+oxaliplatin) after the patient had received oral anticancer drugs for 3 years 4 month. In conclusion, oral chemotherapy drugs may prevent tumor growth over a long period and improve quality of life(QOL)in elderly patients with Stage IV colon cancer.

Topics: Administration, Oral; Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Fluorouracil; Humans; Liver Neoplasms; Lung Neoplasms; Male; Neoplasm Staging; Oxonic Acid; Sigmoid Neoplasms; Tegafur; Time Factors

A 72-year-old woman was admitted to our hospital with bloody stools and constipation. She was diagnosed with advanced lower rectal cancer with multiple liver and pulmonary metastases. Because the rectal cancer was located 2 cm from the anal verge, we suggested she undergo an abdominoperineal resection(Miles operation), but she refused to undergo a colostomy. Then, 6 courses of chemotherapy with S-1/oxaliplatin(SOX)were administered, and the local tumor, liver metastases, and pulmonary metastases were all significantly decreased in size(reduction rate 60%). After chemotherapy, she chose to undergo low anterior resection(LAR), D2. Postoperative recovery was uneventful, and she currently has stable disease with adjuvant SOX chemotherapy. Induction SOX chemotherapy was considered to be useful for maintaining the quality of life(QOL) in a patient with advanced rectal cancer.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Colostomy; Drug Combinations; Female; Humans; Liver Neoplasms; Lung Neoplasms; Neoplasm Staging; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Rectal Neoplasms; Tegafur; Treatment Outcome

The prognosis of patients with advanced gastric cancer is poor. The goal of this study was to evaluate the efficacy and safety of combination therapy of cetuximab and S-1 combined with oxaliplatin (SOX) in Chinese patients with advanced gastric cancer.. For patients in the experimental group (cetuximab in combination with SOX (Ce-SOX), 30 patients), once-weekly cetuximab (400 mg/m2 at the first infusion then 250 mg/m2 every week) was administered. For patients in both the control (SOX alone, 26 patients) and experimental groups, oxaliplatin (100 mg/m2) was administered intravenously on day 1, while S-1 (80 mg/m2/day) was given orally twice daily for 14 days. The endpoints of this study included progression-free survival, response rate, and disease-control rate.. There was no statistically significant difference in response rate between the Ce-SOX and SOX groups (54.8% versus 44%, P=0.225). The difference in disease-control rate was also statistically insignificant between the two groups (87.1% versus 76%, P=0.162). Median progression-free survival in the Ce-SOX group was significantly higher than that in the SOX group (12.8 versus 10.1 months, P=0.007). The median overall survival of the Ce-SOX group and SOX group was 14.0 and 12.2 months, respectively (P=0.043). The one-year survival rate for the Ce-SOX group was 57% compared to 40% in the SOX group. There was no statistical difference in the grade 3 or 4 adverse effects between the two groups.. These findings suggest that the cetuximab combined with SOX regimen is feasible and shows promising efficacy with tolerable adverse effects in Chinese patients with advanced gastric cancer.

Topics: Adult; Aged; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Cetuximab; Drug Combinations; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Peritoneal Neoplasms; Prognosis; Safety; Stomach Neoplasms; Survival Rate; Tegafur

A 63-year-old woman was admitted to our Hospital for treatment of pancreatic head ductal carcinoma, and underwent pancreaticoduodedectomy (PD) in October 2007. At one month after surgery, she received systemic adjuvant chemotherapy using S-1 for three months. Because the serum carbohydrate antigen 19-9 (CA19-9) value was elevated at 23 months after surgery, the patient underwent systemic chemotherapy using gemcitabine. The serum CA19-9 decreased, but abdominal Computed Tomography (CT) revealed a hepatic metastasis in the ventrolateral segment of left hepatic lobe at 28 months after surgery. The chemotherapy was changed to oral S-1. At 35 months after surgery, abdominal CT revealed reduction of liver metastasis and that the serum CA19-9 was normalized, but chemotherapy had to be withdrawn because of severe myelosuppression. Because of her good general condition, the patient underwent partial hepatectomy for the liver metastasis. Histopathological examination demonstrated a complete response. Thirty six months after hepatectomy and 6 years after PD, the patient remains well without recurrence. We herein report a case of successful treatment for metachronous liver metastasis from pancreatic ductal carcinoma after PD by chemotherapy and hepatectomy and review the current literature.

Topics: Antineoplastic Agents; Carcinoma, Pancreatic Ductal; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Hepatectomy; Humans; Liver Neoplasms; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Pancreaticoduodenectomy; Tegafur

We present a case of recurrent gastric cancer in which stable disease status was achieved for four months due to treatment with capecitabine/cisplatin (CDDP)after the failure of multiple anticancer drugs including S-1/CDDP. A 67-year-old man was diagnosed with multiple liver metastases one year after distal gastrectomy+D2 dissection for gastric cancer. S-1/CDDP was given as the first-line treatment, followed by paclitaxel (PTX), irinotecan (CPT-11), and docetaxel (DOC). The tumor in the anterior segment of the liver was resistant to all of these chemotherapies except for PTX, which is why the regimens were changed. However, this tumor shrank and achieved stable disease status for four months after capecitabine/CDDP therapy given as fifth-line treatment. Our case suggests that S-1 and capecitabine do not always exhibit cross-resistance. Therefore, capecitabine may be effective in S-1-pretreated patients, and vice versa.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Cisplatin; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Drug Resistance, Neoplasm; Fluorouracil; Humans; Liver Neoplasms; Male; Neoplasm Staging; Oxonic Acid; Stomach Neoplasms; Tegafur

An 82-year-old man died because of squamous cell carcinoma of the right lung with metastasis to the left femoral bone. At the age of 75 years, he was admitted to our hospital because of hematemesis. Widespread type 3 gastric cancer was detected in the lesser curvature. Computed tomography(CT)showed multiple liver metastases. Preoperative chemotherapy with TS-1/cisplatin(CDDP)was administered. TS-1 was orally administered at 80mg/body/day and CDDP was administered by intravenous infusion at 20mg/body/day every week for 3 weeks and this was followed by a drug-free 2-week period as the first course. After the fourth course, gastrectomy was performed for the primary lesion and radiofrequency ablation(RFA)was performed for the liver metastases. The patient survived for more than 7 years with a complete response (CR)and died thereafter because of squamous cell carcinoma of the lung.

Topics: Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Autopsy; Cisplatin; Drug Combinations; Humans; Liver Neoplasms; Male; Neoplasms, Squamous Cell; Oxonic Acid; Stomach Neoplasms; Tegafur; Time Factors; Treatment Outcome

Colorectal cancer (CRC) is among the most common cancers worldwide, but marked epidemiological differences exist between Asian and non-Asian populations. Hence, a consensus meeting was held in Hong Kong in December 2012 to develop Asia-specific guidelines for the management of metastatic CRC (mCRC). A multidisciplinary expert panel, consisting of 23 participants from 10 Asian and 2 European countries, discussed current guidelines for colon or rectal cancer and developed recommendations for adapting these guidelines to Asian clinical practice. Participants agreed that mCRC management in Asia largely follows international guidelines, but they proposed a number of recommendations based on regional 'real-world' experience. In general, participants agreed that 5-fluorouracil (5-FU) infusion regimens in doublets can be substituted with UFT (capecitabine, tegafur-uracil) and S1 (tegafur, 5-chloro-2,4-dihydroxypyridine and oxonic acid), and that the monoclonal antibodies cetuximab and panitumumab are recommended for KRAS wild type tumors. For KRAS mutant tumors, bevacizumab is the preferred biological therapy. FOLFOX (folinic acid, 5-FU, and oxaliplatin) is preferred for initial therapy in Asian patients. The management of mCRC is evolving, and it must be emphasized that the recommendations presented here reflect current treatment practices and thus might change as more data become available.

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Asia; Bevacizumab; Camptothecin; Capecitabine; Cetuximab; Colonic Neoplasms; Combined Modality Therapy; Deoxycytidine; Drug Combinations; ErbB Receptors; Fluorouracil; Guideline Adherence; Humans; Leucovorin; Liver Neoplasms; Lung Neoplasms; Magnetic Resonance Imaging; Metastasectomy; Neoplasm Staging; Organoplatinum Compounds; Oxaloacetates; Oxonic Acid; Panitumumab; Practice Guidelines as Topic; Proto-Oncogene Proteins; Proto-Oncogene Proteins p21(ras); ras Proteins; Rectal Neoplasms; Tegafur; Tomography, X-Ray Computed

We report two cases of pancreatic cancer with multiple liver metastases for which successful gemcitabine (GEM) +S-1 therapy facilitated radical resection. Case 1: A 40-year-old man with jaundice was diagnosed with pancreatic head cancer and multiple metastases. Radical treatment was not possible. Therefore, he was administered GEM +S-1 (GEM 1,000 mg/m² on days 1 and 8; S-1, 100mg/day for 14 days). Administration of seven courses of therapy achieved complete remission (CR) of the metastatic lesions. Considering the possibility of residual tumors, a subtotal stomach-preserving pancreaticoduodenectomy was performed. Although pathological examination revealed a residual tumor in the primary lesion, R0 resection was achieved. GEM+S-1 therapy was resumed, and the patient is currently relapse-free. Case 2: A 65-year-old man with obstructive jaundice was diagnosed with pancreatic head cancer and multiple metastases. Radical treatment was not possible. Therefore, GEM +S-1 therapy was initiated. After 11 therapy courses, only one metastatic lesion remained. Radical treatment was then deemed possible, and a pylorus-preserving pancreaticoduodenectomy was performed. Pathological examination revealed residual tumors in the primary lesion and the peripancreatic lymph nodes. However, the liver nodules were only fibrotic, and their surgical radicality was R0. GEM +S-1 therapy was resumed, and the patient is currently relapse-free.. The high response rate of GEM+S-1 therapy suggests its usefulness in facilitating radical resection after treatment with (GEM) +S-1.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Gemcitabine; Humans; Liver Neoplasms; Male; Oxonic Acid; Pancreatic Neoplasms; Tegafur

The patient was a 58-year-old man diagnosed with type 2 advanced gastric cancer located at the fundus with multiple liver, lung, and lymph node metastases(Stage IV). Examination of an endoscopically obtained biopsy specimen revealed poorly differentiated adenocarcinoma (por), which stained positive for human epidermal growth factor receptor 2 (HER2) on immunohistochemistry. We started chemotherapy with S-1 plus cisplatin (CDDP) plus trastuzumab. The treatment was effective, as the tumor had reduced in size by 22.5% and 36.2%(partial response[PR])after 3 and 6 courses, respectively. Adverse events related to the treatment were limited to grade 1 fever, nausea, vomiting, and diarrhea. The patient's chief complaints of right upper abdominal pain and abdominal fullness remarkably improved after treatment initiation. Although the therapy was effective against the multiple liver metastases and could be continued for 11 courses, the lymph nodes metastases did not respond to therapy (progressive disease [PD]), and the patient died 9 months after the start of treatment. Chemotherapy with S-1 pus CDDP plus trastuzumab may be effective for HER2-positive advanced gastric cancer with liver metastasis.

Topics: Adenocarcinoma; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Fatal Outcome; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Stomach Neoplasms; Tegafur; Trastuzumab

A 62-year-old woman diagnosed with gallbladder cancer exhibiting broad liver invasion and metastasis to Couinaud's hepatic segments 4 and 8 (S4 and S8) consulted her regular doctor. Owing to the presence of liver metastases, she received treatment with gemcitabine plus S-1. After four cycles of chemotherapy, the size of the main lesion dramatically decreased and the two liver metastases disappeared. After six cycles of chemotherapy, the patient was referred to our hospital for surgical treatment. Upon admission, there was no evidence of any distant metastasis, based on a detailed radiological examination. Therefore, we performed cholecystectomy and central bisegmentectomy of the liver after obtaining the patient's informed consent. Pathological examination demonstrated viable cancer cells with granuloma formation and calcification in the gallbladder, as well as regenerative changes without viable cancer cells in S4 and S8 of the liver. Gemcitabine plus S-1 was again administered as postoperative adjuvant chemotherapy. One and a half years after the surgery, there were no signs of recurrence. In patients selected according to their response to chemotherapy, surgical treatment might therefore be effective against gallbladder cancer with metastasis.

Topics: Adenocarcinoma; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Cholecystectomy; Deoxycytidine; Drug Combinations; Female; Gallbladder Neoplasms; Gemcitabine; Hepatectomy; Humans; Liver Neoplasms; Middle Aged; Neoadjuvant Therapy; Neoplasm Invasiveness; Oxonic Acid; Tegafur

Herein, we report of a long-term survivor who underwent local combined modality therapy for local hepatic recurrences detected 10 years after initial surgery for colorectal cancer and 7 years after metachronous liver metastasis. In the third year after surgery for colorectal cancer, a solitary liver metastasis was detected, and curative surgical resection was performed. However, because local recurrence developed 3 years later, curative resection was repeated. When local recurrence developed again 1.5 years later, the patient declined surgery and systemic chemotherapy, and radiofrequency ablation was performed. However, because of the development of another local recurrence 6 months later, hepatic arterial infusion chemotherapy was initiated. This therapy has been continued for 1.5 years to date, with successful local disease control and no adverse events. Although surgical resection is the first choice for resectable liver metastases of colorectal cancer, thermocoagulation and hepatic arterial infusion chemotherapy can also be valid options for patients who are inoperable or refuse surgery as well as for those who are not suitable for or refuse systemic chemotherapy. Notwithstanding, the guidelines for the treatment of colorectal cancer (2014 edition) now include the following statement: thermocoagulation is not recommended as an alternative to surgical resection. Hepatic arterial infusion chemotherapy appears to be a promising treatment strategy associated with antitumor effects with few adverse events. It is also relatively less expensive than systemic chemotherapy.

Topics: Aged, 80 and over; Catheter Ablation; Combined Modality Therapy; Drug Combinations; Embolization, Therapeutic; Humans; Liver Neoplasms; Male; Neoplasm Recurrence, Local; Oxonic Acid; Sigmoid Neoplasms; Tegafur; Time Factors

We report here an experience treating a patient who developed gastric cancer at the same time as a multifocal intrahepatic recurrence of hepatocellular carcinoma (HCC). The patient was a 76-year-old woman who underwent partial liver resection after diagnosis of HCC in August 2008. Histopathological examination revealed moderately differentiated hepatocellular carcinoma and stage III pathology. Six months following surgery, an upper gastrointestinal endoscopy revealed a typeIIa+IIc gastric tumor in the angle of the stomach, which was pathologically diagnosed as adenocarcinoma(por2/sig) in the biopsy. Simultaneously, abdominal CT scan revealed multifocal intrahepatic recurrence of HCC, so Lip-TACE as performed. Eight days after TACE, S-1 (80 mg/body) was initiated. About one month after TACE, abdominal CT scan revealed multiple new hepat- ic lesions. The patient was repeatedly treated with a combination of Lip-TACE on day 1 and S-1 80 mg/body/day, administered on days 8 to 35 for 28 days, followed by a 7 day interval as 1 course. After 5 courses of medication of S-1, liver function had deteriorated and thrombocytopenia occurred. Although there was no progression of gastric cancer, medication of S-1 was discontinued. Lip-TACE was performed nine times. About one year after the initial TACE, the patient was admitted to our hospital in order to control ascites, 3 days after admission, she suffered a cerebral infarction and died 3 days later.

Topics: Aged; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Combined Modality Therapy; Drug Combinations; Fatal Outcome; Female; Hepatectomy; Humans; Liver Neoplasms; Oxonic Acid; Recurrence; Stomach Neoplasms; Tegafur

A 71-year-old female patient was administered 2 courses of neoadjuvant chemotherapy (GS therapy) for pancreatic body cancer, and underwent pancreatic body and tail resection. She was diagnosed as having T3N0M0, Stage III disease, and adjuvant chemotherapy with gemcitabine was started. However, a solitary 9 mm liver metastasis was found using CT imaging 3 months after the operation. We started hepatic arterial infusion chemotherapy (GEM+5-FU), with additional treatment using RFA after 5 courses, and a CR was achieved. The HAI regimens were changed to GEM+S-1 and a further 18 courses were administered. After HAI, adjuvant chemotherapy (S-1) was continued, but 2 further liver metastases were found. The patient was still alive 4 years after surgery and continued to undergo radiation chemotherapy.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Infusions, Intra-Arterial; Laser Therapy; Liver Neoplasms; Oxonic Acid; Pancreatic Neoplasms; Tegafur

A 62-year-old man was diagnosed with esophagogastric junction cancer following esophagogastroduodenoscopy in response to hematemesis. Although liver metastasis was detected during surgery, a total gastrectomy and lower esophagus resection for local control was performed. Alpha-fetoprotein(AFP)-producing tumor with hepatoid adenocarcinoma was diagnosed on the basis of the pathological examination. Serum AFP levels remained high postoperatively and multiple liver metastases were detected on computed tomography imaging. After 6 courses of chemotherapy with S-1 and cisplatin (CDDP), a significant reduction in the size of the liver metastases and a decrease of serum AFP levels were achieved. Postoperative 2-year tumor control using S-1 single agent chemotherapy was obtained. AFP-producing esophagogastric junction cancer has a poor prognosis. This case raises the possibility that long-term survival can be obtained by combining surgery for local control with systemic chemotherapy.

Topics: alpha-Fetoproteins; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Esophageal Neoplasms; Esophagogastric Junction; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Stomach Neoplasms; Tegafur

A man in his 60s received SP (S-1+CDDP) therapy for gastric cancer with multiple liver metastases. After completion of 3 courses, liver metastases had reduced significantly, and the paraaortic lymph nodes, which had swelled previously, had reduced in size. Furthermore, the serum carcinoembryonic antigen (CEA) level had also improved to the standard value from 814.3 ng/mL. The patient was able to discontinue the opioid he had needed for pain control. The chemotherapy was continued for 18 courses, with the dose reduced at the time of the adverse events along the way. By completion of the 18 courses, we recognized regrowth of the primary lesion and a rise in the serum CEA over the standard value. There was no sign of the regrowth of liver metastases and distant lymph nodes according to examinations for enhanced computed tomography (CT) and ¹⁸F-fluorodeoxyglucose positron-emission tomography (FDG-PET) CT.The patient received distal gastrectomy. The CEA level decreased in standard value or less after surgery and we believed the cancer was limited to the primary stomach lesion.

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoembryonic Antigen; Cisplatin; Combined Modality Therapy; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Oxonic Acid; Stomach Neoplasms; Tegafur

A 55-year-old man suffering from gastric cancer associated with metastases to the lymph node, gallbladder, and liver was administered chemotherapy with S-1 and cisplatin. Before initiation of therapy, the primary tumor, lymph node metastases, and liver metastases showed fluorodeoxyglucose (FDG) accumulation by positron emission tomography (PET). After 1 course of chemotherapy, the patient received curative surgical treatment including distal gastrectomy, partial hepatectomy, cholecystectomy, and lymph node dissection. The final pathological finding was moderately differentiated adenocarcinoma, T4b(SI), N3a(10/20), P0, CY0, pH1, pM1, Stage IV. Five months after surgery, the serum carcinoembryonic antigen (CEA) level was found to be increasing and PET examination identified an FDG-accumulating nodule in the ascending colon. Colonoscopy identified a submucosal tumor diagnosed as a metastasis from the gastric cancer. Right colectomy was performed 7 months after the first surgery resulting in a curative resection. In each surgery, PET examination indicated that no other distant metastases existed, and curative resection would be possible. Furthermore, although solitary metastatic colorectal lesions are rare, PET examination revealed them accurately. Thus, FDG-PET is very useful for identifying metastases in patients with gastric cancer.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Colonic Neoplasms; Combined Modality Therapy; Drug Combinations; Gallbladder Neoplasms; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Recurrence; Stomach Neoplasms; Tegafur

Sorafenib and conventional systemic cytotoxicity chemotherapy are currently being used in parallel for the patients with advanced hepatocellular carcinoma (HCC). While sorafenib has been proven to improve the prognosis in patients with this malignant disease, however, the outcome of other newly developed systemic chemotherapeutic regimens remains controversial. We evaluated the outcome and safety of patients treated with the SOX regimen (oxaliplatin + S-1) and those treated with sorafenib in a single-center cohort. This retrospective study involved a total of 46 patients with advanced HCC, 22 of which were treated with SOX regimen (oxaliplatin [130 mg/m2] on day 1 and S-1 [80 mg/m2/day] on day 1-14, every 3 weeks), and 24 were daily treated with sorafenib (400 mg, b.i.d.). The median progression-free survival was 3.6 months (95% confidence interval [CI], 1.7 to 5.6) with SOX and 1.7 months (95% CI, 1.5 to 1.9) with sorafenib, respectively (P = 0.444). The median overall survival in SOX and sorafenib group was 7.6 months (95% CI, 4.3 to 10.9) and 4.7 months (95% CI, 2.7 to 7.3), respectively (P = 0.246). Response rate was 22.2% with SOX and 5.6% with sorafenib, respectively (P = 0.154). The frequent side effects in SOX-treated patients were thrombocytopenia, elevation of transaminase levels and neuropathy, whereas hand-foot syndrome, diarrhea and pruritus were common in sorafenib-treated patients. These preliminary results suggest that the SOX regimen may serve as an effective treatment for patients with advanced HCC, and the treatment-related toxicities were generally well-tolerated.

Topics: Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Disease-Free Survival; Drug Combinations; Female; Humans; Liver Neoplasms; Male; Middle Aged; Niacinamide; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Phenylurea Compounds; Sorafenib; Tegafur; Treatment Outcome

Sorafenib and S-1 (one mixed formulation containing 5-FU prodrug and dihydropyrimidine dehydrogenase inhibitor) were two effective agents against hepatocellular carcinoma (HCC), but whether they had synergistic effects remained unclear. The present study aimed at evaluating their synergistic effects against HCC and its mechanisms.. Inhibitory effects of sorafenib, 5-FU and their combination on HCC cells PLC/PRF/5 and SK-HEP-1 were evaluated. Expressions of transcription factor E2F-1 and its downstream thymidylate synthetase (TS) in the treated cells were determined using real-time PCR and Western blot. In vivo anti-tumoral efficacy of S-1 plus sorafenib on HCC was evaluated in NOD/SCID mice. E2F-1 and TS expressions in tumors were determined by immunohistochemical staining.. Sorafenib inhibited growth of HCC cells in dose-dependent manner, with IC50 of 5.4 ± 0.3 μmol/L for PLC/PRF/5 and 5.3 ± 0.5 μmol/L for SK-HEP-1. Sorafenib (1 μmol/L) enhanced inhibitory efficacy of 5-FU on HCC cells in vitro, dropping IC50 of 5-FU from 167.7 ± 12.1 to 105.4 ± 8.4 μmol/L for PLC/PRF/5 and 115 ± 10.2 to 82 ± 7.4 μmol/L for SK-HEP-1 (both p < 0.01). Sorafenib downregulated E2F-1 and TS expressions on HCC cells, and its combination with 5-FU yielded a synergistic downregulation of TS expression on HCC cells. In NOD/SCID mice with subcutaneously inoculated HCC, sorafenib combined with S-1 yielded greater inhibition on tumor growth and remarkable TS suppression when compared with sorafenib or S-1 alone (all p < 0.05).. Sorafenib enhanced therapeutic efficacy of 5-FU/S-1 against HCC through downregulation of E2F-1 and TS expressions. Sorafenib combined with S-1 might represent as valuable therapeutic regimen against HCC.

Topics: Animals; Antineoplastic Combined Chemotherapy Protocols; Blotting, Western; Carcinoma, Hepatocellular; Cell Line, Tumor; Dose-Response Relationship, Drug; Down-Regulation; Drug Combinations; Drug Synergism; E2F1 Transcription Factor; Gene Expression Regulation, Neoplastic; Humans; Inhibitory Concentration 50; Liver Neoplasms; Male; Mice; Mice, Inbred NOD; Mice, SCID; Niacinamide; Oxonic Acid; Phenylurea Compounds; Real-Time Polymerase Chain Reaction; Sorafenib; Tegafur; Thymidylate Synthase

A 41-year-old woman who had a pancreatic tail tumor and multiple liver tumors was referred to our hospital. The results of abdominal US, CT and MRI, and histopathological and immunohistochemical findings of the liver tumor biopsy revealed a pancreatic neuroendocrine tumor with excessively-advanced liver metastasis. We treated her with S-1/gemcitabine combination chemotherapy plus long-acting somatostatin analogue octreotide, which produced tumor stabilization and good quality of life for 7 months, and survival time of 15 months. Although the tumor was diagnosed as a poorly differentiated endocrine carcinoma, this therapy was suggested to be effective in this case.

Topics: Adult; Antimetabolites, Antineoplastic; Antineoplastic Agents, Hormonal; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Liver Neoplasms; Neuroendocrine Tumors; Octreotide; Oxonic Acid; Pancreatic Neoplasms; Tegafur

The aim of this study was to evaluate the usefulness of circulating tumor cells (CTCs) after preliminary chemotherapy for prediction of response to further anticancer therapy in patients with initially unresectable metastatic colorectal cancer.. CTCs from 14 consecutive patients with Kirsten rat sarcoma viral oncogene homolog (KRAS) wild-type colorectal cancer with synchronous or metachronous unresectable metastatic lesions were measured using the CellSearch system between January 2009 and December 2011. CTCs were measured before and after chemotherapy. The regimen consisted of four courses (three months) of oxaliplatin with oral S-1 (SOX) + panitumumab.. Ten (71%) out of all patients had no detectable CTCs after chemotherapy. Eight out of these ten patients received further chemotherapy, and liver metastases were completely resected in the other two patients; none of these patients died of cancer within a year after starting chemotherapy. The remaining four patients with CTCs continued to have CTCs after chemotherapy, and all four of these patients died of cancer within eight months after starting chemotherapy. The prognosis of the patients who had no detectable CTCs after the chemotherapy was significantly better than that of those who had CTCs even after the chemotherapy (p<0.01).. CTCs after preliminary chemotherapy may be useful in predicting the response to further anticancer therapy.

Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Antineoplastic Combined Chemotherapy Protocols; Colorectal Neoplasms; Drug Combinations; Female; Follow-Up Studies; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Neoplastic Cells, Circulating; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Panitumumab; Prognosis; Prospective Studies; Survival Rate; Tegafur

To investigate the effect of surgery and chemotherapy for gastric cancer with multiple synchronous liver metastases (GCLM).. A total of 114 patients were entered in this study, and 20 patients with multiple synchronous liver metastases were eligible. After screening with preoperative chemotherapy, 20 patients underwent curative gastrectomy and hepatectomy for GCLM; 14 underwent major hepatectomy, and the remaining six underwent minor hepatectomy. There were 94 patients without aggressive treatment, and they were in the non-operative group. Two regimens of perioperative chemotherapy were used: S-1 and cisplatin (SP) in 12 patients, and docetaxel, cisplatin and 5-fluorouracil (DCF) in eight patients. These GCLM patients were given preoperative chemotherapy consisting of two courses chemotherapy of SP or DCF regimens. After chemotherapy, gastrectomy and hepatectomy were preformed. Evaluation of patient survival was by follow-up contact using telephone and outpatient records. All patients were assessed every 3 mo during the first year and every 6 mo thereafter.. Twenty patients underwent gastrectomy and hepatectomy and completed their perioperative chemotherapy and hepatic arterial infusion before and after surgery. Ninety-four patients had no aggressive treatment of liver metastases because of technical difficulties with resection and severe cardiopulmonary dysfunction. In the surgery group, there was no toxicity greater than grade 3 during the course of chemotherapy. The response rate was 100% according to the response evaluation criteria in solid tumors criteria. For all 114 patients, the overall survival rate was 8.0%, 4.0%, 4.0% and 4.0% at 1, 2, 3 and 4 years, respectively, with a median survival time (MST) of 8.5 mo (range: 0.5-48 mo). For the 20 patients in the surgery group, MST was 22.3 mo (range: 4-48 mo). In the 94 patients without aggressive treatment, MST was 5.5 mo (range: 0.5-21 mo). There was a significant difference between the surgery and unresectable patients (P = 0.000). Three patients in surgery group were still alive at the end of the cut-off date.. Perioperative weekly DCF and SP achieved a good response, and combined with surgery, they could improve prognosis of GCLM.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Docetaxel; Drug Combinations; Female; Fluorouracil; Glycosylation; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Oxonic Acid; Pilot Projects; Stomach Neoplasms; Taxoids; Tegafur; Treatment Outcome

A 71-year-old man was diagnosed with gastric cancer[cT4, cN0, cH1(S6), cP0, cM0, cStage IV]and underwent distal gastrectomy with cholecystectomy, partial colectomy for the invasion to the mesentery of transverse colon, and partial hepatectomy for metastatic liver tumor(segment 6). Although chemotherapy with S-1+CDDP was administered after the operation, a recurrent lesion appeared in the remnant of liver(segment 6). The chemotherapy regimen was changed to S-1+CPT-11. Since the only recurrent tumor was found in the remnant liver, it was resected. After S-1 chemotherapy, no recurrence has been detected since the first operation. A good outcome was obtained for this patient with synchronous liver metastasis and the recurrence remnant liver originating from gastric cancer, possibly as a result of the combination of chemotherapy and surgical resection for the primary lesion and liver metastasis.

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

We report our experience with two cases of postoperative multiple liver metastases that were reduced remarkably by S-1, VNR, and MPA combination therapy for breast cancer. A case diagnosed as Stage II B(T2, N1, M0)breast cancer was treated postoperatively with LH-RH agonist and TAM. Another case, diagnosed as Stage III B(T4b, N2, M0), was treated with postoperative CE therapy. Tumor markers were normalized and liver metastases were shrunk significantly in both cases which received combination chemotherapy of S-1, VNR, and MPA as first-line therapy after recurrence. We conclude that this combination chemotherapy is a useful regimen for metastatic breast cancer patients, because it can be continuously implemented over a long period of time while maintaining high QOL without serious adverse events.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Drug Combinations; Female; Gonadotropin-Releasing Hormone; Humans; Liver Neoplasms; Medroxyprogesterone; Middle Aged; Oxonic Acid; Tamoxifen; Tegafur; Vinblastine; Vinorelbine

The patient was a 78-year-old woman who suffered from right upper quadrant pain. She was diagnosed as colon cancer with hepatic metastasis. Initial chemotherapy using capecitabine plus oxaliplatin(XELOX)+bevacizumab achieved partial response. After 12 months, XELOX was discontinued due to Grade 3 hand-foot syndrome and peripheral neuropathy. Irinotecan plus oral S-1(a combination of tegafur, 5-chloro-2, 4-dihydroxypyridine, and potassium oxonate)and(IRIS)+bevacizumab were continued as second-line therapy, and her status was maintained as stable disease. XELOX and IRIS regimens do not require catheter placement and long infusion process, providing a great advantage to patients.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Capecitabine; Colonic Neoplasms; Deoxycytidine; Drug Combinations; Female; Fluorouracil; Humans; Irinotecan; Liver Neoplasms; Oxaloacetates; Oxonic Acid; Tegafur; Tomography, X-Ray Computed

The aim of this study was to evaluate S-1 and oxaliplatin combination chemotherapy (SOX) in patients with refractory pancreatic cancer (PC).. Consecutive patients with advanced PC refractory to gemcitabine who were treated with oral S-1 (80 mg/m²) on days 1-14 and intravenous oxaliplatin (100 mg/m²) on day 1 every 3 weeks were studied retrospectively. The primary end point was the objective response rate (ORR). The secondary end points were progression-free survival (PFS), overall survival (OS), the disease control rate (DCR), and safety.. Between March 2009 and October 2011, 30 patients were treated with SOX, with a median of two courses (range 1-8). The ORR and DCR were 10.0 and 50.0 %, respectively. Median PFS and OS were 3.4 months (95 % confidence interval [CI] 1.3-5.3) and 5.0 months (95 % CI 3.4-7.4), respectively. The median PFS and OS were 5.6 and 9.1 months in patients receiving S-1 and oxaliplatin as a second-line treatment. Major grade 3 or 4 adverse events included neutropenia (10.0 %), anemia (3.3 %), and diarrhea (6.7 %).. SOX was well tolerated and moderately effective in patients with refractory PC.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Female; Follow-Up Studies; Humans; Incidence; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neutropenia; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Pancreatic Neoplasms; Retrospective Studies; Salvage Therapy; Survival Analysis; Tegafur; Tokyo

The aim of this study was to evaluate the impact of chemotherapy with molecular-targeting agents on liver metastases from colorectal cancer.. Six patients with synchronous colorectal liver metastases who underwent hepatectomy after chemotherapy with S-1 and oxaliplatin (SOX) between January 2010 and December 2011 at the Department of Surgery, Kashiwa Hospital, the Jikei University School of Medicine were enrolled. Two patients received only SOX as chemotherapy, while the others received SOX in combination with one of the three molecular-targeting agents, bevacizumab, cetuximab, and panitumumab.. In the two patients who received SOX alone, liver metastases completely disappeared at more than six months after starting chemotherapy as shown by computed tomographic (CT) scan. However, malignant cells were diffusely detected by pathological examination at the site of liver metastases, as detected by CT scan before chemotherapy. In the other four patients who received SOX in combination with molecular targets, the size of liver metastases appeared unchanged at three months after limited chemotherapy by CT scan. Pathologically, few malignant cells were detected, only at the borderline of the tumor, while most tumor cells inside the tumor were necrotized and been replaced by fibroconnective tissue.. Molecular-targeting agents may induce tumor necrosis rapidly from inside the tumor, which might not be detected by CT scan before surgery.

Topics: Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Cetuximab; Colorectal Neoplasms; Drug Combinations; Female; Humans; Liver Neoplasms; Male; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Panitumumab; Tegafur; Tomography, X-Ray Computed

The aim of this study was to determine the feasibility of S-1 plus oxaliplatin (SOX) or capecitabine plus oxaliplatin (XELOX) as first-line therapy for patients with initially unresectable metastases from colorectal cancer.. Fourteen patients with colorectal cancer who underwent elective colorectal resection between January 2009 and December 2010 at the Department of Surgery, Kashiwa Hospital, the Jikei University School of Medicine, with initially unresectable metastatic lesions were enrolled in this study. After curative resection for the primary colorectal cancer, they underwent adjuvant chemotherapy with SOX or XELOX, starting at one month after surgery.. Seven patients (50%) received SOX, and the others received XELOX as first-line therapy for initially unresectable metastases from colorectal cancer. Four (29%) patients had complete response for liver metastases over six months after chemotherapy, and liver metastases were subsequently judged to be completely resected by surgery. For the other ten patients, the median progression-free survival was 9.1 months and median overall survival was 24.1 months. There were no patients with grade 3 or 4 adverse reactions throughout the entire chemotherapy.. Oxaliplatin with oral S-1 or capecitabine as first-line therapy for patients with initially unresectable metastases from colorectal cancer is safe and feasible.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Colorectal Neoplasms; Deoxycytidine; Disease-Free Survival; Drug Combinations; Feasibility Studies; Female; Fluorouracil; Humans; Liver Neoplasms; Male; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Peritoneal Neoplasms; Tegafur

Here, we report the case of a patient with recurrent breast cancer and multiple liver metastases who showed complete remission (CR) after S-1 plus trastuzumab therapy. A 54-year-old woman with stage IIIA left breast cancer received 4 courses of epirubicin hydrochloride plus cyclophosphamide hydrate therapy and 4 courses of paclitaxel therapy as initial treatment after mastectomy. At 10 months after surgery, the carcinoembryonic antigen (CEA) level increased to 79.0 ng/mL, and multiple liver metastases were detected on close examination. Subsequently, the patient received S-1 plus trastuzumab combination therapy. The CEA level returned to normal after 2 courses of the combination therapy, and the liver metastases disappeared after 5 courses of therapy. CR has been maintained for 1 year and 3 months after the initiation of treatment. Because the present treatment has superior tolerability and safety, it is considered an effective option for treating recurrent breast cancer.

Topics: Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Combined Modality Therapy; Drug Combinations; Female; Humans; Liver Neoplasms; Mastectomy; Middle Aged; Neoplasm Staging; Oxonic Acid; Recurrence; Tegafur; Trastuzumab

Herein, we report four cases of a single liver metastasis after gastric cancer resection. Initially, we chose to perform hepatic arterial infusion( HAI) with high-dose 5-fluorouracil( 5-FU)( 6,000 mg/week) or weekly 500-750 mg of 5-FU. Three patients showed a partial response (PR) and one patient showed no change (NC). Therefore, we performed hepatectomy or radiofrequency ablation( RFA) 300-350 days after HAI. All four patients received postoperative HAI. Two patients survived without recurrence for 12 and 21 months. One patient developed prostate cancer but survived for 22 months as an outpatient. Finally, one patient experienced recurrence in the residual liver, but at a site not supplied by the hepatic artery. This patient survived for 36 months as an outpatient. In conclusion, HAI, liver resection, and RFA are effective in the management of single liver metastasis from gastric cancer.

Topics: Aged; Antimetabolites, Antineoplastic; Catheter Ablation; Combined Modality Therapy; Drug Combinations; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Male; Oxonic Acid; Recurrence; Stomach Neoplasms; Tegafur

The patient was a 71-year-old woman who was referred to our hospital with a diagnosis of gastric cancer. Computed tomography( CT) scans revealed a liver tumor, which we diagnosed as liver metastasis from the gastric cancer. A type 2 tumor was observed in the lesser curvature side of the gastric angle, and a huge tumor measuring 75 mm was seen in the lateral segment of the liver. A tumor thrombus from the metastatic lesion in the liver jutting out into the umbilical portion of the portal vein was observed. Measurement of tumor marker levels showed that the α-fetoprotein (AFP) level was slightly elevated at 20.7 ng/mL. Distal gastrectomy and resection of the left lobe of the liver were performed at surgery. The results of the pathological examination indicated a tub2, T3 (ss), N1, M1 (HEP), ly0, v2, stage IV gastric cancer with liver metastasis, and without AFP expression. The postoperative course was favorable, and the patient was treated in the outpatient clinic with postoperative adjuvant chemotherapy consisting of 80 mg of S-1. No adverse events were noted, and it was possible to complete 10 courses of chemotherapy. Because there was no evidence of recurrence, treatment was completed in 1 year and 2 months. No recurrence was observed until the third year after surgery. Consistent with a slight elevation in the tumor marker levels at 3 years and 6 months, recurrence was observed in the remnant liver. The patient died of her disease at 3 years and 10 months. Gastric cancers that give rise to portal vein tumor thrombosis are rare. Their outcome is generally poor, and early recurrence in the remnant liver is common. In the present case, R0 resection was possible because the liver metastasis was solitary and the tumor thrombosis was mild. To a certain extent, an improvement in the outcome was observed. However, the recurrence progressed rapidly, making it impossible to perform adequate treatment. More diligent examinations and continuation of long-term treatment might have been required to improve the patient's prognosis.

Topics: Aged; Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Drug Combinations; Fatal Outcome; Female; Gastrectomy; Hepatectomy; Humans; Liver Neoplasms; Oxonic Acid; Stomach Neoplasms; Tegafur; Thrombosis

The patient was a 55-year-old man who had been diagnosed as having liver metastases (S3, S4, S5, S6, and S7) from sigmoid colon cancer in March 2010. In June 2010, he underwent sigmoid colon cancer resection, followed by local ablation therapy for the liver tumors( S4, S5, and S6) and hepatic segmentectomy( S3 and S7). Subsequently, adjuvant chemotherapy with S-1 and oxaliplatin( SOX) was initiated. After 6 courses, hepatic metastasis from colon cancer recurred. Thus, primary treatment with SOX plus bevacizumab for advanced metastatic colorectal cancer was initiated. However, progressive disease was diagnosed after 10 postoperative courses of chemotherapy, and therefore, chemotherapy with irinotecan and S-1 (IRIS) plus panitumumab was initiated as secondary treatment. Tumor marker levels reduced with this treatment, and diagnostic imaging indicated a partial response. We report herein a case of a patient who was successfully treated with IRIS plus panitumumab. This therapeutic regimen is useful as second-line treatment because it has the advantage of not requiring a pump for administration and treatment can be tailored to an individual patient's condition, for example, according to pathology and the patient's lifestyle needs.

Topics: Antibodies, Monoclonal; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Chemotherapy, Adjuvant; Drug Combinations; Humans; Irinotecan; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Panitumumab; Salvage Therapy; Sigmoid Neoplasms; Tegafur

A 60-year-old man was diagnosed as having type 3 advanced gastric cancer in the gastric antrum and multiple liver metastases( S2, S3, S4, and S7)( cT3[ SS] N0M0H1, Stage IV). The patient received combined neoadjuvant chemotherapy with S-1 and cisplatin( CDDP). S-1( 80 mg/body/day) was administered orally for 3 weeks followed by 2 drug-free weeks as a course, and CDDP (60 mg/m2) was administered by intravenous infusion on day 8. The gastric tumor reduced in size and the liver metastases improved after 5 courses of treatment. Distal gastrectomy, D2 lymph node dissection, and partial liver resection( 4 sites) were performed. S-1 alone was continued as adjuvant chemotherapy; no recurrence was detected in 2 years and 2 months after surgery. Although there is insufficient evidence to support the benefit of surgical resection in patients with advanced gastric cancer with liver metastases, chemotherapy combined with surgical resection would improve the survival time without deterioration of quality of life of these patients. This case suggests that neoadjuvant chemotherapy is effective against advanced gastric cancer even with multiple liver metastases.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Gastrectomy; Hepatectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm, Residual; Oxonic Acid; Stomach Neoplasms; Tegafur

Although S-1 plus cisplatin (SP) therapy is recognized as the standard treatment for advanced gastric cancer (AGC) in Japan, its safety and efficacy in elderly patients have not been investigated sufficiently.. We retrospectively reviewed the data of 58 patients with AGC selected from 82 consecutive patients who were ≥70 years old and were treated with SP or S-1 monotherapy as the first-line therapy. In SP, S-1 (40 mg/m(2), bid) was administered for 3 weeks and cisplatin (60 mg/m(2)) on day 8, every 5 weeks. In S-1 monotherapy, S-1 (40 mg/m(2), bid) was administered for 4 weeks, every 6 weeks.. SP and S-1 was administered in 21 and 37 patients, respectively. There were some differences in patient characteristics between the treatment groups, such as histological type (P = 0.16); the presence of liver metastasis (P = 0.07); and the presence of peritoneal metastasis (P = 0.02). The incidences of grade 3/4 hematological toxicities were 57% (12/21) in the SP and 35% (13/37) in the S-1 group (P = 0.17). Those of non-hematological toxicities were 14% (3/21) and 14% (5/37) for anorexia, 10% (2/21) and 14% (5/37) for fatigue, and 5% (1/21) and 5% (2/37) for nausea in the SP and S-1 groups, respectively. Median progression-free survival and median overall survival in the SP and S-1 groups were 5.0 and 5.2 months, and 14.4 and 10.9 months, respectively.. SP and S-1 therapy were both feasible in elderly patients, though there is the risk of a high incidence of hematological toxicities.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Disease-Free Survival; Drug Combinations; Female; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Retrospective Studies; Stomach Neoplasms; Tegafur

A 66-year-old man presented with anemia. Endoscopy revealed an elevated lesion with ulceration in the posterior wall of the lesser curvature of the lower gastric body. Endoscopic biopsy demonstrated pathological diagnosis, neuroendocrine carcinoma. A computed tomography scan showed liver metastasis and portal vein invasion. We started chemotherapy with S-1 and cisplatin. After six courses of treatment over seven months, partial response was assessed. We are continuing this chemotherapy now.

Topics: Antimetabolites, Antineoplastic; Antineoplastic Agents; Carcinoma, Neuroendocrine; Cisplatin; Drug Combinations; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Oxonic Acid; Portal Vein; Stomach Neoplasms; Tegafur

Topics: Deoxycytidine; Drug Combinations; Drug Therapy, Combination; Gemcitabine; Humans; Liver Neoplasms; Oxonic Acid; Pancreatic Neoplasms; Tegafur; Treatment Outcome

A 70-year-old female presented with epigastralgia. Gastrointestinal endoscopic examination showed advanced gastric cancer type 2. Computed tomography(CT)showed a liver tumor of 37mm in segment 6. She was treated with oral S-1, 80 mg/body for 14 days, followed by a 7-day rest, and CDDP 20mg/m2(day 1 and 8). After ten courses of treatment, CT showed reduction of the primary cancer, the liver tumor, and the affected lymph nodes. Then, distal gastrectomy, lymph node dissection, and partial liver resection were performed. The histological diagnosis was no viable cancer cells found in stomach, liver or lymph nodes. One year and 1 month postoperatively, the patient is alive without recurrence.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Drug Combinations; Female; Humans; Liver Neoplasms; Oxonic Acid; Remission Induction; Stomach Neoplasms; Tegafur

Although the standard treatment for liver metastasis from gastric cancer is chemotherapy, there are several reports demonstrating better survival after hepatectomy. However, repeat hepatectomy for liver metastasis is still rare. We present a case of long-term survival after repeat hepatectomy for liver metastasis from gastric cancer. A 68-year-old male underwent distal gastrectomy with D2 lymphadenectomy for a gastric cancer. The histopathological finding revealed that the tumor was a moderately-differentiated tubular adenocarcinoma 43mm in diameter, with invasion to subserosa(T3; SS). There was one metastasis to the regional lymph node(#11p). The tumor was classified as T3N1M0(stage II B)according to the 14th edition of the Japanese Classification of Gastric Carcinoma. Fourteen months after the operation, computed tomography revealed two metastases in the lateral segment of the liver. He underwent left lateral segmentectomy followed by adjuvant chemotherapy with S-1(100mg)for one year. Sixteen months after the hepatectomy, a solitary hepatic metastasis 30mm in size at segment 8 was found by follow-up CT scan. He underwent repeat hepatectomy. He is free of recurrence now without adjuvant chemotherapy four years after repeat hepatectomy.

Topics: Aged; Antimetabolites, Antineoplastic; Combined Modality Therapy; Drug Combinations; Hepatectomy; Humans; Liver Neoplasms; Male; Oxonic Acid; Recurrence; Stomach Neoplasms; Tegafur; Time Factors

The patient was a 67-year-old male with type-3 gastric cancer from the upper body of the stomach to the cardia. An abdominal computed tomography scan revealed liver metastases(S8)(T2N0M0H1, Stage IV). The patient received neoadjuvant combined chemotherapy with S-1 and CDDP. S-1(120mg/body/day)was orally administered for 3 weeks followed by 2 drug-free weeks as a course, and CDDP(60mg/m2)was administered by intravenous infusion on day 8. After the second course, significant tumor reduction and disappearance of liver metastases resulted. Total gastrectomy, splenectomy, cholecystectomy, and D2 nodal dissection were performed. The histological diagnosis revealed no metastases in all lymph nodes: Stage I B. The combined neoadjuvant chemotherapy with S-1 and CDDP can be considered an effective treatment for advanced gastric cancer.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Cisplatin; Drug Combinations; Humans; Liver Neoplasms; Male; Neoadjuvant Therapy; Neoplasm Staging; Oxonic Acid; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

A 65-year-old male with type 5 gastric cancer and two lesions of liver metastases was initially treated with S-1/CDDP. After completion of the second course, however, the progression of liver metastases and appearance of massive ascites were detected with CT scan, and dysphagia appeared. Total gastrectomy was performed to improve the symptoms. Later, chemotherapy with weekly PTX was performed, demonstrating the regression of liver metastases and disappearance of ascites after 2 courses. Thus, partial liver resection for liver metastases was performed. PTX has been readministered weekly, and the patient is currently attending the outpatient clinic without recurrence, although two years have passed since his first examination.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Cisplatin; Drug Combinations; Humans; Liver Neoplasms; Male; Neoplasm Staging; Oxonic Acid; Paclitaxel; Remission Induction; Salvage Therapy; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

Poorly differentiated neuroendocrine carcinoma is a very rare malignancy, but it is characterized by agressive histological features and a poor clinical prognosis. We report a 42-year-old man who had poorly differentiated neuroendocrine carcinoma of the pancreas with multiple liver metastases. We administrated combined chemotherapy with S-1 and gemcitabine. This treatment was efficacious and well tolerated, and then this patient obtained objective partial response for 7 months and survived for 13 months after the diagnosis. This case suggests that S-1 and gemcitabine combination produce beneficial responses for patients with this disease.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Neuroendocrine; Deoxycytidine; Drug Combinations; Gemcitabine; Humans; Liver Neoplasms; Male; Oxonic Acid; Pancreatic Neoplasms; Tegafur; Tomography, X-Ray Computed; Treatment Outcome

CASE 1: A 72-year-old man with epigastralgia was diagnosed with gastric cancer and referred to our hospital. An abdominal CT scan revealed liver metastasis and para-aortic lymph node metastasis. He was treated with S-1+CDDP. After 4 courses of this treatment, the liver metastasis and para-aortic lymph node metastasis disappeared, and adjuvant surgery was performed. There has been no recurrence for 16 months postoperatively. CASE 2: A 66-year-old man with anorexia was diagnosed with gastric cancer and referred to our hospital. An abdominal CT scan revealed para-aortic lymph node metastasis. He was treated with S-1+CDDP. After 9 courses of this treatment, para-aortic lymph node metastasis disappeared, and adjuvant surgery was performed. Eight months after the operation, lymph node metastases were confirmed by abdominal CT scan, and he was treated with chemotherapy as an outpatient as of 13 months after the operation. We experienced two cases of Stage IV gastric cancer undergoing adjuvant surgery after down staging by chemotherapy. It was suggested that adjuvant surgery to highly advanced gastric cancer could improve the prognosis of patients.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Neoadjuvant Therapy; Neoplasm Invasiveness; Neoplasm Staging; Oxonic Acid; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

FOLFOX or FOLFIRI are commonly used as first- or second-line chemotherapy for unresectable colorectal cancer or its metastases.Recently, it had become a trend to add bevacizumab or cetuximab(Cmab)limited to the K-ras wild-type or panitumumab(Pmab)limited to the K-ras wild-type.At the present time, a common third-line chemotherapy is CPT-11 plus Cmab limited to the K-ras wild-type, or Cmab/Pmab.However, the results are unsatisfactory.With Cmab plus S-1 we treated a case of remnant liver metastases from rectal cancer which was a K-ras wild-type, after treating 5-FU, L-OHP and CPT-11. The tumor marker dropped and 7 focuses of liver metastases disappeared after 6 courses of treatment(complete response: CR in)and CR was achieved after 9 courses treatment.After 10 courses of treatment, a new lesion appeared on S5 of the liver and we performed percutaneous radiofrequency ablation.

Topics: Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cetuximab; Combined Modality Therapy; Drug Combinations; Fluorouracil; Humans; Irinotecan; Liver Neoplasms; Male; Mutation; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Proto-Oncogene Proteins; Proto-Oncogene Proteins p21(ras); ras Proteins; Rectal Neoplasms; Recurrence; Salvage Therapy; Tegafur; Tomography, X-Ray Computed

A 74-year-old woman was referred to us for patterns of liver metastases found in abdominal ultrasonography. Upper gastrointestinal endoscopy revealed advanced gastric cancer, and the subsequent abdominal CT examination confirmed multiple liver metastases. After the first regimen, a combination of 5-FU and CDDP failed due to adverse events, so monotherapy of S-1 was introduced. An abdominal CT examination in the 21st month showed disappearance of liver metastases. She was judged to have a complete response and continued with this treatment. She survived five years and eight months on monotherapy of S-1 before she died of bronchiectasis.

Topics: Aged; Antimetabolites, Antineoplastic; Bronchiectasis; Drug Combinations; Fatal Outcome; Female; Humans; Liver Neoplasms; Oxonic Acid; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

Recent advances in the treatment of metastatic unresectable gastric cancers (MGC) include the development of new antitumor drugs and new regimens for their use. However, the selection of individually designed regimens by gastric cancer (GC) subtype remains problematic. Here, we investigated the clinical usefulness of programmed chemotherapy.. MGC patients were classified into three groups by clinical condition. We implemented a chemotherapy program consisting of S-1 combination regimens. Median survival time (MST) of level 1 patients was 416 days (95% CI: 313-506 days), with an overall response rate of 47%. MSTs of level 2 and 3 patients were 208 (95% CI: 153-287 days) and 95 days (95% CI: 28-136 days), respectively. Grade 3-4 toxicities were neutropenia in 12% and anorexia in 6%. All treatment- related toxicities were resolved, and no treatment-related deaths occurred.. This program provided reasonable selection of case-matching regimens and may improve the survival of patients with MGC. Further, it may represent the first clinical tool to provide efficient chemotherapy course selection for MGC. Ongoing analysis of newly developed drugs and regimens will allow the efficacy of this chemotherapy program to be improved.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Clinical Trials, Phase II as Topic; Drug Combinations; Female; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Prognosis; Stomach Neoplasms; Survival Rate; Tegafur

A 54-year-old man underwent distal gastrectomy for early gastric cancer in September 2002. CT performed 6 months after the operation revealed liver metastases, and they were resected. Hepatic arterial infusion therapy of 5-FU was performed; however, multiple liver metastases appeared in October 2003. We added arterial infusion of CDDP to 5-FU, but liver metastases increased. We then applied a combination chemotherapy of S-1 and paclitaxel from February 2004. Subsequently, stable disease continued, and after 67 courses of S-1 plus paclitaxel, we changed the administration to S-1 alone from August 2009. After that, liver metastases did not increase, so we discontinued chemotherapy on August 2010, followed by observation. Progression of liver metastases has not been to date.

Topics: Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Drug Combinations; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Paclitaxel; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

Leiomyosarcoma (LMS) of the gastrointestinal tract is an extremely rare high-grade neoplasm with poor prognosis. For advanced LMS with distant metastasis, the decision as to the choice of the most appropriate therapeutic strategy, including chemotherapy and surgery, is difficult. Here, we present an unusual case of LMS of the sigmoid colon with liver metastases and gastric cancer. The survival of this patient was prolonged by a combined modality therapy involving chemotherapy and surgery.. A 66-year-old woman who had been diagnosed with advanced gastric cancer and multiple liver metastases was referred to our hospital. The initial treatment with docetaxel and S-1 considerably reduced both the gastric cancer and liver tumors; consequently we performed surgical resection. Pathological examination revealed that no viable tumor cells remained in the stomach and chemotherapy resulted in complete remission of the gastric cancer. The liver tumors were immunohistochemically diagnosed as LMS. A tumor of the sigmoid colon was subsequently discovered and the liver tumors were found to have recurred. The surgically resected sigmoid colon and liver tumors were all immunohistochemically diagnosed as LMS. These findings indicated that the multiple liver metastases arose from the LMS in the sigmoid colon, and that they were accompanied by advanced gastric cancer. We performed another surgical resection and administered chemotherapy to treat the recurring liver metastases. The patient survived for 4 years and 10 months after initial presentation at our hospital.. Colonic LMS is rare and its joint occurrence with gastric cancer is extremely unusual. Although LMS is a high-grade neoplasm, a multimodal therapeutic approach can increase patient survival time even when multiple liver metastases are present.

Topics: Aged; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Docetaxel; Drug Combinations; Fatal Outcome; Female; Humans; Immunohistochemistry; Leiomyosarcoma; Liver Neoplasms; Neoplasm Recurrence, Local; Oxonic Acid; Sigmoid Neoplasms; Stomach Neoplasms; Taxoids; Tegafur

A 30-year-old man underwent a left lobectomy and S5/6 partial hepatectomy in August 2001 for hepatocellular carcinoma (HCC). A lung tumor was detected by positron emission tomography (PET-CT) 8 years after the surgery. In May 2010, he received pulmonary tumor resection and the histopathological findings revealed metastasis of HCC. However a metastatic brain tumor was detected by computed tomography (CT) in September 2010, therefore surgery and radiation therapy were subsequently performed. Thereafter, metastatic hilar lymph node appeared in December 2010, therefore we performed systemic chemotherapy using S-1/cisplatin combined with radiation therapy for the metastatic tumor. The tumor was markedly decreased and no shadow was detected by PET-CT. He has been followed up in the outpatient clinic with no recurrence.

Topics: Adult; Antimetabolites, Antineoplastic; Brain Neoplasms; Carcinoma, Hepatocellular; Combined Modality Therapy; Drug Combinations; Hepatectomy; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Oxonic Acid; Tegafur

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

We describe our experience with a patient who had advanced hepatocellular carcinoma (HCC) that responded markedly to treatment with the oral fluoropyrimidine anticancer drug S-1 (120mg/day/body bid on day 1 through 28 followed by a 14-day recovery period). The patient was enrolled in a phase I / II study designed to evaluate the safety and efficacy of S-1 in patients with advanced HCC. The best overall efficacy was confirmed to be a partial response (PR). After a total of 6 courses of treatment given on an outpatient basis, the target lesion volume decreased by 73. 8%. With regard to adverse events, the patient did not develop Grade 3 or higher adverse drug reactions. Therefore, the patient continued outpatient treatment for a total of 6 courses. The duration of survival from the start of treatment until death was 820 days, suggesting that S-1 is moderately effective and well tolerated in patients with advanced HCC.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Hepatocellular; Drug Combinations; Fatal Outcome; Hepatitis C; Humans; Liver Neoplasms; Male; Neoplasm Staging; Oxonic Acid; Tegafur

The prognosis for pancreatic cancer with distant metastasis is not good. The case reported here concerns a pancreatic body cancer with multiple liver metastases for which multidisciplinary therapy of S-1+gemcitabine(GEM)therapy, surgery, and radiofrequency ablation proved to be effective, resulting in complete remission. The patient was a 77-year-old female. She was asymptomatic and diagnosed with pancreatic body cancer with multiple liver metastasis at the end of December 2008 by ultrasonography. After careful examination, GEM 1, 200mg/body was administered on days 1 and 15, and S-1 was administered orally at 80mg/day for two weeks, followed by two weeks of rest. By the end of the 15th course, the size of the tumor had reduced from 26. 5mm to 14. 4mm, and all but one of the liver lesions disappeared; the remaining one lesion was measured as 14. 5mm by ultrasonography. We performed pancreas body and tail resection and radiofrequency therapy for the remaining single liver metastasis. After operation, GEM was administered once a month for 4 months. S-1 was not administered, but a new lesion was revealed at the S8 area by ultrasonography. We restarted S-1+GEM therapy and in 5 months the new lesion disappeared from image examinations. She is alive and in complete remission 16 months after the operation.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Liver Neoplasms; Oxonic Acid; Pancreatic Neoplasms; Remission Induction; Tegafur

A 57-year-old woman suffering from lower abdominal malaise was diagnosed with cStage IV advanced gastric cancer because of simultaneous liver metastasis and peritoneal dissemination. Because she was regarded as inoperable, she was administered combined immunochemotherapy comprising S-1/paclitaxel(PTX) and Krestin(PSK). One course of therapy lasted for 3 weeks as follows: 80 mg/m2 of S-1 on days 1-14 orally, 50 mg/m2 of PTX on days 1 and 8 intravenously, and 3g/day of PSK on days 1-21 orally. After 20 courses of this treatment, the metastatic liver tumor and peritoneal dissemination had disappeared on the abdominal computed tomography scan. At that time, curative resection was considered possible and she underwent total gastrectomy (Roux-en Y) with D2 lymphadenectomy. Histopathological examination revealed pStage IB [pT2 (mp), pN0] and the histological effects of the main tumor were diagnosed as grade 2. She is alive and free from recurrent disease for more than 6 years, and remains in a good condition. This combination of immunochemotherapy using S-1/PTX/PSK can be safe and effective, and is an initial treatment option for unresectable advanced gastric cancer.

Topics: Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Female; Humans; Immunotherapy; Liver Neoplasms; Middle Aged; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Proteoglycans; Stomach Neoplasms; Tegafur

We report a case of postoperative liver metastasis arising from pancreatic carcinoma treated with a novel procedure that we developed-percutaneous isolated hepatic perfusion (PIHP). A 69-year-old man diagnosed with pancreatic body cancer(pT3, pN0, pStage III) was treated using distal pancreatectomy and adjuvant therapy with gemcitabine(GEM). Six months later, a metastasis to the medial segment of the liver was found using computer tomography(CT). The patient was treated by chemotherapy with S-1, but the liver metastasis grew, and we therefore employed PIHP as the third-line therapy, using 80 mg doxorubicin (DXR) and 62 mg mitomycin C (MMC). Six weeks after PIHP, the tumor marker carbohydrate antigen 19-9( CA19-9) had decreased from 44,469 to 4,268 U/mL, and the carcinoembryonic antigen(CEA) level decreased from 28.8 to 5.4 U/mL. Although the size of the carcinoma remained the same on CT, some cells had liquefied as a result of necrosis. However, the patient died about 1 year after PIHP due to the growth of liver metastasis, peritoneal metastasis, and local recurrence, reflected by a progressively increasing level of tumor marker. In this case, PIHP seemed to be ineffective due to local recurrence and peritoneal metastasis as well as early enlargement of liver metastasis. However, the reduction in tumor marker levels and the observed tumor necrosis, suggest that PIHP is a potentially effective and promising treatment for liver metastasis arising from pancreatic carcinoma.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Cancer, Regional Perfusion; Doxorubicin; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Pancreatic Neoplasms; Tegafur

A 59-year-old woman was admitted to our hospital for treatment of a right humerus fracture. The patient was diagnosed with hepatocellular carcinoma during work-up for hepatic dysfunction. A diffusely spreading tumor was observed from the right lobe to the medial segment of the liver, and a portal vein tumor thrombus filled the right branch of the portal vein and extended into the main trunk, accompanied by cavernous transformation (Vp4). A multidisciplinary treatment regimen including surgical intervention was planned because the patient desired aggressive treatment. Surgical intervention included a right hepatic trisegmentectomy and excision of the portal vein tumor thrombus. The patient experienced an uneventful postoperative course with no signs of hepatic failure and received transcatheter arterial chemoembolization for residual tumor in the hepatic S1 and S2 regions on post-operative day 15. Beginning at 2 months after the operation, the patient was given 3 courses of intraarterial 5-fluorouracil combined with subcutaneous interferon-α therapy. She tested negative for tumor markers at 3 months post-operatively and was noted to have no viable tumors on computed tomography scans at 5 months post-operatively. However, there was a rapid recurrence with deterioration of her general condition at 8 months after the operation, and she died of recurrence the following month. Hepatocellular carcinoma complicated by portal vein tumor thrombus has an unfavorable prognosis, but it was considered feasible to improve this patient's outcome by giving priority to active surgical resection of the tumors including the tumor thrombus, and by undertaking multidisciplinary therapeutic measures.

Topics: Carcinoma, Hepatocellular; Combined Modality Therapy; Drug Combinations; Fatal Outcome; Female; Hepatectomy; Humans; Interferon-alpha; Liver Neoplasms; Middle Aged; Oxonic Acid; Recurrence; Tegafur

We report a rare case of a patient with multiple liver metastases of gastric and rectal cancers after laparoscopic sigmoidectomy, who responded completely to S-1 therapy followed by open gastrectomy. A 72-year-old man with a chief complaint of occult blood in the feces was referred to our hospital and was diagnosed with rectal cancer by colonoscopy. In addition, we found concomitant gastric cancer by gastrointestinal fiberscopy. Abdominal plain computed tomography showed no liver metastasis. In August 2010, we performed laparoscopic resection of the rectal cancer. However, at the time of discharge, abdominal enhanced computed tomography showed multiple liver metastases. Then, we administered 4 courses of S-1 therapy. In December 2010, abdominal enhanced computed tomography showed no liver metastasis. In March 2011, because no other lesion without residual gastric cancer was detected, the patient underwent gastrectomy followed by S-1 therapy. As of January 2012, the patient is alive and disease free. S-1 therapy with laparoscopic resection for rectal cancer and gastrectomy may help prolong the survival of patients with multiple liver metastases of gastric and rectal cancers.

Topics: Aged; Antimetabolites, Antineoplastic; Colectomy; Combined Modality Therapy; Drug Combinations; Gastrectomy; Humans; Laparoscopy; Liver Neoplasms; Male; Neoplasms, Multiple Primary; Oxonic Acid; Rectal Neoplasms; Stomach Neoplasms; Tegafur

A man is his 50s experienced epigastric discomfort and body weight loss from 60 to 56 kg over 3 months. A lesion was diagnosed as type 3 advanced gastric cancer (group 5, tub2) with para-aortic lymph node and multiple liver metastases. Pretreatment hemoglobin(Hb), albumin(Alb), and C-reactive protein(CRP) levels were 11.0 mg/dL, 3.0 g/dL, and 2.40 mg/dL, respectively. S-1+cisplatin (CDDP) combined chemotherapy (S-1 120 mg/day, day 1-21, CDDP 60 mg/ m2, day 8, q35 days) with nutritional supportive care using enteral nutrition (EN) agent (Prosure) enriched with eicosapentaenoic acid (EPA) was initiated. After 6 weeks, body weight, Hb, Alb, and CRP improved to 60 kg, 13.6 mg/dL, 4.6 g /dL, and 0.14 mg/dL, respectively. Moreover, a marked reduction in para-aortic lymph node and multiple liver metastases was seen on computed tomography (CT) scans 12 weeks after treatment initiation. Accordingly, nutritional supportive care using EN agent enriched with EPA during chemotherapy might be an effective treatment for patients with gastric cancer who show increased CRP and decreased albumin levels.

Topics: Antineoplastic Combined Chemotherapy Protocols; C-Reactive Protein; Cisplatin; Drug Combinations; Eicosapentaenoic Acid; Enteral Nutrition; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Serum Albumin; Stomach Neoplasms; Tegafur

Combination therapy with the oral fluoropyrimidine anticancer drug S1 and interferon is reportedly effective for the treatment of advanced hepatocellular carcinoma (HCC), but selection criteria for this therapy have not been clarified. In this study, we attempted to identify factors predicting the effectiveness of this combination therapy.. Pathological specimens of HCC were collected before treatment from 31 patients with advanced HCC who underwent S1+ pegylated-interferon (PEG-IFN) α-2b therapy between January 2007 and January 2009. In these pathological specimens, the expression levels of CD133, thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), and interferon-receptor 2 (IFNR2) proteins were determined by Western blot assay. The presence or absence of p53 gene mutations was determined by direct sequencing. The relationships between these protein expression levels and the response rate (RR), progression-free survival (PFS), and overall survival (OS) were evaluated.. The CD133 protein expression level was significantly lower in the responder group than in the nonresponder group. Comparing the PFS and OS between high- and low-level CD133 expression groups (n = 13 and 18, respectively) revealed that both parameters were significantly prolonged in the latter group. The expression levels of TS, DPD, and IFNR2 protein and the presence of p53 gene mutations did not correlate with the RR.. CD133 was identified as a predictor of the therapeutic effect of S1+ PEG-IFN α-2b therapy against advanced HCC.

Topics: AC133 Antigen; Adult; Aged; Aged, 80 and over; Antigens, CD; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Carcinoma, Hepatocellular; Dihydrouracil Dehydrogenase (NADP); Disease-Free Survival; Drug Combinations; Female; Genes, p53; Glycoproteins; Humans; Interferon alpha-2; Interferon-alpha; Kaplan-Meier Estimate; Liver Neoplasms; Male; Middle Aged; Mutation; Oxonic Acid; Peptides; Polyethylene Glycols; Predictive Value of Tests; Receptors, Interferon; Recombinant Proteins; Survival Rate; Tegafur; Thymidylate Synthase; Treatment Outcome

After approval of bevacizumab in Japan, post-marketing surveillance studies reported on safety. However, few reports have shown the efficacy of bevacizumab as used in daily practice. We evaluated the efficacy and safety of bevacizumab for metastatic colorectal cancer patients in daily practice.. All unresectable metastatic colorectal cancer patients who began receiving bevacizumab in participating facilities from June 2007 to October 2008 were retrospectively analyzed for safety and efficacy. Adverse events were assessed by the National Cancer Institute Common Terminology Criteria for Adverse Events. Response Evaluation in Solid Tumors criteria, version 1.0, was used for the tumor response rate.. A total of 212 patients from 17 institutions were assessed. Grade 3 or higher adverse events related to bevacizumab included gastrointestinal perforation in 3, thrombosis in 7, hypertension in 30 and gastrointestinal bleeding in 2. Response rates were 62.5, 30.1 and 11.8% overall among patients receiving bevacizumab as first-, second- and third-line or greater therapy. Median progression-free survival was 14.4 [95% confidence interval (CI): 10.8-18.1], 7.8 (95% CI: 6.5-9.1) and 6.0 (95% CI: 4.6-7.3) months, and median overall survival was 32.5 (95% CI: 24.6-40.3), 16.4 (95% CI: 14.4-18.5) and 11.8 (95% CI: 8.6-15.0) months, respectively.. The general cohort of patients in HGCSG0801 showed a similar efficacy and safety profile of bevacizumab as seen in clinical trials. Although the sample size was small and there were several study limitations, these results suggest that colorectal cancer patients in Japan might safely receive and benefit from bevacizumab in combination with chemotherapy in daily practice, as is seen in patients in other countries.

Topics: Adult; Aged; Aged, 80 and over; Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Camptothecin; Cohort Studies; Colorectal Neoplasms; Confidence Intervals; Disease-Free Survival; Drug Administration Schedule; Drug Combinations; Epistaxis; Female; Fluorouracil; Gastrointestinal Hemorrhage; Humans; Hypertension; Irinotecan; Japan; Kaplan-Meier Estimate; Leucovorin; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Organoplatinum Compounds; Oxonic Acid; Proteinuria; Retrospective Studies; Tegafur; Thrombosis; Treatment Outcome

A 75-year-old man with pancreatic body cancer underwent distal pancreatectomy and was treated with gemcitabine (GEM) as an adjuvant therapy. Multiple liver metastases appeared three months after the surgery. With GEM+S-1 combined chemotherapy, liver metastatic lesions became unidentifiable upon imaging 7 months later. Complete response status had continued as long as 13 months. Though grade 3 neutropenia appeared after 2 courses of the combined therapy, the patient well tolerated it after controlling the dosing schedule. The GEM+S-1 combined chemotherapy was expected to have synergistic effects for GEM monotherapy-refractive pancreatic cancer.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Combinations; Fatal Outcome; Gemcitabine; Humans; Liver Neoplasms; Male; Oxonic Acid; Pancreatic Neoplasms; Tegafur; Tomography, X-Ray Computed

Pancreatic acinar cell carcinoma is rare, and its incidence is less than 1% of all the malignant pancreatic tumors. Little is reported on effectiveness of chemotherapy. We report a 64-year-old male patient with pancreatic acinar cell carcinoma and a giant metastatic liver tumor, which responded to combination chemotherapy with gemcitabine(GEM)and peroral S-1 administration. The patient had upper abdominal pain and hypervascular tumors in liver(15 cm in diameter)and pancreas tail (3 cm in diameter), which were detected by an enhanced abdominal computed tomography(CT)scan, and was admitted for further examination. Abdominal angiography, FDG-positron emission tomography(PET), and liver tumor biopsy led to a diagnosis of pancreatic acinar cell carcinoma in the pancreas tail with liver metastasis. The patient was then treated with combination chemotherapy, which consisted of intravenous infusion of GEM and peroral administration of S-1, and the metastatic liver tumor was markedly reduced(partial response in RECIST). Although the prognosis of patients with unresectable pancreatic acinar cell cancers is generally unfavorable, it is suggested that the GEM/S- 1 combination chemotherapy is effective for these patients' treatment.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biopsy; Carcinoma, Acinar Cell; Deoxycytidine; Drug Combinations; Gemcitabine; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Tegafur

The patient was a 54-year-old man. He was an HBV carrier, and hepatocellular carcinoma (HCC) was detected for the first time in 2000. An operation was performed, but HCC recurred. After repeating the operation and transarterial chemo-embolization (TACE) for the recurrent HCC, a tumor was found in January 2009 on the ventral side of the right kidney, and we thought it was a retroperitoneal metastasis of HCC or peritoneal dissemination. He was enrolled in a trial of systemic chemotherapy, called "S-1 monotherapy for extrahepatic metastasis of HCC", but the tumor seemed progressive. Since he showed no other lesion, he was indicated for surgical resection. Intraoperatively, the tumor was localized between the duodenum and the right kidney, and was covered by the retroperitoneum. Pathological examination of the resected specimen revealed retroperitoneal metastasis of HCC. Intrahepatic recurrence was detected 6 months after the resection. Therefore, he underwent TACE, and he is currently (1 year after surgery) alive without any extrahepatic metastasis. We describe herein this case because retroperitoneal metastasis of HCC is very rare.

Topics: Antimetabolites, Antineoplastic; Carcinoma, Hepatocellular; Combined Modality Therapy; Drug Combinations; Hepatitis B virus; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Oxonic Acid; Recurrence; Retroperitoneal Neoplasms; Tegafur; Tomography, X-Ray Computed

We experienced a case of endocrine therapy-resistant recurrent breast cancer with liver and bone metastases, treated with S-1 as first-line chemotherapy and maintaining a good quality of life. The patient was a 31-year-old premenopausal woman. She was diagnosed with cancer of the left breast(T1(18mm), N0, M(-))and underwent breast-conserving surgery, sentinel lymph node biopsy, and radiation therapy in August 2002. As there was hormone sensitivity, she was treated with LHRH analog for 3 years and tamoxifen for 5 years as adjuvant therapy. After her first childbirth, she had a recurrence of liver and bone metastases. After treatment with endocrine therapy failed, an oral administration of S-1 was initiated as first-line chemotherapy considering her QOL. She received 8 months of S-1 therapy with no severe adverse reactions and maintained a high quality of life. Treatment with S-1 is thought to be useful for first-line chemotherapy if the treatment demonstrates a therapeutic equivalence with taxane on patients' overall survival.

Topics: Adult; Antimetabolites, Antineoplastic; Bone Neoplasms; Breast Neoplasms; Drug Combinations; Female; Humans; Liver Neoplasms; Oxonic Acid; Quality of Life; Tegafur; Tomography, X-Ray Computed

A 75-year-old man was admitted for anemia, and a tar stool found by endoscopic examination revealed a type 3 advanced gastric cancer in the lower stomach. Multiple liver metastases 4 cm in diameter were shown on CT. Because we thought that the case was unresectable, S-1/CPT-11 chemotherapy was performed. S-1 (80mg/body/day) was orally administered for 2 weeks followed by a drug-free 1 week, and CPT-11 (100mg/body/day) was given intravenously on days 1 and 8. After 3 courses of chemotherapy, the primary lesion, the regional lymph nodes, and the metastatic lesion of the liver were slightly reduced in size. He was judged as clinical PR, and distal gastrectomy and lymph node dissection were performed. One month after surgery the tumor marker values became normal, and CT could hardly detect metastatic liver tumors. Now, after 3 years, the PR stage has been maintained. Combined use of peroral S-1 and CPT-11 by intravenous infusion is effective for multiple liver metastasis after gastrectomy in gastric cancer.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Camptothecin; Combined Modality Therapy; Drug Combinations; Humans; Irinotecan; Liver Neoplasms; Lymph Node Excision; Male; Oxonic Acid; Remission Induction; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

Topics: Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Combined Modality Therapy; Drug Combinations; Fatal Outcome; Humans; Irinotecan; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Stomach Neoplasms; Tegafur

We experienced 3 cases of anti-cancer drug-resistant recurrent breast cancer with liver metastasis showing significant improvement by S-1. Almost all patients maintained the full dose through the whole course of treatment, and the drug showed good tolerability. Furthermore, long-term therapeutic efficacy(more than 2 years)and QOL have been maintained for all patients. We concluded that S-1 is not only effective as a therapeutic agent, but is safe and maintains QOL.

Topics: Aged; Antimetabolites, Antineoplastic; Breast Neoplasms; Drug Combinations; Female; Humans; Liver Neoplasms; Oxonic Acid; Quality of Life; Tegafur; Time Factors

A 63-year-old man was found to have an upper abdominal mass, and was referred to our hospital. Endoscopic examination and abdominal CT showed gastric cancer with liver metastasis. A large metastatic tumor of the liver invaded the hepatic hilus, making curative resection impossible. We started chemotherapy using S-1(120 mg/body/day), orally administered for three weeks followed by 2-week rest period, and cisplatin(100mg/body), administered intravenously on day 8 as 1 course. After 5 courses of chemotherapy, the liver tumor reduced markedly and the gastric cancer pathologically disappeared, enabling partial gastrectomy and left hepatectomy. Histological examination showed a well-differentiated adenocarcinoma in the mucosal layer of the resected stomach. A resected specimen of the liver showed a moderately-differentiated adenocarcinoma with signet-ring cells, compatible to liver metastasis from gastric cancer. Bile leakage the remaining liver occurred, but he recovered soon. Gastrointestinal examination revealed another early gastric cancer after seeing him for 2 years on an outpatient basis. We conducted subtotal gastrectomy, and the patient remains alive 30 months after the first operation. This case suggests that S-1/CDDP chemotherapy may reduce the stage of unresectable liver metastasis from gastric cancer and make a curative operation possible.

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

A woman in her sixties underwent total gastrectomy for gastric cancer. The pathological diagnosis was pT3, pN3, sH0, pCY0, sP0, sM0, fStage IV. Chemotherapy with S-1 was used after surgical treatment. Because a CT scan after three courses chemotherapy showed the paraaortic lymph nodes swelling, combination chemotherapy with S-1 and docetaxel was used as a second-line chemotherapy. When the CT scan after 8 courses of this combination chemotherapy revealed multiple liver metastases, the chemotherapy was changed to CPT-11 monotherapy and paclitaxel monotherapy as the third-and fourth-line chemotherapy, respectively. In spite of those chemotherapies, the metastatic disease progressed, and therefore, combination chemotherapy with S-1 and CDDP was used as the fifth-line chemotherapy. After 6 courses of this treatment, serum CEA and CA19-9 levels dropped into the normal range. Multiple liver metastases were markedly reduced, and were considered as a partial response(PR). The patient is still alive, maintaining the effect of PR for 17 months without any adverse effects except appetite loss and vomiting of grade 2.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Drug Synergism; Female; Humans; Liver Neoplasms; Oxonic Acid; Salvage Therapy; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

To evaluate the feasibility of oral fluoropyrimidines after resection and microwave coagulation(MCT), or radiofrequency ablation(RFA)of liver metastases from colorectal cancer.. Background factors, fluoropyrimidine administration(S-1 or UFT/LV), and adverse events were analyzed in 20 patients(17 males, 3 females; an average of 62. 4 years)with colorectal liver metastases after resection and RFA or MCT.. The synchronous: metachronous metastases ratio was 13:7. Fifteen patients received the recommended dose and 5 received a reduced dose. S-1 was administered for 4 weeks followed by a 2-week rest for 7 patients, and for 2 weeks followed by a 1-week rest for 9 patients. UFT/LV was administered for 4 weeks followed by a 1-week rest for 4 patients. Fourteen patients(70%)had adverse events. One patient showed grade 3 leukocyte toxicity while other patients showed grade 1 or 2. Two patients discontinued chemotherapy because of grade 2 delirium and grade 2 CPK elevation; another 2 discontinued voluntarily. Eight patients with recurrence changed the rugs, while 8 of 12(67%)continued for 1 year. Median disease-free and med ian overall survival lengths were 16. 1 and 4 7. 6 months, respectively.. S-1 and UFT /LV were used safely as adjuvant chemotherapies after the resection and local coagulation therapy of liver metastases.

Topics: Administration, Oral; Adult; Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Colonic Neoplasms; Drug Combinations; Electrocoagulation; Female; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Survival Rate; Tegafur; Uracil

We report a case of anal cancer in a 58-year-old woman who complained of narrow, bloody stools and anal pain. Physical examination revealed anal stenosis associated with a circular mass arising in the anal canal. Histological examination of biopsy specimens confirmed a diagnosis of moderately differentiated squamous cell carcinoma. Enhanced computed tomography revealed anal cancer invading the levator ani and the vagina, with lymph-node, multiple hepatic, and pulmonary metastases. The patient received two cycle of chemoradiotherapy with S-1 plus low-dose cisplatin with rest for 4 weeks, leading to complete response of the primary lesion and a partial response of the metastatic lesions. Each cycle included oral S-1 (120 mg/body; day 1-21), cisplatin (10 mg/body; day 1-5, 8-12) and radiotherapy (2 Gy/day; day 1-5, 8-12, 15-19). Adverse effects of treatment were mild perineal skin erosion and mild appetite loss, but no hematologic toxicity. Although the patient died 16 months after first admission, chemoradiotherapy with S-1 plus cisplatin is potentially effective for the management of advanced anal cancer.

Topics: Antineoplastic Combined Chemotherapy Protocols; Anus Neoplasms; Chemoradiotherapy; Cisplatin; Drug Combinations; Female; Gamma Rays; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; Oxonic Acid; Tegafur; Treatment Outcome

Pancreatic cancer shows the worst prognosis among the solid tumors, and survival for patients with high-grade liver metastasis is estimated at around a few months. We reported the effects of combination therapy with gemcitabine and S-1 (GS therapy) on pancreatic cancer patients with high-grade hepatic metastasis. Patients with severe metastatic pancreatic cancer received chemotherapy comprising S-1 (30mg/m² p.o. b.i.d., days 1-14) and gemcitabine (1000mg/m² on days 1 and 8), repeated every 3 weeks. Fourteen patients (7 men, 7 women) received treatment at a mean age of 56.5 years (range, 39-76 years), achieving complete response in 1 patient, partial response in 5 patients, and stable disease in 3 patients and progressive disease in 5 patients. The response rate was thus 43%. Median progression-free survival was 186 days (95% confidence interval, 40-247 days). Median overall survival was 261 days (95% confidence interval, 162-358 days). GS therapy appears to be well-tolerated and effective in patients with high-grade hepatic metastasis.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Tegafur

We report a long-term survival case of rectal cancer that was initially thought unresectable treated with chemoradiotherapy (CRT). The patient was a 50s female with advanced rectal cancer and liver metastasis. The primary tumor was expanded locally and made abscess around the rectum. We evaluated the primary lesion as unresectable, and we performed CRT after colostomy. After radiation therapy (total 60 Gy) and chemotherapy with S-1 (3 courses), the primary tumor was remarkably reduced. The liver metastasis showed a progressive growth in size but not in number. She underwent complete resection of rectal tumor and partial resection of metastatic liver tumor. Postoperative course was uneventful, and she is alive without a recurrence for 5 years after the surgery.

Topics: Antimetabolites, Antineoplastic; Chemoradiotherapy; Drug Combinations; Female; Humans; Liver Neoplasms; Middle Aged; Oxonic Acid; Rectal Neoplasms; Remission Induction; Tegafur; Time Factors; Tomography, X-Ray Computed

A 67-year-old man visited our hospital for further check-up of biliary tract disease since his two brothers suffered from biliary tract cancer. Abdominal CT scan revealed a wall thickning at the fundus of gallbladder and its vascularity was rich. Chronic cholecystitis was diagnosed, however, cancer was highly suspected. Cholecystectomy was performed and the frozen section of the gallbladder was compatible for cancer. Therefore, segment-4a and -5 liver resections with regeonal lymph node dissection were added. Although preoperative radiological findings were free of liver metastasis, the resected liver specimen included a nodule of 1 cm in segment-5. Extrahepatic bile duct was not resected because the stump of the cystic duct was free from cancer. The final pathological diagnosis according to the TNM classification was pT3N1M1, Stage IV. We considered the patient to be in the high-risk group of recurrence, adjuvant chemotherapy using both gemcitabine and S-1 was performed. S-1 (80 mg/body/day) was scheduled on day 1-14, and gemcitabine (1,000 mg/body) was scheduled on day 8, day 15. The treatment was continued for two years (a total of 28 courses) without experiencing advese events. The patient is cancer free by means of radiological and hematological studies. Gallbladder cancer with liver metastasis in segment-4a and/or -5 can be considered as "local" metastasis, which a liver resection and adjuvant therapy may lead to a good prognosis.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Gallbladder Neoplasms; Gemcitabine; Humans; Liver Neoplasms; Male; Neoplasm Staging; Oxonic Acid; Tegafur

A 60-year-old man with intrahepatic cholangiocarcinoma (ICC) underwent a left hepatectomy. Following the procedure, S-1 was administered during the period of five months. About two years after the hepatectomy, the patient underwent a hepatic resection again for remunant hepatic recurrences of ICC. Aggressive surgical resection may be the only method to assure a good outcome. An indication of resection for the hepatic recurrence of ICC will be examined in the future.

Topics: Antimetabolites, Antineoplastic; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Gemcitabine; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Oxonic Acid; Recurrence; Tegafur; Tomography, X-Ray Computed

A 77-year-old man was diagnosed as hepatocellular carcinoma, and was referred to our hospital. After he was treated by transcatheter chemoembolization, he underwent a left hepatic lobectomy of the liver and cholecystectomy. Serum AFP and PIVKA-II remarkably elevated 7 months after surgery, and CT scan revealed multiple metastatic nodules in bilateral lungs. The nodules were diagnosed as lung metastasis of HCC. Because the lesions grew larger, S-1/IFN was administered. Diagnostic imaging and tumor markers showed a marked improvement after 4 courses of S-1/IFN therapy, and he is still alive with good condition without recurrence and progression of tumors.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Drug Combinations; Embolization, Therapeutic; Hepatectomy; Humans; Interferon-alpha; Liver Neoplasms; Lung Neoplasms; Male; Oxonic Acid; Recurrence; Remission Induction; Tegafur; Tomography, X-Ray Computed

A case of a 68-year-old man with hepatocellular carcinoma (HCC) is presented. He underwent partial liver resection for three times and transcatheter arterial chemoembolization (TACE) for three times. Follow-up CT revealed a recurrent hepatic surface mass with malignant extended into the inferior vena cava (IVC) and right atrium (RA). CT scan also revealed multiple metastatic nodules in bilateral lungs. The tumor thrombus into the RA and the hepatic surface mass were successfully treated with surgical resection. Pathological specimen allowed the diagnosis of poorly-differentiated HCC. Adjuvant chemotherapy with S-1 resulted in complete remission of lung metastases. Tumor markers showed a significant improvement after S-1 administration. This case report suggests that a surgical resection followed by S-1 administration would be effective for a patient with lung metastases and a tumor thrombus into IVC or RA.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Drug Combinations; Humans; Liver Neoplasms; Lung Neoplasms; Male; Neoadjuvant Therapy; Oxonic Acid; Recurrence; Tegafur; Tomography, X-Ray Computed

A 65-year-old man underwent a total gastrectomy and distal pancreatectomy for acinar cell carcinoma of the pancreas. Multiple metastatic liver lesions were found one year postoperatively. He was treated with S-1 chemotherapy over 34 months, and the tumors significantly reduced in size without severe side effects. Four years after surgery, the liver metastases increased in size, associated with pain especially in the right upper quadrant. We then performed right hepatectomy. Peritoneal dissemination and multiple lung metastases were found 8 months after liver resection. Acinar cell carcinoma of the pancreas is a rare and highly malignant tumor, and there are few reports regarding treatment with chemotherapy. Herein, we report a case with multiple liver metastases which were controlled by systemic chemotherapy using S-1.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Acinar Cell; Drug Combinations; Gastrectomy; Hepatectomy; Humans; Liver Neoplasms; Male; Oxonic Acid; Pancreatectomy; Pancreatic Neoplasms; Tegafur

A 69-year-old man was admitted to our hospital with complaints of loss of appetite, fatigue and dysphasia. Upper gastroscopy revealed advanced gastric cancer. Abdominal CT suggested liver metastases. At first we thought the liver metastases has been completely resected, but we found multiple liver metastases unexpectedly. So only total gastric resection and liver biopsy were performed. The pathological diagnosis was metastatic carcinoma. Paclitaxel (PTX) and S-1 combination chemotherapy was started after operation and was continued for 42 courses. A CT scan showed a complete response, and he has been well without tumor re-growth ever since. The combination of PTX and S-1 not only may be an effective regimen for gastric cancer with liver metastases, but also can be used without side effects for a long time.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Oxonic Acid; Paclitaxel; Stomach Neoplasms; Tegafur

The patient was a 67-year-old male with Type 3 gastric cancer who underwent distal gastrectomy and D2 dissection in December 2004. It was diagnosed to be a cancer of se, n(1+), Stage IIIA. In October 2006, 22 months after the operations, abdominal CT showed multiple tumors with a maximum diameter of 35 mm in both hepatic lobes. The tumors were diagnosed as multiple hepatic metastases of the gastric cancer. After 5 courses of concomitant S-1+CPT-11 therapy, abdominal CT in February 2007 showed complete elimination of the multiple tumors in both hepatic lobes, and it was considered that a complete response (CR) had been obtained. After initiation of the treatment, 32 courses of S-1+CPT-11 therapy were performed, and at present, 24 months after the therapy, the patient has survived with no redevelopment of the cancer. All of the treatments were performed in an outpatient setting, and no side effects have been confirmed other than grade 1 gastric and skin symptoms. We experienced a case in which CR was achieved by S-1+CPT-11 therapy in a patient with hepatic metastasis of a gastric cancer.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Camptothecin; Drug Combinations; Gastrectomy; Humans; Irinotecan; Liver Neoplasms; Male; Oxonic Acid; Stomach Neoplasms; Tegafur

A 48-year-old woman was referred to our hospital with complaints of appetite loss caused by a sigmoid colon cancer and multiple liver metastasis. To prevent bowel obstruction, a sigmoid colon resection was performed. On postoperative day 27, FOLFOX was begun for the liver metastasis. But FOLFOX6 was discontinued due to diarrheal symptoms of grade 3. The liver metastasis was pointed out again in CT after two months, and S-1 was begun. It became CR on CT again. S-1 can be expected to be an effective agent for the treatment of colon cancer with liver metastasis.

Topics: Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Drug Combinations; Female; Fluorouracil; Humans; Irinotecan; Leucovorin; Liver Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Sigmoid Neoplasms; Tegafur

A 73-year-old woman was admitted to our hospital for hemorrhagic shock due to HCC rupture and treated by transcatheter arterial chemoembolization (TACE) in July 2007, followed by partial hepatic resection two months later. Multiple pulmonary and remnant liver metastases were detected by CT six months after the surgery. Since treatment with UFT for two months was not effective, the chemotherapy was changed to S-1 100 mg/body/day in June 2008. After S-1 treatment for three months, lung metastases remarkably diminished, as did the serum AFP level. Meanwhile, although the S-1 dose was gradually reduced to 50 mg/body/day due to adverse effects, pulmonary lesions and serum AFP level remained stationary for five months. While there is no established regimen for distant metastases of HCC, S-1 may be effective even at a reduced dose.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Drug Combinations; Female; Humans; Liver Neoplasms; Lung Neoplasms; Oxonic Acid; Tegafur; Tomography, X-Ray Computed

A 73-year-old man had undergone right hemicolectomy for advanced colon cancer in May 2006, and he concurrently had multiple liver metastases. After the operation, the patient was given chemotherapy with FOLFIRI. A partial response was achieved for twelve months, and then the liver tumors enlarged. Second-line chemotherapy with FOLFOX was delivered. After several months the liver tumors further enlarged and a new pulmonary lesion appeared with an increased serum CEA level. Therefore, chemotherapy with S-1 (120 mg/day) was started, with 2 weeks' administration followed by a one-week drug-free period. Several months later, the liver tumors and tumor makers decreased. S-1 is expected to be an effective agent for the treatment of advanced colon cancer with liver metastases after FOLFIRI and FOLFOX.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Camptothecin; Carcinoembryonic Antigen; Colonic Neoplasms; Drug Combinations; Fluorouracil; Humans; Leucovorin; Liver Neoplasms; Male; Organoplatinum Compounds; Oxonic Acid; Salvage Therapy; Tegafur; Tomography, X-Ray Computed

The treatment for hepatocellular carcinoma with distant metastasis remains unclear. We experienced a successful case of S-1 chemotherapy for bilateral pulmonary recurrence of hepatocellular carcinoma following hepatectomy after gaining chemoresistance through pretreatment. A 62-year-old man underwent extended right hepatectomy for hepatocellular carcinoma occupying the whole right lobe. CT scan 15 months after hepatectomy revealed bilateral multiple pulmonary recurrence. Pharmacokinetic modulation chemotherapy (PMC) was performed after treatment of UFT, and stable disease status for 24 months was achieved. Pulmonary metastatic lesions gradually became larger, so oral administration of 100 mg per day of S-1 was followed by stable disease status for 9 months. The present case suggests that S-1 chemotherapy may be useful for hepatocellular carcinoma with distant metastasis.

Topics: Administration, Oral; Carcinoma, Hepatocellular; Drug Combinations; Hepatectomy; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Tegafur; Time Factors

In May 2005, a 79-year-old woman was referred to our hospital with complaints of right lower quadrant mass and feces mixed with blood. After examination, she was diagnosed with ascending colon cancer and synchronous multiple liver metastases. Postoperative diagnosis after right hemicolectomy and D3 lymph node dissection was T2, N1, H2, P0, M0, and Stage IV. One month after the operation, we started a combination chemotherapy using 5-FU plus UFT as pharmacokinetic modulating chemotherapy with hepatic arterial infusion (HAI-PMC). But abdominal CT scan revealed the increase of multiple liver metastases, PD, after 4 courses of treatment. We then changed to modified HAI-PMC (additional CPT-11, once every four weeks), but had to cancel it due to her exhaustion and inappetence. Therefore, S-1 was started from October, 2005. Each course consisted of daily oral administration of 80 mg S-1 for 4 weeks and withdrawal for 2 weeks. After 4 courses, abdominal CT scan revealed a reduction in the number of multiple liver metastases, PR. PR has continued for a long term to date. As an adverse event, we had grade 3 neutropenia and grade 2 diarrhea in January 2009, and we changed the administration method (80 mg S-1 for 2 weeks and withdrawal for 1 week). She continues to undergo outpatient treatment with good QOL without a lesion for 4 years and 6 months. S-1 is expected to be an effective agent for the treatment of advanced colon cancer.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Colonic Neoplasms; Drug Combinations; Female; Humans; Liver Neoplasms; Oxonic Acid; Quality of Life; Tegafur; Time Factors; Tomography, X-Ray Computed

The case is a woman in her 50's. A total glandectomy was performed for her breast cancer on August 8, 1998, and subsequently chemotherapy(5'-DFUR, CMF, uracil.tegafur, CEF, and docetaxel)as well as radiation therapy and surgical resection have been performed for local recurrence. With multiple hepatic metastasis recognized in September, 2007, chemotherapy combined with S-1/paclitaxel(PTX)has been performed. In view of the side effects such as reduction in appetite and leukocyte, the dosage has been reduced as of the second course of treatment. With the disappearance of hepatic metastasis on CT, 6 courses of S-1monotherapy have been performed after completing 6 courses of chemotherapy combined with S-1/ PTX. As of March, 2009, the therapeutic effect shows that continuous CR and outpatient follow-up have been performed while maintaining QOL. Since any chemotherapy after thirdline treatment for recurrent breast cancer has not been established yet, chemotherapy combined with S-1/PTX is considered to be one of the regimens and therefore, the second and thirdphase clinical tests ahead are expected to bring better outcomes.

Topics: Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Drug Combinations; Female; Humans; Liver Neoplasms; Middle Aged; Oxonic Acid; Paclitaxel; Recurrence; Tegafur; Tomography, X-Ray Computed

A 72-year-old man underwent total gastrectomy for gastric carcinoma. Postoperative staging was Stage IA. One year after operation, abdominal CT revealed a metastatic tumor in the left lateral posterior segment of the liver. He was given S-1/ CDDP combination chemotherapy(S-1 120mg/body, day 1-21, CDDP 95mg/body, day 8)every 5weeks as first-line treatment. After 2 courses of the treatment, the liver tumor was not detected by PET-CT. The clinical response was assessed to be complete response. After total 5 courses of the treatment, we changed to a single administration of S-1(120mg/body, day 1- 14)every 3 or 4 weeks as second-line chemotherapy. The effect has been continued for 18 months after the initial metastasis. S-1/CDDP and S-1 chemotherapy are effective for metachronous liver metastasis from gastric carcinoma, although prognosis of the disease is poor.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Neoplasm Staging; Oxonic Acid; Positron-Emission Tomography; Recurrence; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

A 7 0-year-old female underwent distal gastrectomy for gastric cancer in November 2001. She did not wish to receive postoperative adjuvant chemotherapy. In May 2002, her serum carcinoembryonic antigen(CEA)level rose. CT demonstrated liver(S5/6)and lung(S9)metastases in August 2002. We started to treat her with S-1(100mg/day day 1-14 orally), and restaging CT showed complete regression of liver and lung metastases in August 2003. In spite her complete response(CR), we continued S-1 treatment for the successive two years. No adverse reaction to chemotherapy occurred. Although CR was maintained for about 4 years, she was found to have a 9-mm solitary lesion in the upper pole of the spleen in June 2007. After 6 months, this tumor increased to 15mm in size, and we considered it as a solitary metastasis to the spleen from gastric cancer. S-1 chemotherapy was restarted, but tumor size gradually increased. Tumor size finally reached 25mm in December 2008. She underwent splenectomy in January 2009. From then until now, she has not received any chemotherapy, and has been followed well without any recurrence.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Drug Combinations; Female; Gastroenterostomy; Humans; Liver Neoplasms; Lung Neoplasms; Neoplasm Metastasis; Oxonic Acid; Remission Induction; Splenectomy; Splenic Neoplasms; Stomach Neoplasms; Tegafur; Time Factors; Tomography, X-Ray Computed

We experienced a case of Luminal B recurrent breast cancer with liver and lymph node metastases achieving significant improvement by S-1 plus trastuzumab combination therapy. This patient was a 47-year-old woman. Trastuzumab monotherapy was administered after recurrence, but her condition grew worse. Thus, we started combination therapy of trastuzumab plus S-1. S-1 was administered orally at 100 mg/day every day for 4 weeks followed by a 1-week rest period as one course, and trastuzumab was then injected at 2 mg/kg every week. All metastases disappeared after two courses of the treatment, and no new malignant lesions appeared. In conclusion, combination therapy of S-1 plus trastuzumab could be effective treatment for maintaining good QOL in Luminal B recurrent breast cancer with lymph node and liver metastases.

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Drug Combinations; Female; Humans; Liver Neoplasms; Lymphatic Metastasis; Middle Aged; Oxonic Acid; Recurrence; Salvage Therapy; Tegafur; Tomography, X-Ray Computed; Trastuzumab

A 61-year-old man with the chief complaint of pressure with swallowing was referred to our hospital with type 3 cardiac gastric cancer. Gastrofiberscope showed type 3 cardiac cancer with esophageal invasion. On the abdominal computed tomography, there was evidence of lymph node swelling in the lesser curvature and multiple liver metastases. Blood tumor markers were elevated: CEA 200 ng/mL, CA19-9 2,490 U/mL. He was diagnosed as unresectable advanced gastric cancer UE-circ, type-3, c-T3N2H1P0M1, Stage IV. A biopsy revealed adenocarcinoma (tub2-por1). We started bi-weekly docetaxel and S-1 combination chemotherapy(DOC 40 mg/m2 day 1, 14, S-180 mg/m2 day 1-7, 14-21). After completion of the first course of this combination therapy, his feeling of pressure was relieved and CT showed reduction of multiple liver lesions and lymph node metastases, indicating partial response. No regrowth was seen for 7 courses of the therapy. Regarding toxicity, grade 2 nausea and grade 1 nail pain were observed. After 7 courses, because of serum CEA elevation, bi-weekly CPT-11/CDDP therapy (CPT-11 60 mg/m2, CDDP 30 mg/m2) was administered followed by weekly PTX therapy (65 mg/m2 day 1, 7, 14; total of 4 weeks). To date, 17 months after administration of chemotherapy, he has been treated on an outpatient basis. Biweekly DOC/S-1 therapy can be novel antitumor therapy which can be conducted safely in an outpatient setting for advanced gastric cancer.

Topics: Antineoplastic Combined Chemotherapy Protocols; Docetaxel; Drug Combinations; Esophageal Neoplasms; Esophagoscopy; Gastroscopy; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Oxonic Acid; Stomach Neoplasms; Taxoids; Tegafur; Tomography, X-Ray Computed

A 73-year-old man diagnosed as having pancreatic body cancer with multiple liver metastases was referred to our hospital. Since the patient preferred oral agents, S-1 monotherapy (4-week administration followed by 2-week interval) was started. The initial dose of S-1 was 80 mg, and gradually increased to 150 mg/day. There were no significant adverse events. The liver metastases disappeared and the pancreatic tumor was markedly reduced in size at the completion of 4 courses. Distal pancreatectomy was carried out at 7 months since his first visit. Pathological diagnosis was non-functioning well-differentiated neuroendocrine carcinoma (pT4, pN0, pM0, Stage IVa). He is alive without relapse 6 months after operation. S-1 might be a candidate for chemotherapy for this neuroendocrine tumor.

Topics: Aged; Antimetabolites, Antineoplastic; Drug Combinations; Humans; Liver Neoplasms; Male; Neoplasm Staging; Neuroendocrine Tumors; Oxonic Acid; Pancreatic Neoplasms; Positron-Emission Tomography; Tegafur; Tomography, X-Ray Computed

A 71-year-old man suffering from epigastric discomfort and dizziness was admitted to our hospital and diagnosed with advanced gastric cancer with bulky lymph node metastases and liver metastasis. We thought a complete resection would be difficult, so he was treated with neo-adjuvant immunochemotherapy in combination with S-1 80 mg/m2 (2 weeks administration and 2-week rest), paclitaxel (PTX) 50 mg/m2 (day 1, 8, 15) and Lentinan (LNT) 2 mg/body (day 1, 8, 15). After 5 courses of this treatment, swollen lymph nodes decreased in size and the metastatic liver tumor disappeared. Total gastrectomy with lymph node dissection was performed. The histological diagnosis was pT2 pN0, Stage I B. Histological effects of primary tumor and lymphnodes were judged to be grade 2 and grade 3, respectively. We considered that the combination of S-1, PTX and LNT can be effective and safe for advanced gastric cancer.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Gastrectomy; Humans; Lentinan; Liver Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Neoadjuvant Therapy; Neoplasm Staging; Oxonic Acid; Paclitaxel; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

We report a case of a 77-year-old man with gastric cancer of Borrmann type 3, pyloric stenosis and liver invasion. Distal gastrectomy with liver film resection was performed. Pathological staging was IV(sig, pT4, pN2, H0, P0, CY0, M0, ly3, v3). We recommended adjuvant chemotherapy but the patient refused. He was diagnosed with a recurrence of peritoneal dissemination 4 months after the operation. He received docetaxel(DOC)at a starting dose of 40 mg/m2 by iv infusion on day 1 and S- 1 at a full dose of 100 mg/body daily for two weeks every three weeks. After 5 cycles of this combination therapy, the gastric cancer with peritoneal dissemination completely disappeared. He was recognized to have grade 2 hematologic toxicity, hand foot syndrome and stomatitis, and all treatment-related toxicities were resolved. No re-growth of gastric cancer has been seen for 9 months with this chemotherapy.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Docetaxel; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Oxonic Acid; Peritoneal Neoplasms; Remission Induction; Stomach Neoplasms; Taxoids; Tegafur; Tomography, X-Ray Computed

The prognosis for pancreatic cancer with distant metastases is not good. The case reported here is of pancreatic body cancer with multiple liver metastasis in which S-1+gemcitabine (GEM) therapy proved to be effective.. A 77-year old female. She was asymptomatic and diagnosed as a pancreatic body cancer with multiple liver metastases at the end of December 2008 by periodical ultrasonography. After careful examination, GEM 1,200mg/body was administered on days 1 and 15, and S-1 was administered orally at 80mg/day for two weeks, followed by two weeks rest. Currently, at the end of the 10th course, tumor size has been reduced from 26.5mm to 18.9 mm, and two of the five liver metastatic lesions have disappeared, while the remaining three liver lesions have been revealed as scars by CT examination. Tumor marker levels have been remarkably decreased. Ten months from the initial diagnosis, there has been no side effect and chemotherapy is being continued.. In pancreatic cancer with distant metastases, S-1+GEM therapy may be able to provide a long-term prognosis.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Liver Neoplasms; Oxonic Acid; Pancreatic Neoplasms; Tegafur; Tomography, X-Ray Computed; Ultrasonography

A 65 -year-old male was admitted to our hospital because of epigastregia. Computed tomography (CT) and abdominal ultrasonography (AUS) revealed advanced gallbladder cancer and two S5 liver metastases. Selective gallbladder angiogram revealed his cystic vein was draining into the portal vein (P5), so cholecystectomy and S4a+S5-subsegmentectomy were performed. Pathological study of the resected specimens showed three liver metastases. After surgical resection lumbar metastasis was suspected, so radiotherapy and UFT at 300mg/day were started. Next, we started oral administration of S-1 alone (100mg/body) for 4 weeks followed by a 2-week rest period as one course. 100mg/day was changed to 80mg/body after 3 courses because of grade 2 neutropenia. A total of 31 courses of S-1 80mg/day were administered postoperatively for five years. The patient is alive and free of disease five years and ten months after the operation.

Topics: Aged; Drug Combinations; Gallbladder Neoplasms; Humans; Liver Neoplasms; Male; Neoplasm Staging; Oxonic Acid; Remission Induction; Tegafur; Tomography, X-Ray Computed

A 55-year-old man underwent a pylorus-preserving pancreatoduodenectomy in August 2006 because of acinar cell carcinoma of the head of the pancreas. Since abdominal CT revealed multiple liver metastases, we started systemic chemotherapy with gemcitabine (1,400 mg/body, day 1, 8, 15/q4w) in October 2006. At the beginning of this treatment, it seemed to be a stable disease, but CT revealed tumor progression in January 2007. Despite the change to oral chemotherapy with S-1 (100 mg/body, day 1-14/q3w), tumors were markedly enlarged in March 2007. Therefore, we selected combination chemotherapy with oral S-1 and hepatic arterial infusion of CDDP (50 mg/body) as third-line. After 6 months of treatment, abdominal CT revealed marked shrinkage of tumors, accompanied by a decrease in AFP level. Though the patient died of hepatic failure in July 2009 (33 months after recurrence), he spent most of his time at home and worked as usual. We suggest that combination chemotherapy with oral S-1 and intra-arterial CDDP can be effective treatments for pancreatic acinar cell carcinoma.

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Acinar Cell; Cisplatin; Drug Combinations; Fatal Outcome; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Recurrence; Tegafur; Tomography, X-Ray Computed

We report a case of alphafetoprotein (AFP)-producing gastric cancer that accompanied early gastric cancer and was treated effectively by chemotherapy. The patient was a 73-year-old male. A type 1 tumor was observed in the upper gastric body and a 0-IIa tumor was noted on the anterior wall of the lower gastric body. Abdominal CT showed multiple metastatic lesions in the liver. A subtotal gastrectomy was performed, and the pathological examination revealed that the type 1 tumor was positive for AFP and the 0-IIa tumor was negative for AFP. After 5 courses of postoperative administration of S-1, hepatic metastatic lesions disappeared on imaging. The serum AFP level, which had increased to the maximum of 49,660 ng/ml, was normalized. After 60 months, there has been no sign of recurrence. We encountered a case of AFP-producing gastric cancer that accompanied early gastric cancer and was treated effectively by S-1. Various therapies for AFP-producing gastric cancer have been reported; however, a standardized regimen has not been established. Since the concurrence of AFP-producing gastric cancer and tubular adenocarcinoma is rare, and hepatic metastatic lesions disappeared, the case under study is considered to be of interest. Therefore, we report this case with a review of the literature.

Topics: Aged; alpha-Fetoproteins; Drug Combinations; Humans; Liver Neoplasms; Oxonic Acid; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

We report a case of multi-drug-resistant breast cancer with liver metastases which completely responded and improved the quality of life (QOL)by S-1 monotherapy. The patient was a 53-year-old woman, who was diagnosed as breast cancer with invasive chest wall, cervical lymph node metastases, multiple bone metastases and bilateral pleural effusion[invasive ductal carcinoma, scirrhous type, ER(-), PgR(+), HER2(1+)]. After six courses of cyclophosphamide+epirubicin(CE)and weekly paclitaxel for 3 months, cervical lymph node metastasis was judged as a partial response(PR)and the bilateral pleural effusion disappeared. After chemotherapy, aromatase inhibitor (AI) was used. However, primary lesion and multiple bone metastases no change(NC). Following pass through AI+ oral anticancer drug combination chemotherapy and oral anticancer drug monotherapy, the therapy was changed to palliative, and she was referred to our hospital in January 2007. On arrival at the hospital, respiratory distress and bilateral pleural effusion had appeared, so it was an emergency admission. After removing the pleural effusion, pleurodesis was done and the symptoms disappeared. Although AI plus bisphosphonate therapy were started at hospital discharge, disease progression and fatigue appeared. In December 2007, we started S-1 monotherapy. S-1 was given orally at 80 mg/m2 for day 1-28 followed by a 2-week rest period, within a 6-week courses. Six months after treatment was started, multiple liver metastases disappeared and peritoneal effusion decreased. During the period of S-1 treatment, there were no serious adverse events, and treatment was possible without compromising QOL. This result suggested that S-1 treatment was a reasonable option for multi-drug-resistant breast cancer.

Topics: Antimetabolites, Antineoplastic; Breast Neoplasms; Carcinoma, Ductal, Breast; Drug Combinations; Drug Resistance, Multiple; Drug Resistance, Neoplasm; Female; Humans; Liver Neoplasms; Lymphatic Metastasis; Middle Aged; Neoplasm Metastasis; Oxonic Acid; Tegafur

Based on its potent inhibition of dihydropyrimidine dehydrogenase (DPD), S-1 is expected to be more active than other flouropyrimidines against tumors with higher DPD activity, such as hepatocellular carcinoma (HCC).. We retrospectively investigated the efficacy of S-1 and platinum in HCC. Patients received S-1 (80 mg/m(2)/day on days 1-14) with either cisplatin (60 mg/m(2) on day 1) or oxaliplatin (130 mg/m(2) on day 1) every 3 weeks. The primary end point was overall response rate.. Among the 21 HCC patients, 12 and 9 patients received S-1-based chemotherapy as a first-line and salvage treatment, respectively. Partial response was seen in 5 patients and stable disease in 6. The median time-to-progression was 4.0 months (95% confidence interval [CI], 2.4-5.6) and median overall survival was 14.0 months (95% CI, 6.7-21.3). Most patients were tolerable to chemotherapy and no grade 4 toxicity was observed. Tumors with lower DPD expression were more responsive to the therapy (response rate 60.0% in lower vs. 0.0% in higher DPD, p=0.045).. S-1 and platinum combination chemotherapy shows favorable efficacy and tolerability in advanced HCC.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Carcinoma, Hepatocellular; Cisplatin; Drug Combinations; Female; Humans; Immunohistochemistry; Liver Neoplasms; Male; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Oxonic Acid; Retrospective Studies; Tegafur

The patient was a 74-year-old man whose chief complaint was epigastralgia. A detailed examination revealed a gastric cancer located from antrum to duodenal bulb with multiple liver metastases. Because of a difficulty with oral intake, we performed a distal gastrectomy at first. After the operation, a combination chemotherapy with S-1 and weekly paclitaxel was performed, and liver metastases were successfully disappeared after 4 courses of the regimen. A subsequent CT evaluation after 6 courses of the regimen revealed that liver metastases maintained the clinical complete response (cCR), but a right adrenal tumor was detected. We performed a right adrenalectomy after 13 months from gastrectomy, and a histopathological examination revealed that the adrenal tumor was a recurrent gastric cancer. After the second operation, only one course treatment of S-1 alone was performed because the patient rejected the chemotherapy. The patient is alive without a chemotherapy and maintained cCR for 75 months after the second operation.

Topics: Adrenal Gland Neoplasms; Adrenalectomy; Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Oxonic Acid; Paclitaxel; Remission Induction; Stomach Neoplasms; Tegafur

We report a case of postoperative liver metastasis of pancreatic cancer that was resistant to S-1 and gemcitabine (GEM) successfully treated by hepatic arterial infusion of 5-fluorouracil (5-FU) and cisplatin (CDDP). A 70s woman was referred to our hospital for treatment of a pancreatic head cancer in November 2007. Pancreaticoduodenectomy with a regional lymphadectomy was performed in December 2007 and the pathological stage was Stage IVa. Adjuvant chemotherapy of UFT was administered one month after operation. However, a second chemotherapy of S-1 was administered because DUPAN-2 levels showed a high range 8 months after operation. Ten months after operation, abdominal computed tomography demonstrated a 2 cm tumor in the liver. Although, we performed a systemic GEM infusion and a combination of GEM and S-1, the liver metastasis had progressed. Then, hepatic arterial infusion (HAI) chemotherapy of 5-FU/CDDP was instituted weekly. This efficacy maintained a Partial Response from the start of HAI to the fifth month. She is alive to date, maintaining a stable tumor growth of 30 months after surgery. We suggest that HAI chemotherapy of 5-FU+CDDP might be an effective treatment to liver metastasis of pancreatic cancer and prolong prognosis of those patients.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Drug Resistance, Neoplasm; Female; Gemcitabine; Hepatic Artery; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Lymph Node Excision; Oxonic Acid; Pancreatic Neoplasms; Pancreaticoduodenectomy; Tegafur

A case was a 57-year-old man. Despite a diagnosis of cStage IV gastric cancer (cN2, cH0, cM0, cT3 (SE), cP1), we preferentially performed a non-curative surgery to avoid stenosis or bleeding by tumor invasion. Since no evidence of peritoneal metastasis was found at surgery, distal gastrectomy with D2 lymph node dissection was performed, and lymph nodes anterior to the pancreatic head were sampled. The pathological diagnosis was pT3 (SE), pN2, sH0, pM1 (LYM), pStage IV. After the surgery, S-1 was administered. One year and 9 months later, a solitary metastasis was found in S6 of the liver, and the patient underwent radiofrequency ablation (RFA) followed by adjuvant S-1. Currently, 5 years and 10 months after the surgery, the patient is under follow-up, and remains alive with recurrence-free. We speculate that in the presence of N or M (LYM) factors for stage IV gastric cancer, surgery with lymphadenectomy, which does not prevent the completion of adjuvant chemotherapy, followed by multimodal treatments such as continued chemotherapy and RFA, led to the long-term survival.

Topics: Antimetabolites, Antineoplastic; Catheter Ablation; Combined Modality Therapy; Disease-Free Survival; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Lymph Node Excision; Male; Middle Aged; Neoplasms, Second Primary; Oxonic Acid; Stomach Neoplasms; Tegafur; Treatment Outcome

An 85 years old man was performed systemic chemotherapy after the palliative gastrectomy for unresectable gastric cancer with multiple liver metastases. The response evaluation revealed a progressive disease after 4 courses of first-line S-1 therapy and 3 courses of second-line paclitaxel therapy. At this point, metastatic lesions were still localized in the liver, so hepatic arterial infusion chemotherapy (HAI) was introduced as third-line therapy. Despite the marked reduction of all target lesions and reduced tumor marker level after 25 weeks of HAI without any adverse event, novel multiple metastatic lesions had appeared in the lung and celiac LNs, resulted in the cessation of HAI. Then he had suffered grade 3 mucositis oral and anorexia throughout 2 courses of fourth-line S-1 + CDDP therapy and fifth-line docetaxel therapy. Considering that the goal of treatment for unresectable gastric cancer patients is to delay developing symptoms and to prolong their life with the least adverse event, HAI could be an effective therapy.

Topics: Aged, 80 and over; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Agents, Phytogenic; Cisplatin; Combined Modality Therapy; Drug Combinations; Hepatic Artery; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Male; Oxonic Acid; Quality of Life; Stomach Neoplasms; Tegafur

Gastric endocrine cell carcinoma is known to be highly malignant with a poor prognosis, and no standard treatment has been established. We experienced a case of gastric endocrine cell carcinoma with liver and lymph node metastases. The lesions became resectable after chemotherapy with S-1/cisplatin (CDDP). The patient was a 68-year-old male. He had gastrointestinal endoscopy for screening without complains. The endoscopy findings showed that a type 3 gastric cancer on lesser curvature of ventricular angle of the stomach, and was histologically diagnosed as an endocrine cell carcinoma by the biopsy specimen. A computed tomography (CT) scan showed metastatic lesions at S2 and S3 of the liver, and No.6 lymph node enlargement. Thus he was diagnosed as gastric endocrine cell carcinoma with liver and lymph node metastases. He was treated chemotherapy with S-1/CDDP every 5 weeks. After these courses of treatment, liver and lymph node metastatic lesions had reduced in size, but the primary lesion was still remained. Then he suffered from a drug induced eruption due to S-1. We changed the chemotherapy to biweekly CPT-11/CDDP. After 21 courses, he underwent distal gastrectomy with lymph node dissection and a partial liver resection. Histological findings revealed that there were no cancer cells in removed specimens. He had treated 8 courses of CPT-11/CDDP therapy after the surgery, and survived for 5 years without recurrence.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cisplatin; Drug Combinations; Endocrine Gland Neoplasms; Gastrectomy; Hepatectomy; Humans; Irinotecan; Liver Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Oxonic Acid; Stomach Neoplasms; Tegafur; Treatment Outcome

In a patient with multiple liver metastases of colorectal cancer whose tumor response had been achieved by 5-FU hepatic arterial infusion, a catheter for arterial infusion chemotherapy was occluded resulting in re-elevation of tumor marker levels. For this reason, a second-line IRIS therapy using S-1 and CPT-11 was started. IRIS therapy reduced tumor marker levels to a degree greater than that of previously achieved with 5-FU hepatic arterial infusion, and a diagnostic imaging allowed a judgment of partial response. Although a ratio of liver tumor volume to liver volume was 57% on admission of this patient, the ratio was reduced to 16% by the 14th course of 5-FU hepatic arterial infusion immediately before the catheter was occluded. The ratio was 18% after the 7th course of IRIS therapy, and the diagnostic imaging showed a partial response. Hepatic arterial infusion therapy is one of the treatment methods characterized by a lower incidence of adverse reactions, relatively low cost, and expectation of high anti-tumor efficacy as compared to chemotherapy such as FOLFIRI. IRIS therapy does not require a port insertion and it costs about a half of FOLFIRI therapy. When used as a second-line therapy for unresectable colorectal cancer, IRIS therapy has demonstrated non-inferiority compared to FOLFIRI in a phase III clinica (l FIRIS) study.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colorectal Neoplasms; Drug Combinations; Fluorouracil; Humans; Infusions, Intra-Arterial; Irinotecan; Leucovorin; Liver Neoplasms; Male; Oxonic Acid; Tegafur; Tumor Burden

A 54-year-old man was diagnosed as hepatitis B in 1987 and observed. In January 2007, he was detected a 7 cm mass in the posterior segment of the liver with inferior vena cava tumor thrombus (Vv3), a 4.5 cm mass and multiple small nodules in the liver by computed tomography. Moreover, his right pubic bone has solitary small osteolytic change in x-ray and abnormal up take on bone scintigram. We diagnosed it having a highly advanced hepatocellular carcinoma (HCC) with bone metastasis. We started to treat with multidisciplinary therapy. We performed Transarterial chemoembolization (TACE) twice for intrahepatic lesions and radiotherapy for bone metastasis. Interferon-α and S-1 combination therapy were performed for three months. A new lesion in the liver was appeared advanced slowly 16 months after the last TACE, and caused to increase PIVKA-II. He received TACE for this lesion. Three years after the diagnosis, and he is alive in good condition without a new extrahepatic metastasis. This case suggests that some patients with highly progressive HCC involving inferior vena cava tumor thrombus (Vv3) and bone metastasis can gain a long-term survival by multidisciplinary therapy including TACE and Interferon-α and S-1.

Topics: Antimetabolites, Antineoplastic; Bone Neoplasms; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Combined Modality Therapy; Drug Combinations; Humans; Immunologic Factors; Interferon-alpha; Liver Neoplasms; Male; Middle Aged; Neoplastic Cells, Circulating; Oxonic Acid; Tegafur; Vena Cava, Inferior; Venous Thrombosis

It is not clear what the optimal treatment of chemotherapy is for patients with heavily treated metastatic breast cancer (MBC). We have retrospectively examined the efficacy and safety of S-1 in patients with MBC who had been previously treated with anthracycline, taxane, and capecitabine.. Patients with MBC who had been administered S-1, an oral modulated compound containing a fluoropyrimidine derivative, between November 2001 and June 2003 at the Cancer Institute Hospital were retrospectively reviewed. S-1 at a standard dose of 50 mg/body was administered twice daily for four weeks, followed by a two-week rest period. This was repeated every six weeks until disease progression or unacceptable toxicity.. Thirty-five patients were assessed. The patients were heavily pretreated with anthracycline (100%), taxane (paclitaxel or docetaxel) (100%), capecitabine (100%), vinorelbine (71%), and mitomycin (69%). Median follow-up time of patients was 9.6 months (range, 1.2-26.6). ORR was 3% (95% confidence interval: 0-9%), and CBR was 20% (95% confidence interval: 6-33%). Time to treatment failure was 2.8 months. Overall survival was 21.4 months. Grade 1 or 2 adverse events were observed in 17% and 13%, respectively. Grade 3 events occurred as anorexia (9%), nausea (9%), vomiting (9%), diarrhea (14%), fatigue (3%), and elevation of AST/ALT (3%). No grade 3 was seen as hand-foot syndrome. Neither grade 3 nor 4 was observed in bone marrow suppression.. S-1 was fairly well tolerated, but demonstrated very limited activity in capecitabine-pretreated patients who had already been exposed to anthracycline and taxane. It was suggested that S-1 clinically exhibited cross-resistance to capecitabine.

Topics: Adult; Aged; Aged, 80 and over; Anthracyclines; Antimetabolites, Antineoplastic; Bone Neoplasms; Breast Neoplasms; Bridged-Ring Compounds; Capecitabine; Deoxycytidine; Drug Combinations; Drug Resistance, Neoplasm; Female; Fluorouracil; Humans; Liver Neoplasms; Lung Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Oxonic Acid; Pleural Neoplasms; Prognosis; Retrospective Studies; Survival Rate; Taxoids; Tegafur; Treatment Outcome

The patient was a 70-year-old male with advanced cancers of stomach and rectum and multiple metastatic hepatic tumors. No resectability was detected. The origin of metastatic hepatic tumors was unknown, so the combination of S- / 1 and CPT-11 as a treatment regimen was selected. S-1, 80 mg m(2), was administered on 14 consecutive days followed / by a 14-day rest period, and CPT-11, 100 mg/m(2), was administered on day 1 and day 15. One cycle was defined as 4 weeks, and cycles were repeated. CR was achieved as long as metastatic hepatic tumors after completion of 5 cycles. When we encounter a case of simultaneous double cancers with metastatic sites which has no respectability, generally speaking, it is difficult to determine the strategy for chemotherapy. This case suggests that the combination of S-1 and CPT-11 may be an effective regimen for the treatment of simultaneous advanced cancers of stomach and rectum with multiple hepatic metastases.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Camptothecin; Carcinoembryonic Antigen; Drug Combinations; Endoscopy, Gastrointestinal; Humans; Irinotecan; Liver Neoplasms; Male; Neoplasms, Multiple Primary; Oxonic Acid; Rectal Neoplasms; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed; Treatment Outcome

The case was a 70-year-old man with type-2 gastric cancer in the lesser curvature accompanied by multiple liver metastases. He received combination chemotherapy of S-1 and CDDP. S-1 was administered at 100 mg/body/day for 21 days followed by withdrawal for 14 days, and CDDP was prescribed at 80 mg/body/day div on day 8. After 3 courses of treatment, the multiple liver metastases disappeared. The primary gastric lesion had changed to a scar and endoscopic biopsy revealed no cancer cell. After the 4th course, we changed the therapy to S-1 alone and after that to UFT alone. Now, 3 years and 3 months after inducing CR, the patient continues to receive UFT with no regrowth of the tumor.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Cisplatin; Drug Combinations; Humans; Liver Neoplasms; Male; Neoplasm Staging; Oxonic Acid; Remission Induction; Stomach Neoplasms; Tegafur; Time Factors; Tomography, X-Ray Computed

A 82-year-old man with advanced gastric cancer underwent distal gastrectomy in January 2006. The histological diagnosis was poorly-differentiated adenocarcinoma, T2(MP), pN2, sH0, sP0, CY0; fStage III A. Three months after the operation, two metastatic nodules were noticed on the liver. The patient was treated with S-1 in April 2006. After the 8 courses of S-1 treatment, a complete response was achieved. However, a lymph node metastasis was newly found adjacent to the remnant stomach 2 months after the complete response to S-1. 5'-DFUR+paclitaxel combination therapy was then performed. After the 2 courses, the metastatic lymph node completely disappeared. We continued a total of 18 courses of the 5'-DFUR+paclitaxel therapy approximately for 1 year without critical drug toxicity. The patient has been alive without any recurrent site. Thus 5'-DFUR+paclitaxel as a second-line therapy following S-1 should be recommended for a gastric cancer patient with a recurrent tumor.

Topics: Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Carcinoembryonic Antigen; Drug Combinations; Floxuridine; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Oxonic Acid; Paclitaxel; Remission Induction; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

Perfusion-weighted magnetic resonance imaging (MRI) can detect the changes of signal intensity in tumors. We evaluated the prognostic value of perfusion-weighted MRI in patients with advanced pancreatic cancer (PC).. Perfusion-weighted MRI was performed before treatment on 27 consecutive patients with advanced PC. The American Joint Committee on Cancer (AJCC) stages of patients were as follows (8, stage III; 19, stage IV). Imaging acquisition was continually repeated with echo planar sequence every 2 seconds for 2 minutes after a bolus injection of gadolinium. We made a time intensity curve of PC and calculated the signal ratio (SR) on perfusion-weighted imaging. We assessed the relation between SR and clinical factors including tumor stage, lymph node metastasis, liver metastasis, and so on. Patients were divided into low and high SR group and compared SR with the overall survival.. All cases showed transient decreases signal intensity (SR, 6.9-55.7%). These patients were classified into 2 groups at cutoff median SR of 22.0% The high SR group significantly correlated with the higher stage (P=0.03) and the presence of lymph node metastasis (P=0.04). The high SR group had significantly shorter overall survival (P=0.04).. Perfusion-weighted MRI may predict the survival in advanced PC patients.

Topics: Aged; Antineoplastic Agents; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Pancreatic Neoplasms; Prognosis; Tegafur

A 58-year-old woman was admitted to the hospital because of abdominal fullness and anorexia. Abdominal CT scan revealed pancreatic cancer with massive ascites showing peritoneal dissemination, combined with lymph node and liver metastases. Cytology of ascites showed malignancy. Abnormally high values of CA19-9 (1,908 U/mL) and CA125 (545 U/mL) were detected in serum. Histologically, metastatic adenocarcinoma was recognized by laparoscopic biopsy of peritoneal dissemination. We performed systemic chemotherapy of S-1, gemcitabine and peritoneal infusion of paclitaxel for nonresected pancreatic cancer. After 5 courses, ascites disappeared and the serum CA19-9 and CA125 levels regained their normal value. Peritoneal seeding was not found by second laparoscopic examination 20 months after beginning chemotherapy. Thus, we consider the patient had an effective response, and performed distal pancreatectomy and proximal resection of the stomach. Histological examination of the primary lesion revealed no cancer cells where fibrosis presented.

Topics: Adenocarcinoma; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; CA-125 Antigen; CA-19-9 Antigen; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Liver Neoplasms; Middle Aged; Oxonic Acid; Paclitaxel; Pancreatic Neoplasms; Peritoneal Neoplasms; Tegafur

The patient was a 73-year-old man who was hospitalized with advanced gastric cancer. Computer tomography showed multiple liver and mediastinum lymph node metastases. Therefore, he was diagnosed as unresectable gastric cancer(Stage IV). We attempted low-dose combination therapy of CDDP and S-1, but it was ineffective against advance gastric cancer. We decided to change the chemotherapy, using combination therapy of paclitaxel and S-1. In the regimen, paclitaxel (60 mg/m/2) was administered on day 1, day 8, and day 15. S-1 (80 mg/m2) was administered 4 weeks with a 2-week rest. After the 2 courses, computer tomography showed reduction of the liver metastasis and disappeared of the lymph node metastases. Therefore, he could undergo total gastrectomy and radiofrequency ablation of liver metastases. He continued this combination therapy one year after the operation. The cancer has not recurred thus far. When combination chemotherapy of paclitaxel and S-1 was effective against Stage IV gastric cancer, we suggested that radical surgery is possible for those cases.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Mediastinum; Neoadjuvant Therapy; Oxonic Acid; Paclitaxel; Stomach Neoplasms; Tegafur

A 59-year-old man was admitted to our hospital for the treatment of gastric cancer with synchronous and multiple metastatic liver tumors. After total gastrectomy in February 2005, partial resection of the posterior segment of the liver was carried out in the next month. Pathological study of both the resected specimens showed moderately differentiated adenocarcinoma. The postoperative treatment with S-1 was initiated without any evidence of recurrence. However, CT scans showed recurrent multiple liver tumors after 4 courses of treatment with S-1. Subsequently, a combination chemotherapy of S-1 (80 mg/m(2) over day 1-14 with a 2-week rest) and paclitaxel (PTX) (120 mg/m(2), day 1 and 15) was applied. After 3 courses, CT scans showed reduced liver metastases, judged as a partial response(PR)on Response Evaluation Criteria in Solid Tumors (RECIST). However, metastatic liver tumors showed progressive disease (PD) after 7 courses of treatment. The treatment was changed to combination chemotherapy with S-1 (80 mg/m(2) over day 1-21 with a 2-week rest) and CPT-11 (80 mg/m(2) day, day 1 and 15) for 6 courses, but the legions showed PD. He was then treated with combined chemotherapy with S-1 (70 mg/m(2) over day 1-14 with a 1-week rest)and cisplatin (CDDP) (10 mg/m(2), day 1 and 8). However, his condition became worse and he was treated at the palliative care unit. There were no adverse effects greater than grade 4 throughout the treatment period, and his treatment was continued as an outpatient for more than two years. This case suggests that after failure of S-1 therapy, S-1 combination chemotherapy might be an effective treatment for recurrent gastric cancer.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Chemotherapy, Adjuvant; Cisplatin; Drug Combinations; Fatal Outcome; Gastrectomy; Humans; Irinotecan; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Paclitaxel; Recurrence; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

A57 -year-old man. Though chronic hepatitis C was pointed out before, it had been left untreated for about 5 years. He was hospitalized because many venereal diseases had been pointed out in the liver by abdomen ultrasonography. Results of close examination revealed stage IV B with bone metastases, and pulmonary metastases was diagnosed. After consultation, whole-body chemotherapy combining S-1 and PEG-IFN was attempted as of June 26, 2007. S-1 (80 mg/day) was then administered every day for two weeks with drug withdrawal for one week. PEG-IFNalpha-2a (180 microg)was administered once a week. We set three weeks as one course. The liver tumor was markedly reduced, and the pulmonary metastases were also reduced at the completion of 5 courses. The therapeutic effectiveness of this chemotherapy was confirmed by imaging test. The course was favorable, and whole-body chemotherapy was discontinued on January 29, 2008. At this writing in October of 2008, the course has been uneventful. This treatment method is a promising choice for whole-body chemotherapy for advanced hepatocarcinoma in the future. We have added some review of the literature, and the S-1+PEG-IFN combination chemotherapy is reported.

Topics: Angiography; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Carcinoma, Hepatocellular; Drug Combinations; Hepatitis C, Chronic; Humans; Interferon alpha-2; Interferon-alpha; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Polyethylene Glycols; Recombinant Proteins; Tegafur; Tomography, X-Ray Computed

The patient was a 51-year-old male diagnosed with gastric cancer in July 1999 by endoscopic examination, revealing multiple liver metastasis with abdominal computed tomography (CT). The serum levels of alpha-fetoprotein (AFP)were determined to be 91 ng/mL, and tumors were histopathologically identified as AFP-producing gastric cancer by immunohistological staining. We started combination chemotherapy with 5-fluorouracil (5-FU), Leucovorin (LV), etoposide (VP-16) and cis-diaminedichloroplatinum (CDDP) (designated as FLEP)in August 1999. The serum AFP value was normalized after two courses, and the liver metastases disappeared. The primary gastric tumor became a ulcer, and disappearance of the cancer was confirmed histologically. We continued adjuvant chemotherapy with S-1 as an outpatient. In April 2000, there was no sign of the liver metastases, but endoscopic examination showed IIc-like lesion in the stomach. We performed 2 courses of FLEP, but the tumor did not disappear. He underwent total gastrectomy with D2 dissection in June 2001. The pathological diagnosis was por 1, ss, ly2, v1, n(1+). He was still alive with no sign of recurrence 84 months after surgery. We experienced this AFP-producing gastric cancer in which CR was possible by FLEP. There was no recurrence after total gastrectomy for local recurrence.

Topics: Adenocarcinoma; alpha-Fetoproteins; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Cisplatin; Drug Combinations; Etoposide; Fluorouracil; Gastrectomy; Humans; Immunohistochemistry; Leucovorin; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Remission Induction; Stomach Neoplasms; Tegafur

The patient was a 42-year-old female who had advanced rectal cancer(Ra, type 2)with liver metastasis. The preoperative diagnosis was T2N1H2, but the liver tumor was unresectable for hepatic vein invasion in September, 2004. She underwent low anterior resection for primary rectal cancer at first after she was given S-1 80 mg/day(14 days)for a histological effect judgment. The pathological diagnosis was moderately-differentiated adenocarcinoma, ss, n1, and the histological effect was Grade 1a. Because CT showed reduction of liver metastasis after the operation, she was treated with 2 courses of chemotherapy using S-1. Radiographic examination showed reduction of liver metastasis(36%)and improvement of hepatic vein invasion. In January, 2005, she underwent hepatectomy and the pathological diagnosis was moderately-differentiated adenocarcinoma, metastasis and the histological effect was Grade 1a. There has not been any recurrence for 48 months after hepatectomy. We experienced this case in which preoperative S-1 proved effective for liver metastasis from rectal cancer.

Topics: Adenocarcinoma; Adult; Antimetabolites, Antineoplastic; Drug Combinations; Female; Hepatectomy; Humans; Liver Neoplasms; Neoadjuvant Therapy; Oxonic Acid; Rectal Neoplasms; Tegafur

Feasibility and efficacy of S-1 and cisplatin followed by surgery was evaluated, and factors contributing to survival benefit were analyzed.. In total, 120 consecutive patients with highly advanced gastric cancer were treated with S-1 (80 mg/m(2) for 21 consecutive days) and cisplatin (50 mg/m(2) on day 8).. The response rate was 62.5% overall, and 75.7% for these with metastatic lymph nodes. Grade 3/4 adverse events were less than 10%. The median survival time was 41.9 months among 93 patients whose primary lesion was resected. Liver metastasis, R2 resection, poor performance status and lack of response were identified as independent risk factors by a multivariate analysis.. Preoperative chemotherapy with S-1 and cisplatin was effective. The results show the need for different approaches in the treatment of patients with metastases and these without.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Cisplatin; Drug Combinations; Female; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoadjuvant Therapy; Oxonic Acid; Retrospective Studies; Stomach Neoplasms; Survival Rate; Tegafur; Treatment Outcome

A 78-year-old man underwent a radical resection for esophageal cancer (Stage III) and cardiac gastric cancer (Stage IA) at another hospital 2 years ago. After the operation, he was followed at that hospital. In 2008, abdominal CT scan and FDG-PET/CT revealed a liver tumor. He was referred to our hospital and was diagnosed as esophageal cancer with liver metastasis. He received chemo-radiation therapy (CRT). The regimen was docetaxel hydrate (30 mg/m2, day 1, 8, 29 and 36) and S-1 (60 mg/m2, day 1-14 and day 29-45) with radiation (45 Gy) for liver metastasis. He finished the CRT without any hematotoxicity, liver disorder and non-hematotoxic adverse event (grade 3). Abdominal CT was done 2 months after the end of CRT and revealed that the tumor lesion disappeared completely. The patient is alive for 11 months after the CRT without any evidence of recurrence. The tumor disappeared completely for the last 11 months. We conclude that CRT is safe and very effective for esophageal cancer with liver metastasis.

Topics: Aged; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Docetaxel; Drug Combinations; Esophageal Neoplasms; Humans; Liver Neoplasms; Male; Oxonic Acid; Taxoids; Tegafur

We report herein a long-term survival case of liver metastasis after distal gastrectomy for gastric cancer. A 72-year-old woman, whom we performed distal gastrectomy with D2 lymph node dissection for type 2 gastric cancer at age 66, was diagnosed as pT2N1M0, stage II. No adjuvant therapy was performed. Liver metastasis was found 1 year and 7 months after surgery. PTX plus CPT-11 was performed. Six courses of therapy were done, and found cCR in the liver metastasis. A total of 23 courses of therapy were done. A recurrence of liver metastasis was found, transcatheter arterial chemoembolization (TACE), radiofrequency ablation( RFA)and operation were performed. She received S-1 plus CDDP, and cCR has been maintained for 6 years and 11 months after gastrectomy (5 years and 4 months after liver metastasis) suggesting that the interdisciplinary therapy was effective.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Catheter Ablation; Cisplatin; Combined Modality Therapy; Drug Combinations; Embolization, Therapeutic; Female; Gastrectomy; Humans; Liver Neoplasms; Lymph Node Excision; Neoplasm Recurrence, Local; Oxonic Acid; Stomach Neoplasms; Tegafur

A 73-year-old man underwent a distal gastrectomy with dissection of D2 lymph nodes for type 2 gastric cancer at the front wall of pyloric antrum in June 2006 (Pathological finding was moderately differentiated adenocarcinoma, T2, N0, H0, P0, M0, fStage IB). Although he was given UFT and PSK for postoperative adjuvant therapy, MRI showed a liver metastasis at segment 6 of the liver in June 2007. After 2 courses of S-1, posterior segmentectomy of the liver was performed. After hepatectomy, 5 courses of S-1 as adjuvant therapy were administered. However, another metachronous liver metastasis appeared at segment 8 in August 2008. After 3 courses of S-1 and CDDP, we performed radiofrequency ablation (RFA) therapy and a good cauterization effect was obtained. There has been no recurrence for 3 years since gastrectomy, or 2 years since the first liver metastasis. We experienced a case of metachronous liver metastasis from gastric cancer treated with multidisciplinary therapy that was beneficial for a long term survival.

Topics: Adenocarcinoma; Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Catheter Ablation; Cisplatin; Combined Modality Therapy; Drug Combinations; Hepatectomy; Humans; Liver Neoplasms; Male; Neoplasms, Second Primary; Oxonic Acid; Stomach Neoplasms; Tegafur

The patient was a 75-year-old man, who was diagnosed with type 3 gastric cancer with solitary liver metastasis whose diameter was 12 mm. Distal gastrectomy with D2 lymph node dissection was performed in June 2008. S-1 monotherapy (120 mg/day, day 1-28/42 days) for liver metastasis started as the first-line chemotherapy. After 3 courses, the diameter of liver metastasis enlarged to 22 mm. Moreover, S-1 and CDDP combined chemotherapy (S-1: 120 mg/day, day 1-21/ 35 days, CDDP: 60 mg/m2, day 8/35 days) was performed as the second-line chemotherapy, nevertheless the diameter of liver metastasis enlarged to 26 mm. No distant metastasis without solitary liver tumor was observed for 6 months after gastric resection, so a partial hepatic resection was performed in February 2009. Five months after the operation, the patient is doing well and shows no signs of recurrence of the cancer. A combination gastrectomy with D2 lymphadenectomy and postoperative chemotherapy was considered to be a radical treatment for H1, Stage IV gastric cancer.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Hepatectomy; Humans; Liver Neoplasms; Male; Oxonic Acid; Stomach Neoplasms; Tegafur

We report a case of successful multimodal treatment for combined hepatocellular and cholangiocarcinoma with portal venous tumor thrombus. A 66-year-old man was diagnosed with hepatocellular carcinoma with Vp3 by abdominal enhanced CT. He underwent a complete tumor resection and following interferon and 5-FU combined intra-arterial chemotherapy as an adjuvant setting. The histological findings were consistent with combined hepatocellular and cholangiocarcinoma. At 9 months after the surgery, lymph node metastases were detected. Then we started an oral fluoropyrimidine anticancer agent S-1, because the recurrence was suspected to be originated from the cholangiocarcinoma component. Thereafter, sustained partial remission was achieved. In case of combined hepatocellular and cholangiocarcinoma, we need to create a treatment strategy against characteristics of both components.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Combined Modality Therapy; Drug Combinations; Fluorouracil; Hepatectomy; Humans; Interferons; Liver Neoplasms; Male; Neoplastic Cells, Circulating; Oxonic Acid; Tegafur

A 68-year-old man lost in unconscious and was diagnosed as ruptured hepatocellular carcinoma (HCC) in a local emergency hospital. He was treated by transcatheter arterial embolization, and further investigation revealed simultaneous cancer in rectum. He was referred to our institute, and admitted in June 2005. He underwent lateral segment and S8 partial resection of the liver, cholecystectomy, anterior resection of rectum, and D3 lymphadenectomy in August 2005. Multiple HCC recurrences in the remnant liver appeared in December 2005. He was subsequently treated with transcatheter chemoembolization four times. In May 2006, CT scan revealed multiple metastatic nodules in bilateral lungs with remarkably elevated serum AFP and PIVKA-II. The nodules were diagnosed as lung metastasis of the HCC. Because the lesions grew larger, S-1 was started in February 2007. Diagnostic imaging and tumor markers showed a marked improvement 2 months after S-1 administration, and no recurrence has been found since then. This case illustrates that S-1 may be an effective treatment for HCC with extrahepatic metastasis.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Hepatocellular; Drug Combinations; Hepatectomy; Humans; Liver Neoplasms; Lung Neoplasms; Male; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Oxonic Acid; Rectal Neoplasms; Tegafur

Gemcitabine monotherapy is accepted as a standard first-line treatment for locally advanced unresectable or metastatic pancreatic cancer. On another front, S-1 and gemcitabine combination chemotherapy is challenging but promising. We report a long-term survival case of pancreatic cancer with hepatic metastasis after surgical resection treated by S-1 and gemcitabine combination chemotherapy. A 59-year-old woman was diagnosed as locoregionally advanced pancreas head cancer without metastatic disease. Pancreatoduodenectomy with regional lymph node dissection was performed after preoperative chemoradiotherapy. Pathological examination revealed a poorly differentiated adenocarcinoma. A solitary hepatic metastasis was detected by CT imaging one year after the surgery. The patient received 35 courses of S-1 and gemcitabine combination therapy. The metastatic tumor was disappeared, and serum CEA decreased to a normal level. S-1 and gemcitabine combination therapy is not only effective but also well tolerated and safe. This combination therapy should be considered one of selective choices for advanced or metastatic pancreatic cancer.

Topics: Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Liver Neoplasms; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Pancreaticoduodenectomy; Tegafur

A 67-year-old man with multiple liver metastases of colonic cancer was treated with combination therapy of S-1 and irinotecan (CPT-11): S-1 (120 mg/day) administered orally for 14 consecutive days followed by 14 days rest. CPT-11 (100 mg/m(2)) was given as a 2-hour infusion on day 1 and 15. The patient complained of high fever and subsequent exertional dyspnea in the middle of the second course of S-1/CPT-11 therapy. He was hospitalized with severe hypoxemia. CT scan showed extensive ground glass and consolidative changes in bilateral lungs. Steroid pulse therapy with oxygen therapy remarkably improved his symptoms, and abnormal findings on CT scan also resolved. Drug-induced pneumonia needs to be considered in the differential diagnosis when patients treated with S-1/CPT-11 combination therapy present high fever and dyspnea.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colonic Neoplasms; Drug Combinations; Humans; Irinotecan; Liver Neoplasms; Lung Diseases, Interstitial; Male; Oxonic Acid; Tegafur; Tomography, X-Ray Computed; Treatment Failure

The patient was a 70-year-old man with metastatic pancreatic cancer. After he received combination chemotherapy with gemcitabine and oral S-1 on day 1, he experienced severe general fatigue, anorexia and nausea. Then we changed the dose of gemcitabine from 1,000 mg/m(2) 2 to 500 mg/m(2) according to the criteria for an individual maximum repeatable dose (iMRD) determination method on day 8. His general condition recovered, and treatment schedule of gemcitabine with S-1 was continued sequentially at an outpatient clinic. His tumor marker levels, and the sizes of primary pancreatic tumor and liver metastatic lesions remarkably decreased. Partial response has been obtained for 7 months.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Deoxycytidine; Drug Combinations; Gemcitabine; Humans; Liver Neoplasms; Male; Neoplasm Staging; Oxonic Acid; Pancreatic Neoplasms; Tegafur; Tomography, X-Ray Computed

A 75-year-old man with advanced gastric cancer underwent distal gastrectomy with lymph node dissection(D1)and Roux-en Y reconstruction. Pathological staging was Stage IV (T3N3P1CY1M1), and curability was Cur C. He started adjuvant chemotherapy with oral administration of S-1(100 mg/body weight), but experienced grade 3 anorexia for one month. Abdominal computed tomography(CT)2 months postoperatively showed multiple liver metastases and ascites. We then conducted tailored S-1/CPT-11 as second-line chemotherapy(S-1 80 mg/body weight on days 1-5 and 8-12, CPT-11 60 mg/body weight on days 1 and 8). After 5 courses of this therapy, CT showed that the liver metastases and ascites had disappeared, leading to a complete response(CR). The only adverse event was general grade 1 fatigue. He continues to undergo oral administration of S-1(80 mg/body weight)as maintenance therapy, and maintained CR for 12 months since undergoing chemotherapy. Adverse events in tailored S-1/CPT-11 combination therapy are mild and tolerable, making this regimen a potential therapeutic strategy for patients with advanced or recurrent gastric cancer.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Camptothecin; Drug Combinations; Gastroscopy; Humans; Irinotecan; Liver Neoplasms; Male; Neoplasm Staging; Oxonic Acid; Peritoneal Neoplasms; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

A 46-year-old female was admitted to Kagoshima University Hospital with a complaint of epigastralgia and dysphasia. Gastrointestinal scopy revealed advanced gastric cancer in the upper third of the stomach. Pathological diagnosis of the biopsy specimen was moderately-differentiated adenocarcinoma. Abdominal CT suggested multiple liver metastases, so a combination of biweekly paclitaxel(PTX)and S-1 was started. After five courses of this regimen, the liver metastases and primary tumor were remarkably regressed. PTX was discontinued because of a grade 3 adverse effect of numbness. Nevertheless S-1 monotherapy for liver metastases resulted in a complete response. She has been well without tumor re-growth for 4 years. The combination of PTX and S-1 may be an effective regimen for gastric cancer with liver metastases.

Topics: Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Female; Gastroscopy; Humans; Liver Neoplasms; Middle Aged; Neoplasm Staging; Oxonic Acid; Paclitaxel; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

In October 2004, a 73-year-old man underwent loop ileostomy because of unresectable peritoneal disseminated sigmoid colon cancer with liver metastasis. The oral chemotherapy by S-1 was administered(80 mg/day for 4 weeks followed by a 2-week rest period). A half year later, the primary lesion was remarkably diminished on barium enema, and peritoneal dissemination and liver metastasis disappeared on CT. Because he was unwilling to have an ileostomy, we decided to resect the primary lesion and close the ileal stoma in May 2005. There was no obvious peritoneal dissemination, and operation was successful. He died without intestinal stoma one year after second operation. This therapy can be orally administered at home, and is considered to be useful from the viewpoint of QOL as well. S-1 is expected to be an effective agent for the treatment of colon cancer.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Peritoneal Neoplasms; Sigmoid Neoplasms; Tegafur; Tomography, X-Ray Computed; Treatment Failure

We report on two patients, successfully treated by the combination therapy of S-1 and 24-h infusion of cisplatin (CDDP), who were initially diagnosed with unresectable stage 4 advanced gastric cancer. Each patient had a very good clinical response and underwent curative gastrectomy after completion of 14 and 10 courses of S-1/CDDP chemotherapy, respectively. A microscopically detailed examination of surgically obtained specimens showed the complete disappearance of malignant cells in the two cases. S-1/CDDP combination therapy can, therefore, be highly active in incurable advanced gastric carcinoma.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Cisplatin; Drug Combinations; Female; Humans; Infusions, Intravenous; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Peritoneal Neoplasms; Prognosis; Remission Induction; Stomach Neoplasms; Survival Rate; Tegafur

A 65-year-old man with common bile duct cancer was treated by pylorus-preserving pancreaticoduodenectomy with D2 lymph node dissection. Three months after surgery, tumor marker was increasing, and CT demonstrated multiple liver metastatic tumors. Single drug chemotherapy with S-1(100 mg/body/day)was administered. After 6 months, the liver metastatic tumors could not be visualized by CT. S-1 may be the chemotherapy of choice for recurrence of bile duct cancer.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Bile Duct Neoplasms; Biomarkers, Tumor; Drug Combinations; Humans; Liver Neoplasms; Male; Neoplasm Recurrence, Local; Oxonic Acid; Tegafur; Tomography, X-Ray Computed

Cholangiocarcinoma is a therapeutically challenging malignancy. This report describes a case where the patient received multimodal therapy, including surgery, adjuvant chemoradiation therapy, and combination chemotherapy and successfully achieved long-term survival. Specifically, the patient achieved an extended complete response after combination chemotherapy with TS-1 (an orally administered drug that is a combination of tegafur, 5-chloro-2, 4-dihydroxypyridine [CDHP], and oteracil potassium [Oxo]) and cisplatin for recurrence. This result suggests that chemoradiation or combination chemotherapy regimens using oral 5-fluorouracil (5-FU) analogues might therefore be helpful in patients with this malignancy. However, further clinical trials are required.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Cisplatin; Combined Modality Therapy; Disease-Free Survival; Drug Combinations; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Oxonic Acid; Tegafur

There is no standard treatment for hepatocellular carcinoma (HCC) patients with extrahepatic metastases. We assessed the efficiency and safety of the oral fluoropyrimidine anticancer drug S-1 combined with interferon alpha (IFN-alpha) for HCC patients with extrahepatic metastases.. Twenty-nine HCC patients with extrahepatic metastases received S-1/IFN. One cycle of combination therapy represented 2 weeks followed by 2-4 weeks of rest. In each cycle, S-1 was administrated orally at 80-120 mg (depending on body surface area) every day and IFN-alpha intramuscularly at 5 million units thrice weekly.. The overall response of 29 patients was complete response (CR) in 4 (14%), partial response (PR) in 1, stable disease in 4, progressive disease in 12, and dropout in 8 patients. Objective response (CR + PR) was 17%. The time to progression and survival rate were significantly higher in patients with lung metastases (n = 19) than in those with painful bone metastases (n = 7; p = 0.0058 and 0.0015). With regard to NCI-CTC grade 3 adverse reactions, 3 (10%), 3 (10%) and 2 (7%) patients developed anorexia, leukopenia, and neutropenia, respectively. No grade 4 adverse reaction or toxicity-related death occurred.. S-1/IFN is a potentially safe and suitable combination therapy for HCC patients with extrahepatic metastases, especially those with lung metastases.

Topics: Administration, Oral; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Disease Progression; Drug Combinations; Female; Humans; Interferon-alpha; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Remission Induction; Retrospective Studies; Tegafur; Treatment Outcome

We report three cases with liver metastasis from gastric or colon cancer successfully treated with S-1 with CPT-11. Case 1: A total gastrectomy was performed for a gastric cancer located in the lower to upper body of the stomach (T3 (SE), N2, H0, P0, por 2, stage III B). Abdominal computed-tomography (CT) revealed a solitary liver metastasis in the S8 subsegment of the liver. We treated the patient with S-1 combined with CPT-11. Abdominal CT revealed a complete response (CR) after 5 courses. Case 2: Sigmoidectomy and partial resection of small intestine and abdominal wall were performed for sigmoid colon cancer. The intraoperative findings revealed liver metastases in left lobe of the liver (Si, N1, H1, P0, M0, tub 1, stage IV). After surgery, the patient was treated with S-1 combined with CPT-11. Abdominal CT demonstrated CR after 5 courses. Case 3: Laparoscopic right hemicolectomy was performed for ascending colon cancer (SE, N1, H0, P0, M0, tub 1, stage III a). Abdominal CT showed a solitary liver metastasis in the S6 subsegment of the liver 3 months after surgery. We treated the patient with S-1 combined with CPT-11. Abdominal CT revealed CR after 3 courses. The three cases are alive without any signs of recurrence.

Topics: Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colonic Neoplasms; Drug Combinations; Female; Humans; Irinotecan; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

S-1 was found to be highly effective against metastatic hepatic lesions from multiple drug-resistant breast cancers, in 2 patients. The details of these cases are presented below. Case 1, a 59-year-old woman, was HER2-positive. For chemotherapy following a recurrence, trastuzumab+weekly paclitaxel and trastuzumab+vinorelbine regimens were attempted, but the hepatic metastasis worsened. On the other hand, a trastuzumab+S-1 regimen resulted in a notable reduction in the metastatic foci of the liver approximately one month after the initiation of the therapy. This effect was sustained for 5 months thereafter. Case 2 involved a 67-year-old woman with HER2-negative breast cancer. Following a recurrence, chemotherapeutic agents, such as taxane and vinorelbine, were applied, which all resulted in PD. Treatment with S-1 alone reduced the size of the hepatic metastatic lesion, as seen in case 1. Currently (14 months after the initial treatment with S-1), therapeutic efficacy has been maintained. Adverse effects were minimal and QOL was not compromised in either case. We speculate that S-1 is not only effective as a therapeutic agent but is also useful in view of safety and QOL.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Breast Neoplasms; Drug Combinations; Drug Resistance, Multiple; Drug Resistance, Neoplasm; Female; Humans; Liver Neoplasms; Middle Aged; Oxonic Acid; Tegafur; Tomography, X-Ray Computed

In pancreatic carcinoma, vascular endothelial growth factor (VEGF) expression at the primary site has been suggested to be a prognostic parameter. We quantitatively analyzed VEGF expression in liver metastases from pancreatic carcinoma and examined the correlation among VEGF expression in liver metastases, clinicopathologic factors, and clinical outcome.. The subjects consisted of 23 patients with pancreatic adenocarcinoma who had liver metastases and were treated with S-1 and gemcitabine as the first-line treatment. VEGF expression was quantitated by enzyme immunoassay in biopsy specimens of liver metastases and nontumorous liver tissue, and in plasma. In 10 of the 23 patients, VEGF expression was also quantitated in biopsy specimens of the primary pancreatic tumor. All samples were collected before treatment.. The VEGF level in nontumorous liver tissue was 36.6 +/- 10.0 pg/mg protein versus 376.8 +/- 106.1 pg/mg protein in liver metastases (P = 0.0016). Pretreatment VEGF levels in plasma and in primary pancreatic carcinoma did not correlate with VEGF levels in the corresponding liver metastases. The median VEGF level in liver metastases (138.9 pg/mg protein) was used as the cutoff value between high and low VEGF expression in liver metastases. Patients showing high VEGF expression had a significantly longer progression-free survival and overall survival than patients showing low VEGF expression in liver metastases (P = 0.0219 and P = 0.0074, respectively).. Evaluation of VEGF levels in liver metastases might be useful in assessing the prognosis of patients with metastatic pancreatic carcinoma who are under systemic chemotherapy.

Topics: Adenocarcinoma; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Combinations; Enzyme-Linked Immunosorbent Assay; Female; Gemcitabine; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Prognosis; Tegafur; Vascular Endothelial Growth Factor A

A 68-year-old man underwent esophagogastroduodenoscopy (EGD) in February 2005. A type 2 advanced gastric cancer was observed on the gastric antrum. Abdominal US and CT revealed no distant metastasis. Curative distal gastrectomy with D2 lymph node dissection was therefore performed the next month. Postoperative staging was stage I B. In June 2005, he had symptoms of right hypochondralgia, general fatigue and appetite loss. An abdominal CT the next month revealed multiple liver metastases and so S-1/CDDP combination chemotherapy was initiated. After two courses of chemotherapy, marked decreases in size of the liver metastasis were recognized. However, we had to change the chemotherapy regimen because of adverse effect from the chemotherapy regime after the initial 2 courses. The patient died from tumor progression in May 2006.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Cisplatin; Drug Combinations; Humans; Liver Neoplasms; Male; Neoplasm Recurrence, Local; Oxonic Acid; Stomach Neoplasms; Tegafur; Time Factors; Tomography, X-Ray Computed; Treatment Failure

There are currently no effective treatments for patients with advanced hepatocellular carcinoma (HCC) with vascular invasion or extrahepatic metastases. We evaluated the efficacy and safety of combination therapy with S-1 and pegylated interferon (PEG-IFN)-alpha for advanced HCC.. A total of 22 patients received combination therapy with S-1 and PEG-IFN. One cycle of the combination therapy consists of oral S-1 (80 mg/m(2)) administration and subcutaneous PEG-IFN injection (PEG-IFN-alpha-2a 90 microg weekly or PEG-IFN-alpha-2b 50 microg weekly) for 4 weeks with 1- to 2-week intervals.. One patient was evaluated as complete response, 6 as partial response, 8 as stable disease, and 6 as progressive disease. One patient was not evaluable because therapy had to be discontinued as a result of jaundice. The median survival time was 15.3 months (95% CI: 4.4-26.2 months). The 1- and 2-year survival rates were 54.9 and 36.6%, respectively. The overall response rate was 31.8% and the disease control rate was 68.2%. Grade 3 neutropenia (18.2%), leukopenia (9.1%), anemia (9.1%), and thrombocytopenia (18.2%) were observed. Grade 4 toxicities were not observed.. Combination therapy with S-1 and PEG-IFN is effective and feasible, and is therefore a promising regimen for advanced HCC.

Topics: Adult; Aged; Antineoplastic Agents; Carcinoma, Hepatocellular; Disease Progression; Drug Combinations; Drug Therapy, Combination; Feasibility Studies; Female; Humans; Interferon alpha-2; Interferon-alpha; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Polyethylene Glycols; Recombinant Proteins; Survival Analysis; Tegafur; Treatment Outcome

A 65-year-old male underwent a curative distal gastrectomy for advanced gastric cancer in June 2000. S-1 mono- therapy (80 mg/m2, day 1-28/42 days) for liver metastasis in S6 started as the first-line chemotherapy in October 2004. After 3 courses, complete response (CR) was observed for liver metastasis which had continued until January 2007. During the first-line chemotherapy, grade 2 non-hematological toxicities occurred and the S-1 dose reduction was required. Thereafter, no more grade 2 non-hematological toxicities were observed. Paclitaxel mono-therapy (80 mg/m2, day 1, 8, 15/28 days) for multiple lung metastases started as the second-line chemotherapy in February 2007. After 4 courses, complete response (CR) was observed for lung metastasis which has continued until now, May 2008. During the second- line chemotherapy, grade 3 neutropenia and grade 2 leukopenia occurred and a 10% dose reduction of paclitaxel was required three times. Consequently, the hematological toxicities have not occurred.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Humans; Liver Neoplasms; Lung Neoplasms; Magnetic Resonance Imaging; Male; Oxonic Acid; Paclitaxel; Radiography; Stomach Neoplasms; Tegafur

We report a successful case of chemotherapy accompanied with grade 4 adverse events for unresectable advanced gastric cancer. A 73-year-old man was admitted to our hospital with complaint of abdominal pain in July 2007. The detailed examination had revealed advanced gastric cancer, lymph node metastasis, and multiple hepatic metastases. Performance status (PS) was level 0, and oral intake of medications was possible. Combined therapy with S-1 and CPT-11 (IRIS regimen) was performed from August as the first-line therapy. As a consequence of first course, grade 4 hematological adverse events (AEs) appeared and an urgent hospitalization was required. With whole body supportive care against grade 3 non-hematological AEs, which were diarrhea, anorexia, and fatigue, G-CSF, the broad-spectrum antibiotic were administered at the clean-room. After 1 course, cyto-reductive change was confirmed at the primary lesion and hepatic metastases. We continued the same regimen with dose reduction (S-1: 2 level dose down, CPT-11: 10% dose down). Although the regression of hepatic metastases was seen, we repeated the dose reduction of CPT-11 and the dose down level was reached to 40% for prolonged grade 2 neutropenia. After 6th courses, complete responses at primary lesion, lymph node, and hepatic metastases were achieved. The patient has received the same regimen of 9th course continuously as an outpatient, and CR has been maintained.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Blood Cell Count; Camptothecin; Cell Proliferation; Drug Combinations; Gastroscopy; Humans; Irinotecan; Liver Neoplasms; Magnetic Resonance Imaging; Male; Neoplasm Staging; Oxonic Acid; Stomach Neoplasms; Tegafur

A 57-year-old man who had brown urine, jaundice and appetite loss from June 2006 was diagnosed with advanced pancreatic cancer. He received pylorus-preserving pancreatoduodenectomy in July 2006. Liver metastasis in S6 lesion was revealed by abdomen CT and SPIO-MRI in November and December 2006, respectively. Chemotherapy with gemcitabine hydrochloride (GEM) 1,400 mg/body was administered once a week on days 1, 8 and 15 for 4 weeks. At the beginning of this chemotherapy, it seemed to be a stable disease, but abdominal CT revealed a tumor progress in April 2007. So we selected combination chemotherapy with GEM and S-1 as second-line. At first serum CA19-9 was decreased but gradually increased, and the CT scan revealed the tumor progression in the liver and the local recurrence appeared in February 2008. So we selected combination chemotherapy with GEM and nedaplatin as third-line. After 2 months, CT scan revealed no change in tumor size. This combination chemotherapy can be effective in some patients with GEM-refractory pancreatic cancer.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Deoxycytidine; Drug Combinations; Gemcitabine; Humans; Liver Neoplasms; Male; Middle Aged; Organoplatinum Compounds; Oxonic Acid; Pancreatic Neoplasms; Recurrence; Tegafur; Tomography, X-Ray Computed

A 60-year-old man diagnosed as advanced sigmoid colon cancer was performed sigmoidectomy and D3 lymph node dissection. Intra-operative findings were SE, P0H1N4M (-), and Stage IV. One month after the operation, we started a combination chemotherapy using S-1 plus CPT-11 as one course for five weeks. S-1 (120 mg/body/day) was orally administered continuously for 3 weeks, and CPT-11 (80 mg/m2) was done intravenously on days 1 and 15. A Follow-up abdominal CT scan revealed a drastic reduction of liver metastasis and disappearance of para-aortic lymph node swelling (PR in). The combination chemotherapy was once finished after eight courses due to the patient's request. However, we started to administer the same regimen to him again six months later because of re-growth of liver metastasis. An additional six-course administration resulted in a reduction of liver metastasis by CT scan, and no other abnormal concentration besides two liver metastases by PET-CT examination was observed, and we performed a partial resection (two parts) of the liver and cholecystectomy 24 months after the first operation. The patient has been alive with disease free for five months since the second operation.

Topics: Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Carcinoembryonic Antigen; Drug Combinations; Humans; Irinotecan; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Positron-Emission Tomography; Sigmoid Neoplasms; Tegafur; Time Factors; Tomography, X-Ray Computed

A 74-year-old woman was referred to our hospital with complaints of constipation and abdominal distention caused by a sigmoid colon tumor. After examination, she was diagnosed as sigmoid colon cancer with multiple liver metastases. To prevent bowel obstruction, a sigmoid colon resection was performed. On postoperative days 15, S-1 was started, and she was discharged on postoperative day 26. Each course consisted of daily oral administration S-1 for 4 weeks followed by 2 drug-free weeks. However, because of grade 2 anorexia in the 1st course, the treatment plan was changed to administration for 2 weeks and withdrawal for 1 week. After 7 courses of treatment, computed tomography revealed that the liver metastases were remarkably reduced. Although she experienced an adverse event involving a cutaneous symptom of grade 2, the treatment was continued under ambulatory management. After eight courses, elevation of tumor marker and metastasis at the right femur were found, and she died of the cancer 12 months after the operation. S-1 is expected to be an effective agent for the treatment of advanced colorectal cancer.

Topics: Aged; Biomarkers, Tumor; Drug Combinations; Female; Humans; Liver Neoplasms; Oxonic Acid; Sigmoid Neoplasms; Tegafur; Tomography, X-Ray Computed; Treatment Failure

To the authors' knowledge, there is no effective therapy for extrahepatic metastasis of hepatocellular carcinoma (HCC). In a pilot study, the results of combination therapy of S-1, a novel oral dehydropyrimidine dehydrogenase (DPD) inhibitor, and interferon-alpha (IFN-alpha) are reported for HCC patients with extrahepatic metastasis.. Twelve patients with extrahepatic metastasis of HCC were enrolled in the pilot study. S-1 was administered orally at a dose based on body surface area, twice daily after a meal, for 4 weeks. IFN-alpha was injected subcutaneously on Days 1, 3, and 5 of each week. One course consisted of consecutive administration for 28 days followed by 14 days rest.. An objective response was observed in 3 (25%) of 12 patients. The overall 1-year survival rate was 61.7%. Grade 3 leukocytopenia was observed in 1 patient (8.3%). No severe toxicity or treatment-related deaths were observed.. The combination therapy of S-1 and IFN-alpha appears to be highly efficacious, with low toxicity in patients with extrahepatic metastases of HCC. The combination chemotherapy of oral S-1 and subcutaneous IFN-alpha is a potentially promising treatment strategy for advanced HCC with extrahepatic metastasis.

Topics: Administration, Oral; Adult; Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Dihydrouracil Dehydrogenase (NADP); Drug Combinations; Female; Follow-Up Studies; Humans; Immunologic Factors; Injections, Subcutaneous; Interferon-alpha; Leukopenia; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pilot Projects; Remission Induction; Survival Rate; Tegafur; Thrombocytopenia

A treatment of multiple liver metastases of gastric cancer is very hard and its prognosis is extremely poor. At this time, we reviewed an efficacy of the therapeutic experience case with a new anticancer agent. The treatment was performed on nine cases of synchronia multiple liver metastases of gastric cancer since the new anticancer agent was introduced to the treatment. All of the 9 gastric cancer cases were diagnosed as being resectable other than ones with metastases to the liver, or a primary tumor resection was performed on the cases. The 1st line chemotherapy regimen was a combination of S-1+CDDP intra-arterial injection. The 2nd line chemotherapy regimen was S-1+CPT-11 intra-arterial injection. Furthermore, the 3rd line chemotherapy regimen was an administration of paclitaxel. There were no adverse events, such as hematotoxicity and non-hematotoxicity, that were greater than grade 3 during the duration of chemotherapy. Hence, we could continue the treatment regimen on all of the cases. The tumor responses for all of the cases were judged to be stable disease (SD). The best overall responses for all of the cases were judged to be progressive disease (PD). A median survival time (MST) of the treatment was 16 months, and that was significantly improved from 5.5 months, the regimen without a new anticancer agent (p=0.002). An ambulatory treatment was capable with the QOL in all of the cases. In conclusion, the tumor response did not show on the imaging, but it could be evaluable when there was an efficacy in the treatment that would support a daily life of patient.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Female; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Stomach Neoplasms; Survival Rate; Tegafur; Time Factors; Tomography, X-Ray Computed

A 70-year-old female was admitted to our hospital with high fever about 5 days before this writing, along with anemia and hyperglycemia. Upper gastrointestinal series and endoscopy revealed type 1 gastric cancer in the greater curvature. CT and MRI showed multiple liver metastasis in the right lobe. Distal partial gastrectomy with lymphadenectomy and cannulation of hepatic artery was performed. The pathological findings revealed moderately-differentiated adenocarcinoma, T2, N0, H1, M0, stage IV. The postoperative chemotherapy with S-1 (80 mg/day) was administered for 4 weeks followed by 1 week rest and CDDP (50 mg) administered once every 4 weeks by arterial infusion. Two months after operation the tumor marker values have become normal, and CT can hardly detect the metastatic liver tumors. At 8 months after operation, CT and MRI revealed complete disappearance of these tumors. Then, 12 months after operation, FDG-PET revealed no accumulation. Now, at 18 months, the CR stage has been maintained. Combined use of peroral S-1 and CDDP by arterial infusion is effective for multiple liver metastasis after gastrectomy in gastric cancer.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Female; Gastrectomy; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Lymph Node Excision; Oxonic Acid; Positron-Emission Tomography; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

The patient was a 64-year-old woman. Oral S-1 and hepatic arterial infusion (HAI) of low-dose CDDP therapy were started for unresectable advanced gallbladder cancer associated with liver metastasis and numerous lymph node metastases. Marked regression of the liver metastasis and lymph node metastases was observed by this treatment, and upon completion of the second course they had almost completely resolved. The tumor marker values also converted to negative. We report a case in which oral S-1 and HAI of low-dose CDDP therapy was effective against advanced gallbladder cancer associated with liver metastasis and multiple lymph node metastases.

Topics: Administration, Oral; Angiography; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Cisplatin; Drug Combinations; Female; Gallbladder Neoplasms; Hepatic Artery; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Middle Aged; Neoplasm Staging; Oxonic Acid; Tegafur; Tomography, X-Ray Computed

We report a patient with multiple hepatic metastases and ovarian metastases of transverse colon cancer treated by combination of S-1 and CPT-11. The patient was a 51-year-old woman with cancer of the transverse colon and multiple hepatic metastases. She had undergone surgery. Resection of the transverse colon and left ovary was performed because left ovarian metastases were found during the operation. After the operation, the patient was given chemotherapy with S-1 (120 mg/body on days 1-14) and CPT-11 (150 mg/body on day 1). After completion of 11 courses of chemotherapy, abdominal CT scans revealed that the LDAs of the liver had disappeared, so the patient was judged to have achieved CR. No adverse event was observed. This case suggests that the combination of S-1 and CPT-11 may be an effective regimen for advanced colon cancer with multiple hepatic metastases.

Topics: Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colonic Neoplasms; Drug Combinations; Female; Humans; Irinotecan; Liver Neoplasms; Middle Aged; Ovarian Neoplasms; Oxonic Acid; Tegafur; Tomography, X-Ray Computed

Gastric endocrine cell carcinoma is known to be highly malignant with a poor prognosis, and no standard treatment has been established. We experienced a case of endocrine cell carcinoma of the stomach with liver and lymph node metastases. The lesions became resectable at curability B after chemotherapy with S-1/cisplatin (CDDP). A 59-year-old man, who had no specific complaint, had gastrointestinal endoscopy for screening. A 30-mm tumor was found at the greater curvature of the lower body of the stomach, and was histologically diagnosed as an endocrine cell carcinoma from the biopsy specimen. A computed tomography (CT) scan and abdominal magnetic resonance imaging (MRI) showed masses at S5 and S6 of the liver, and No. 4 lymph node enlargement. Diagnosed as gastric endocrine cell carcinoma with liver and lymph node metastases, he was referred to our hospital. We started chemotherapy with a daily dose of S-1 administered on days 1 to 14 and CDDP of 70 mg/m(2) on day 8, every 4 weeks. After three courses of treatment, the primary lesion became a small scar and the metastatic lesions vanished from the CT and MRI. Then we performed distal gastrectomy with lymph node dissection and partial liver resectomy. Histological findings revealed no cancer cells, except for a few cells in the S5 liver lesion.

Topics: Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Small Cell; Cisplatin; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Middle Aged; Oxonic Acid; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

A 55-year-old man was admitted to our hospital because of high grade fever in October 1999. Computed tomography showed a solid tumor in the tail of the pancreas with multiple liver tumors. We diagnosed him as unresectable pancreatic tail cancer with multiple liver metastases at first, so systemic chemotherapy using UFT was performed. Gradually, liver metastases were slightly reduced, and tumor markers (CEA, CA19-9) decreased to the normal range. In April 2001, percutaneous transhepatic tumor biopsy was performed. Histopathological examination revealed a malignant pancreatic endocrine tumor. Long NC had continued by using the UFT regimen. But because tumors had gradually grown since October 2003, the chemotherapy with S-1 was followed by gemcitabine (GEM). The patient has now survived for 7.5 years while receiving the combined chemotherapy of S-1/GEM.

Topics: Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Islet Cell; Deoxycytidine; Drug Combinations; Gemcitabine; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Radiography; Tegafur

We described a case with recurrent gallbladder carcinoma, successfully treated by combination chemotherapy using gemcitabine, CPT-11, and S-1 that was administered as second-line chemotherapy after failure of gemcitabine monotherapy. The level of CA19-9 was normalized three months later, and metastatic tumors of the liver were calcified. She had received the combination chemotherapy for 15 months and is now alive.

Topics: Adenocarcinoma; Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Calcinosis; Camptothecin; Deoxycytidine; Drug Combinations; Female; Gallbladder Neoplasms; Gemcitabine; Humans; Irinotecan; Liver Neoplasms; Neoplasm Recurrence, Local; Oxonic Acid; Tegafur

The patient was a 44-year-old male in whom low anterior resection of the rectum, partial pneumonectomy, and liver biopsy were performed because of suspicion of synchronous liver and pulmonary metastases of rectal cancer which caused familial adenomatous polyposis. Because anticancer drug sensitivity testing by the HDRA method performed on tissue collected from the cancer immediately postoperatively revealed sensitivity to 5-FU and CPT-11, and measurement of nucleic acid metabolizing enzymes showed a high level of DPD, a 5-FU metabolizing enzyme, combination therapy with TS-1 and CPT-11 was started. TS-1, 120 mg/body, was administered on 14 consecutive days followed by a 7-day rest period, and CPT-11, 120 mg/body, was administered on day 1 and day 8. One cycle was defined as 3 weeks,and cycles were repeated. Grade 2 diarrhea occurred, but the CPT-11 dose was reduced to 100 mg/body, and treatment was continued. CR was achieved when the 4th course had been completed. Thoracic and abdominal CT was performed after 4 courses, but no recurrent foci were detected in the residual lung tissue, and all of the metastatic liver foci had resolved. To date 6 courses have been completed, and no relapses have been detected by thoracic CT. We report a case in which it was possible to predict efficacy as a result of treatment based on anticancer drug sensitivity testing and measurements of nucleic acid metabolizing enzymes.

Topics: Adenomatous Polyposis Coli; Adult; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Combined Modality Therapy; Diabetes Complications; Diabetes Mellitus, Type 2; Drug Administration Schedule; Drug Combinations; Humans; Irinotecan; Liver Neoplasms; Lung Neoplasms; Male; Neoplasms, Multiple Primary; Oxonic Acid; Rectal Neoplasms; Remission Induction; Tegafur

Topics: Adenocarcinoma; Aged; Antimetabolites, Antineoplastic; Drug Combinations; Duodenal Neoplasms; Female; Humans; Liver Neoplasms; Oxonic Acid; Tegafur

Advanced hepatocellular carcinoma (HCC) with distant metastases, in particular to the lung, has a poor prognosis. This study was undertaken to evaluate the effectiveness of TS-1 as chemotherapy in advanced HCC with lung metastases. Between January 2004 and October 2005, 8 patients with advanced HCC with lung metastasis were enrolled. All patients received systemic chemotherapy with TS-1. The drug was administered at a dose of 80 mg/m(2)/day for four weeks, followed by a two-week rest, repeated every six weeks until disease progression, unacceptable toxicity, or the patient's refusal. Median age of the patients was 59 years (range, 44 to 79 years). All patients were in Child-Pugh class A. A total of 22 cycles were administered to each patient (range, 1 to 5). No complete or partial responses were observed. There were two patients (25%) with decreasing tumor marker. Median progression-free survival was 79.5 days (range, 29 to 225). The median overall survival was 257 days (95% confidence interval, 191 to 323 days). TS-1 as chemotherapy was well tolerated when administered in the schedule used in this study. Some patients achieved stable disease and clinical benefits, though this regimen has limited activity in HCC with lung metastases. Randomized controlled trials are necessary to clarify survival benefits in patients with advanced HCC with lung metastasis.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Carcinoma, Hepatocellular; Drug Administration Schedule; Drug Combinations; Female; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Oxonic Acid; Prognosis; Retrospective Studies; Survival Rate; Tegafur; Treatment Outcome

The patient was a 70-year-old man who was diagnosed inoperable because of liver metastases of advanced gastric cancer and his respiratory dysfunction. He received docetaxel at the starting dose of 40 mg/m(2) by iv infusion over 1 hour on day 1 and TS-1 at the full dose of 80 mg/m(2) daily for two weeks every three weeks. After 6 cycles of this combination therapy, gastric cancer with liver metastases entirely disappeared. No re-growth of gastric cancer has been seen for three years with chemotherapy of TS-1. This chemotherapy shows a high degree of safety and efficacy in this patient.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Docetaxel; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Remission Induction; Stomach Neoplasms; Taxoids; Tegafur

In recent years, a high success rate of combination chemotherapy with TS-1/CDDP has been reported against advanced gastric carcinoma. We, this time, experienced a case of advanced hemorrhagic gastric cancer with multiple hepatic metastases for which total gastrectomy was performed, followed by postoperative combination chemotherapy with TS-1/CDDP which culminated in achieving CR for the liver metastases.. The patient was a 59-year-old woman who was hospitalized for a type IV gastric carcinoma in the upper part of the gastric body. Further examination revealed liver (S 2, S 5, S 7) and lymph node metastases. Due to hemorrhage from the tumorous lesion, the treatment strategy selected was total gastrectomy followed by postoperative chemotherapy. Operative and clinicopathological findings revealed a mass lesion of MLU, type IV, 16.0x14.0 cm, sT 3 (SE), sH 1 (bilobular multiple metastases) and CY 0, and por 1, pT 2 (SS), pN 1 (+) [23/38], int, INF beta, ly 3 and v 1, respectively. Combination chemotherapy with TS-1/CDDP was instituted after surgery. As for the dosing method of combination chemotherapy,the patient was treated with a course of TS-1 80 mg daily divided into two doses over 21 days continuously, followed by a 14-day cessation of the drug,together with a dose of CDDP 70 mg on day 8. The patient received a total of four courses. At the completion of the third chemotherapy course, her multiple hepatic metastases disappeared. Further, the preoperative CA 19-9 level of 370 U/mL returned to normal after chemotherapy. Adverse events observed were leukopenia and thrombocytopenia, both of which were judged to be grade 2. At two years and nine months, the patient is being followed on an outpatient basis without any sign of postoperative recurrent disease.. We experienced a patient who was successfully treated with combination chemotherapy and demonstrated disappearance of her multiple hepatic metastases, showing a clinical response of CR lasting for more than two years against the metastases. It was inferred that this regimen of TS-1/CDDP is an effective treatment modality not only as preoperative but also postoperative chemotherapy after surgery for advanced gastric carcinoma.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Administration Schedule; Drug Combinations; Female; Gastrectomy; Humans; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Oxonic Acid; Postoperative Period; Remission Induction; Stomach Neoplasms; Tegafur

We evaluated efficacy of biweekly paclitaxel and S-1 for advanced gastric cancer patients with liver metastases. A total of 14 patients had multiple liver metastases. None of whom received chemotherapy before the current regimen. The patients were given 80 mg-130 mg/m(2) of paclitaxel every two weeks and 80 mg of S-1 during the first two weeks. Chemotherapeutic efficacy for liver metastases was 50%. The 3-year-survival rate of the 14 patients was 50%, which was significantly higher than that of historical control patients (p<0.01). Two patients received gastrectomy with curative intent. Histological exploration revealed disappearance of liver metastases. In conclusion, biweekly paclitaxel+S-1 regimen was one of the promising therapies for advanced gastric cancer patients with liver metastases.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma; Drug Administration Schedule; Drug Combinations; Female; Humans; Liver Neoplasms; Male; Oxonic Acid; Paclitaxel; Stomach Neoplasms; Survival Rate; Tegafur

A 60-year-old man, who had been admitted to another hospital with complaints of constipation, abdominal fullness and appetite loss, was referred to our hospital for further examination and therapy. The patient was diagnosed as advanced gastric cancer (type-3) with multiple liver metastasis and obstructive jaundice. He was treated with combination therapy of paclitaxel and TS-1 (60 mg/m(2)/day of paclitaxel was iv administered on day 1 and 8, and TS-1 of 80 mg/m(2)/day was orally administered for 2 weeks followed by one drug-free week), and showed a remarkable response. However, because of ascites, elevated serum CEA level and resistance in the liver metastasis and gastric region, we attempted two courses of combination therapy with high-dose CPT-11 and cisplatin (70 mg/m(2)/day of CPT-11 was administered iv on day 1 and 15, and 80 mg/m(2)/day of cisplatin on day 1 followed by two drug-free weeks) which showed a remarkable response. Two courses of combination therapy with low-dose CPT-11 and cisplatin (60 mg/m(2)/day of CPT-11 and 30 mg/m(2)/day of cisplatin were administered iv on day 1 and 15 followed by two drug-free weeks) on an outpatient basis. However, the patient showed resistance to the latter combination therapy, increased ascites due to suspicious peritonitis carcinomatosa and obvious re-growth of the metastatic tumors in the liver. He died on May 23, 2006, about ten months after initial diagnosis. We reported a case of successful treatment of combination chemotherapy for advanced gastric cancer with obstructive jaundice due to progressive multiple metastatic tumors in the liver and obtained comparative long-term survival maintaining high quality of life.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cisplatin; Drug Administration Schedule; Drug Combinations; Humans; Irinotecan; Jaundice, Obstructive; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Paclitaxel; Stomach Neoplasms; Survivors; Tegafur

We report a case of TS-1-resistant recurrent gastric cancer with lung metastasis responding to TS-1 and irinotecan (CPT-11) combination therapy. A 72-year-old man underwent total gastrectomy with pancreaticosplenectomy for advanced gastric cancer on October 18, 2001, and partial hepatectomy for postoperative liver metastasis on August 22, 2002. In March 2004, a chest computed tomography scan revealed metastatic lesions in the bilateral lungs, and he received a single administration of TS-1, resulting in partial response. After 13 courses, this therapy was discontinued due to progressive disease. Then,TS-1 and CPT-11 combination therapy was chosen as the second-line chemotherapy. After 4 courses, a partial response was obtained in lung metastasis, and thereafter has been maintained. He has been treated on an outpatient basis because of no grade 3 or severer adverse reactions. TS-1 and CPT-11 combination therapy could be a promising regimen as the second-line chemotherapy for gastric cancer resistant to TS-1.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Drug Resistance, Neoplasm; Gastrectomy; Humans; Irinotecan; Liver Neoplasms; Lung Neoplasms; Male; Oxonic Acid; Pancreas; Splenectomy; Stomach Neoplasms; Tegafur

A 37-year-old female with advanced gastric cancer and liver metastases was treated with S-1. Since the patient noticed a transient cough and low-grade fever in the middle of the third course of treatment, administration of S-1 was discontinued. Her symptoms resolved in three days, and the fourth course was started again. However, two weeks later she was hospitalized with non-productive coughing, and exertional dyspnea with severe hypoxemia. CT scan showed minimal ground glass shadow in bilateral lungs and that the multiple liver metastases were strikingly reduced in size. CT scan obtained on the third hospital day showed extensive ground glass and consolidative changes in bilateral lungs. She died on the same day despite high-dose steroid therapy. Although a definite causal relationship between pneumonia and S-1 is still unproven, S-1-induced pneumonia needs to be considered in the differential diagnosis when patients present with dyspnea are treated with S-1.

Topics: Adult; Antimetabolites, Antineoplastic; Diagnosis, Differential; Drug Combinations; Dyspnea; Female; Humans; Liver Neoplasms; Lung Diseases, Interstitial; Lymph Nodes; Lymphatic Metastasis; Oxonic Acid; Stomach Neoplasms; Tegafur

An 85-year-old man, who had undergone right hemicolectomy and partial hepatectomy for caecum cancer with liver metastasis, was diagnosed with recurrent multiple liver metastasis 10 months after surgery. TS-1 administration at a dose of 80 mg/day induced grade 3 anorexia, and after complete recovery from the adverse reaction, it was converted to a low-dose TS-1 administration at 40 mg/day. This treatment reduced the diameter of the liver metastasis and was continued for ten months without any adverse reaction. Pharmacokinetic analysis in this patient on low-dose TS-1 showed that Cmax and AUC of 5-chloro-2,4-dihydroxypyridine (CDHP) were equivalent to the values reported in cancer patients with normal renal function receiving standard-dose administration. TS-1 therapy may provide a safe and effective alternative to chemotherapy for elderly patients with advanced colorectal carcinoma. Pharmacokinetic analysis could be useful for determining the ideal dose of TS-1.

Topics: Adenocarcinoma; Aged, 80 and over; Antimetabolites, Antineoplastic; Appendiceal Neoplasms; Colonic Neoplasms; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Tegafur

A 62-year-old woman with Barrett's esophageal cancer was hospitalized. Abdominal CT confirmed metastases to the liver and lymph nodes, for which surgical excision and radiotherapy were not indicated. We started chemotherapy with a course of daily oral S-1 at a dose of 80 mg/m(2) for 21 days, with a 2-hour drip of cisplatin at 60 mg/m(2) on day 8. Breaks of 14 drug-free days were given between courses. After two courses, a repeat CT confirmed that the liver and lymph node metastases had disappeared; after three courses, another CT confirmed that the metastatic foci were still absent, so we judged the disease to be in complete remission. Endoscopy and upper GI series confirmed that the primary tumor was reduced, and endoscopic mucosal resection performed using the strip biopsy method. The excision specimen was well differentiated adenocarcinoma, and mucosal invasion, and the excision stump was negative. After two more courses of S-1 + cisplatin, chemotherapy has been suspended with the patient's consent, and in the 21 months after endoscopic mucosal resection, no recurrence has been observed. This is a rare case of metastatic Barrett's esophageal cancer in which the metastases were eradicated by S-1 + cisplatin, and the primary tumor successfully excised by endoscopic mucosal resection after downstaging.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Barrett Esophagus; Cisplatin; Drug Combinations; Esophageal Neoplasms; Female; Humans; Liver Neoplasms; Lymphatic Metastasis; Middle Aged; Mucous Membrane; Oxonic Acid; Salvage Therapy; Tegafur; Tomography, X-Ray Computed

We experienced a case with liver metastasis of gastric cancer that disappeared by S-1 administration following non-curative operation. A distal gastrectomy for advanced gastric cancer with liver metastasis was performed on a 71-year-old male. S-1 was administered at 100 mg/body/day for 4 weeks followed by withdrawal for 2 weeks, and CDDP was prescribed at 5 mg/body/day div, for 2 days per a week as 1 course. After one course of treatment, the liver metastatic lesion decreased in size (reduction ratio was 87.4%). For side effect, S-1 100 mg alone was administered beginning with the second course. This lesion became CR after four courses. The adverse events of grade 3 observed during S-1 administration were neutropenia and diarrhea. We changed S-1 to UFT after nine courses, and the patient has now survived 1 year without recurrence after the disappearance of liver metastasis.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Neoplasm Staging; Oxonic Acid; Quality of Life; Stomach Neoplasms; Tegafur; Uracil

The patient was a 79-year-old a man who had a sigmoid colon resection for sigmoid colon carcinoma in another hospital 11 years ago. Four years later,he was noted to have multiple unresectable hepatic metastases on CT. Therefore,intrahepatic arterial and portal infusion with CDDP 10 mg + 5-FU 250 mg, respectively,were started. His CEA level decreased to the normal range,and a partial response (PR) was achieved. But two years later, the CEA level increased again,so radiofrequency ablation (RFA) therapy was given during abdominal surgery. Then, IFL, CPT-11+S-1, and FOLFOX were administered. Currently, the patient is being treated as an outpatient with CPT-11+S-1. The patient's multiple hepatic metastases were treated with multidisciplinary therapy, and the man has lived for 6 years 11 months since his first hepatic metastases were noted. The multidisciplinary therapy that was used lengthened this patient's life.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Catheter Ablation; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Fluorouracil; Hepatic Artery; Humans; Infusion Pumps, Implantable; Infusions, Intra-Arterial; Irinotecan; Leucovorin; Liver Neoplasms; Male; Organoplatinum Compounds; Oxonic Acid; Sigmoid Neoplasms; Survivors; Tegafur

S-1 is an oral fluoropyrimidine that promises better and accessible treatment. This article identifies the risk factors for severe adverse events of S-1 from nationwide survey data.. Advanced gastric cancer patients scheduled to receive S-1 monotherapy (80 mg/day for days 1-28, every 6 weeks) were registered throughout Japan between 1999 and 2000 (n = 3758). Univariate and multivariate analyses were performed to explore the risk factors for severe adverse events.. A multivariate analysis revealed that grade 3 or 4 neutropenia was significantly associated with baseline renal function [odds ratios (ORs) corresponding to creatinine clearance (ml/min) ranges of 50-79, 30-49, and <30 in reference to >80 increased to 1.21, 1.79, and 2.43, respectively], and the estimated incidence probability of grade 3 or 4 neutropenia ranged from 5.0% to 33.7% depending on the initial status of renal function and baseline neutrophil count. Some prior chemotherapeutic drug use may be implicated in the experience of adverse events; decreases in hemoglobin, nausea/vomiting, and hyperbilirubinemia were observed to be influenced by the previous use of irinotecan (OR = 3.07, P = 0.003), mitomycin (OR = 2.28, P = 0.004), and cisplatin (OR = 1.60, P = 0.007), respectively.. These findings identified possible risk factors for severe adverse events of S-1 and the patient subgroups at potentially higher risk from its administration. The results will facilitate safer administration of S-1 and thus promote enhanced tolerability and efficacy.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic; Creatinine; Drug Combinations; Female; Health Surveys; Humans; Japan; Liver Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm, Residual; Neutrophils; Oxonic Acid; Platelet Count; Product Surveillance, Postmarketing; Prospective Studies; Risk Factors; Stomach Neoplasms; Survival Rate; Tegafur

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Benzenesulfonates; Cetuximab; Clinical Trials, Phase III as Topic; Drug Combinations; Head and Neck Neoplasms; Humans; Liver Neoplasms; Niacinamide; Oxonic Acid; Phenylurea Compounds; Pyridines; Sorafenib; Stomach Neoplasms; Tegafur

We treated hepatic metastasis of gastric cancer with CPT-11 therapy and obtained complete remission of the hepatic tumor that has been maintained for than 2 years postoperatively. The patient was a 71-year-old man with a history of angina pectoris. In 1988, gastric cancer was diagnosed, and he underwent distal gastrectomy at another hospital. In 2003, the patient began to suffer from regurgitation symptoms and presented to our hospital in October of the year. Remnant gastric cancer was diagnosed as a result of detailed investigation. Preoperative imaging revealed the presence of a solitary tumor (6 cm in diameter) in the posterior lobe of the liver, and it was confirmed to be a hepatic metastasis from the remnant gastric cancer by needle biopsy. We decided to treat this metastasis with postoperative systemic chemotherapy. Total resection of the remnant stomach was done in November 2003 and oral S-1 therapy was started 3 weeks after surgery. When the response of the hepatic metastasis was evaluated after the completion of 3 courses, the tumor showed enlargement. Therefore, his chemotherapy was changed to CPT-11. After a total 900 mg of CPT-11 had been administered, imaging studies confirmed disappearance of the hepatic metastasis. The patient remains disease-free and has no impairment of daily activities 2 years after resection of the remnant stomach.

Topics: Adenocarcinoma; Aged; Antineoplastic Agents, Phytogenic; Camptothecin; Drug Administration Schedule; Drug Combinations; Gastrectomy; Humans; Irinotecan; Liver Neoplasms; Male; Oxonic Acid; Remission Induction; Stomach Neoplasms; Tegafur

A 53-year-old woman was revealed to have gallbladder cancer with liver metastases (H 1). Since a curative operation is impossible in this case, we started systemic chemotherapy employing S-1 combined with hepatic arterial infusion using epirubicin hydrochloride and mitomycin C. After three months, the primary lesion was reduced in size. The patient has been receiving systemic chemotherapy using S-1 only as an outpatient for 16 months. Although there is not enough evidence to support standard treatment, systemic chemotherapy combined with hepatic arterial infusion would improve the survival time without deterioration of quality of life in patients with advanced gallbladder cancer. This combined therapy should be considered one of the promising strategies for advanced gallbladder cancer.

Topics: Antineoplastic Combined Chemotherapy Protocols; Drug Administration Schedule; Drug Combinations; Epirubicin; Female; Gallbladder Neoplasms; Hepatic Artery; Humans; Infusion Pumps, Implantable; Infusions, Intra-Arterial; Liver Neoplasms; Middle Aged; Mitomycin; Oxonic Acid; Remission Induction; Tegafur

High-dose toremifene therapy (120 mg/day) is useful for the recurrence of receptor-positive breast cancer. However, some reports show that combination therapy of high-dose toremifene and chemotherapy exhibits additive effects. Twelve patients were given oral chemotherapy (capecitabine, 5'-DFUR+CPA, S-1) with high-dose toremifene. The overall response rate was 41.7%, in addition to 58.3% with no change beyond three months. Adverse events were restricted to headache, stomatitis and nausea. Average time to progressive (TTP) was 5.8 months. It was shown that high-dose toremifene and oral chemotherapy were useful for breast cancer recurrence without severe side effects.

Topics: Administration, Oral; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Capecitabine; Cyclophosphamide; Deoxycytidine; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Female; Floxuridine; Fluorouracil; Humans; Liver Neoplasms; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Quality of Life; Skin Neoplasms; Tegafur; Toremifene

We report a case of advanced gastric cancer with multiple liver metastases,in which a complete resection was performed following a bypass operation and chemotherapy. A 55-year-old man presented with vomiting and body weight loss. Gastrointestinal endoscopy revealed advanced gastric cancer with pyloric stenosis, and abdominal computed tomography showed multiple liver metastases in segments 2, 3, 5, and 6. A gastrojejunostomy was performed on August 24, 2004. The patient was then treated with 3 cycles of S-1 (120 mg/body, days 1-21) plus cisplatin (80 mg/body,day 8),followed by 8 cycles of weekly paclitaxel (wPTX; 140 mg/body, days 1,8, and 15). The primary tumor and liver tumors remained stable following the 3 cycles of S-1 plus cisplatin, but the liver tumors were considerably smaller after 3 cycles of wPTX. On August 25, 2005, a distal gastrectomy with D2 lymphadenectomy,lateral segmentectomy,and S5 partial hepatectomy was performed. The surgery was completed with no residual macroscopic or microscopic tumors. The patient received 6 cycles of wPTX as adjuvant therapy,and remained well with no evidence of tumor recurrence 28 months after the initial treatment.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Drug Administration Routes; Drug Combinations; Gastrectomy; Gastric Bypass; Humans; Liver Neoplasms; Lymph Node Excision; Male; Middle Aged; Oxonic Acid; Paclitaxel; Remission Induction; Stomach Neoplasms; Tegafur

We experienced a case of advanced gallbladder cancer with a remarkable response treated by oral fluoropyrimidine anticancer drug S-1 (120 mg/day on day 1 through 28 followed by a 14-day recovery period) as first-line chemotherapy. The patient was enrolled in the late phase II trial of S-1 for metastatic biliary tract cancer designed to evaluate efficacy and safety. The anti-tumor effect was observed in both primary lesion of gallbladder and metastatic lesion of liver,and the efficacy was confirmed to be a partial response (Japan Society for Cancer Therapy Criteria). After the first two courses of treatment, the reduction ratio of the tumor volume was 88.1% in the measurable lesions of liver metastasis. No severe adverse event was noted except grade 3 desquamation. The patient continued the outpatient treatment for a total 7 courses. The overall survival time was 470 days,suggesting that S-1 is highly effective and tolerable for metastatic gallbladder cancer.

Topics: Administration, Oral; Aged; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Gallbladder Neoplasms; Humans; Liver Neoplasms; Male; Oxonic Acid; Quality of Life; Tegafur

Biliary tract cancers, including extrahepatic bile duct cancer, are often diagnosed at an advanced stage; however,no standard therapies have been established as yet for this disease,and new,effective chemotherapeutic agents are being sought. Recently, a late phase II study of S-1, an oral fluoropyrimidine, in 40 patients with advanced biliary tract cancer yielded a good response rate of 35.0%. In this article,we report two patients with advanced extrahepatic bile duct cancer enrolled in the study who showed a partial response to S-1 monotherapy.

Topics: Adenocarcinoma; Antimetabolites, Antineoplastic; Bile Duct Neoplasms; Bile Ducts, Extrahepatic; Drug Administration Schedule; Drug Combinations; Female; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Quality of Life; Tegafur

We report the case of a 62-year-old man with advanced gastric cancer and multiple liver metastases who was successfully treated with combined chemotherapy including S-1. The patient was clinically diagnosed with stage IV (T3 N2 H1 P0) disease and was initially treated with 100 mg/body per day S-1 administered orally for 21 days and 10 mg/body per day cisplatin (CDDP) infused on days 1-5, 8-12, and 15-19. This chemotherapy resulted in significant reduction of the liver and gastric tumors. After receiving additional CDDP/S-1 administration as an outpatient, the patient's liver masses disappeared as shown on abdominal computed tomography (CT). With the patient's desire and informed consent, he underwent curative surgery with total gastrectomy, D1+alpha lymph node dissection, and partial resection of liver S4. After discharge without any surgical complication, CT revealed regrowth of the S4 liver mass, and combined docetaxel and CDDP was selected as second-line chemotherapy with local radiation therapy against the hepatic metastasis. Additionally, a third regimen with irinotecan and S-1 was given. At 2 years 7 months after the initial treatment, no sign of cancer (including liver metastasis and peritoneal dissemination) has been identified by radiological follow-up examinations.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Docetaxel; Drug Combinations; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Stomach Neoplasms; Taxoids; Tegafur

We report 2 cases of advanced gastric cancer with synchronous liver metastases who were successfully downstaged using S-1 plus low-dose cisplatin chemotherapy followed by surgical resection. S-1 was administered orally (80 mg/m(2)/day) twice daily for 14 consecutive days, and cisplatin (15 mg/m(2)) was infused over 1 h on days 1 and 8. Successful downstaging of the hepatic metastases was confirmed by imaging analyses; however, neither patient showed a complete response of the primary lesion in the stomach. Toxicities, according to the WHO criteria, were mild. The patients underwent surgical resection within 4 weeks after the last chemotherapy. Postoperatively, they were discharged without complications and received adjuvant chemotherapy. Both patients remained alive and well at 17 and 12 months after surgery, respectively, without recurrence. These cases provide further evidence that S-1 plus low-dose cisplatin chemotherapy enables downstaging of advanced gastric cancer and a subsequent potentially curative resection without serious complications.

Topics: Cisplatin; Drug Combinations; Drug Therapy, Combination; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Preoperative Care; Stomach Neoplasms; Tegafur; Tomography Scanners, X-Ray Computed

A 70-year-old man with abdominal pain and anemia was diagnosed with duodenal cancer upon upper gastrointestinal endoscopy and biopsy. Pancreatoduodenectomy was performed. Pathological findings were duodenal cancer, T 4 SI (Panc) N0P0V0A0H0. Three months after operation, abdominal CT showed multiple liver metastasis. He then underwent combined chemotherapy consisting of two weeks administration of S-1 (80 mg/body) followed by one week rest and injections of docetaxel (40 mg/body) every three weeks as one course. Metastatic tumors were gradually reduced and successfully controlled,and there was no other recurrence until he died about three years later of another illness. Combined S-1 and docetaxel chemotherapy is known to be effective for esophageal cancer, gastric cancer and other digestive cancer, as well as for duodenal cancer.

Topics: Aged; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Docetaxel; Drug Combinations; Duodenal Neoplasms; Humans; Liver Neoplasms; Male; Oxonic Acid; Taxoids; Tegafur

We report a patient with type 3 gastric cancer with peritoneal dissemination and hydronephrosis who was successfully treated with intraperitoneal infusion of paclitaxel and oral administration of S-1. He was diagnosed with unresectable gastric cancer with severe peritoneal dissemination by staging laparoscopy. We selected combined chemotherapy with both paclitaxel and S-1. Paclitaxel at 60 mg/m(2) was administered intraperitoneally on days 1 and 8, and S-1 at 100 mg/body was administered orally for 14 days, followed by 7 days' rest, as one course. After five courses, primary tumor reduction was confirmed and no cancer cells were detected on pathocytological investigation at second-look laparoscopy. The patient underwent total gastrectomy with lymph node dissection. He died from liver metastasis 29 months after the initial treatment, but he had not suffered from peritoneal metastases and had kept a good quality of life (QOL) since that treatment. This chemotherapy can be applied as one of the promising candidates for the treatment of patients with peritoneal metastasis of gastric cancer.

Topics: Adenocarcinoma; Administration, Oral; Adult; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Drug Combinations; Humans; Hydronephrosis; Infusions, Parenteral; Liver Neoplasms; Male; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Stomach Neoplasms; Tegafur

Topics: Antimetabolites, Antineoplastic; Deoxycytidine; Drug Combinations; Drug Resistance, Neoplasm; Gemcitabine; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Tegafur; Treatment Failure; Treatment Outcome

We have experienced a successful case of liver metastasis from gastric cancer treated with S-1 plus induced hypertensive hepatic arterial infusion chemotherapy. A 50-year-old man had undergone distal gastrectomy with extended lymphadenectomy for advanced gastric cancer. Although he was given 100 mg/day of S-1 for postoperative adjuvant therapy, an abdominal CT scan showed a liver metastasis at the hepatic segment 6 after 3 courses of adjuvant chemotherapy. Then, intra-arterial hepatic cannulation connecting to a subcutaneously implanted port system was indwelt via left subclavial artery. Mitomycin C (10 mg) was injected through out the induced hypertension with intravenously-administered angiotensin II once a month. After he received three courses of this combination chemotherapy, the liver metastasis has disappeared on CT scan and a complete response (CR) has been maintained.

Topics: Drug Combinations; Gastrectomy; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Pressure; Stomach Neoplasms; Tegafur; Treatment Outcome

5-FU plus Cisplatin combination therapy had been employed against primary liver carcinomas for years. S-1 is a fourth-generation oral fluoropyrimidine and attracts considerable interest for the activity against gastric cancer. We herein examined the effect and adverse effects of S-1 plus Cisplatin combination therapy for primary liver carcinomas.. 4 patients with hepatocellular carcinoma (HCC) and 3 with cholangiocellular carcinoma (CCC) were employed for this study. They all had far-advanced diseases in and/or out of the liver at the time of the therapy initiation. They were 4 men and 3 women. Their ages were in the range of 42-73 (58 +/- 9.73, mean +/- SD) years old. The protocol of the therapy is a 3-week period of S-1 (70-80 mg/m2/day) oral administration combined with 2 intravenous administration of CDDP (20-35 mg/m2) during the period. With two weeks of intermission, the therapy was repeatedly performed 2-11 times for each patient.. Three patients had PR and 2 had NC response with the therapy. Two patients with HCC and pre-treatment with 5-FU had PD response. Although the patients developed leukopenia and thrombocytopenia, the therapy was well tolerable also in the outpatient basis.. S-1 plus Cisplatin combination therapy is a potential therapy for advanced primary liver carcinomas.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Cisplatin; Drug Combinations; Female; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Oxonic Acid; Prognosis; Tegafur; Tomography, X-Ray Computed

We report the case of 67-year-old man who was given a diagnosis of advanced gastric adenocarcinoma. Complete response of multiple liver and paraaortic lymph node metastases occurred in this patient after combination chemotherapy with systemic injection of paclitaxel and oral administration of novel dihydropyrimidine- dehydrogenase- inhibitory fluoropyrimidine (S-1). Following 7 courses of the biweekly paclitaxel and S-1 combination chemotherapy, the patient underwent total gastrectomy with D3 extended lymph node dissection. According to the operative findings, the tumor was curatively removed along with the liver metastases and paraaortic lymph node metastases. Biopsy of the liver was performed and the pathological diagnosis indicated no gastric adenocarcinoma cells. The pathological report showed that the lymph node metastases had completely disappeared with single exception and minute cancerous lesions were identified in the gastric mucosa and submucosa. Therefore, the histological efficacy was evaluated as Grade 2. For postoperative chemotherapy, oral S-1 administration only was chosen. However, 6 months later, biweekly paclitaxel and S-1 combination chemotherapy was administered in sequence as a second adjuvant chemotherapy because the serum level of the tumor marker was elevated. The patient is fine and has not shown any recurrence at other sites 37 months after surgery. Salvage surgery following paclitaxel and S-1 chemotherapy may be feasible for patients with advanced gastric cancer and complete regression of distant metastases. Biweekly paclitaxel and S-1 combination chemotherapy has been used safely and its administration may be continued for a long time in an outpatient clinic setting for the treatment of advanced gastric cancer.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Aorta; Drug Combinations; Endoscopy, Gastrointestinal; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Oxonic Acid; Paclitaxel; Remission Induction; Salvage Therapy; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

Three cases with unresectable advanced gastric cancer with liver metastases were successfully treated by the combination therapy of TS-1 and cisplatin( CDDP). TS-1 (1.25 m2>: 80 mg/day, 1.25 m2-1.50 m2: 100 mg/day, > or =1.50 m2: 120 mg/day) was administered orally for 14 consecutive days followed by 14 days rest,and a 24-h infusion of CDDP (70 mg/m2) was administered on day 8 of each course. Treatment was repeated every 4 weeks unless disease progression was observed. Partial response was obtained in all of the following three advanced gastric cancer cases with liver metastases. Case 1: 67-year-old male with Borrmann type I gastric cancer with multiple liver metastases. Case 2: 55-year-old female with multiple liver and lymph node metastases whose primary gastric lesion was surgically resected. Case 3: 53-year-old-male with Borrmann type III gastric cancer with liver and lymph node metastases. TS-1/CDDP therapy can be highly recommended for the treatment of advanced gastric cancer with liver metastases.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Female; Humans; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Pyridines; Quality of Life; Stomach Neoplasms; Tegafur

A 66-year-old woman (156 cm, 58 kg) underwent sigmoid colectomy for cancer. She was found to have simultaneous liver and peritoneal metastases at operation, which had not been detected with CT examination before operation. After operation, CT showed multiple liver metastasis and a high level of CEA and CA19-9 . Pathological findings were type 3, 30 x 20 mm, poorly-differentiated adenocarcinoma, se, ly 2, v 2, n 2 (+), ow (-), aw(-), H 3, P 0 (stage IV). Treatment of the patient consisted of daily oral administration of 80 mg TS-1 for 21 days and 60 mg CPT-11 on 1 day and 15 day as one course. After 2 courses, tumor sizes of liver metastases and the level of tumor markers became reduced. The current case suggested that the administration of TS-1 and CPT-11 may have a potent therapeutic efficacy in advanced colorectal cancer.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Drug Administration Schedule; Drug Combinations; Female; Humans; Irinotecan; Liver Neoplasms; Lung Neoplasms; Oxonic Acid; Pyridines; Sigmoid Neoplasms; Tegafur; Tomography, X-Ray Computed

A 64-year-old man with unresectable sigmoid adenocarcinoma due to peritoneal dissemination (P3) and liver metastasis (H2) treated with TS-1, showed a complete response. TS-1 is an oral anticancer drug that produces biochemical modulation. It is composed of tegafur, gimestat and ostat potassium in a molar ratio of 1:0.4:1 to increase the effect of 5-FU and to decrease toxicity in the digestive canal. Treatment with TS-1 requires no hospitalization and can enhance the quality of life of the patient. TS-1 is expected to be an effective agent for the treatment of colon cancer with liver metastasis and peritoneal dissemination.

Topics: Adenocarcinoma; Antimetabolites, Antineoplastic; Biomarkers, Tumor; CA-19-9 Antigen; Carcinoembryonic Antigen; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Peritoneal Neoplasms; Pyridines; Remission Induction; Sigmoid Neoplasms; Tegafur

We experienced a case of recurrent breast cancer resistant to prior medications, which was treated with oral S-1, a fluoropyrimidine-class anticancer drug, and exhibited the marked shrinkage of liver metastasis. The prior treatments including anthracycline and taxane were judged not effective because of the progressive disease. Then the oral treatment with S-1 was started at 120 mg/day bid. targeting metastatic lesions of the liver. At the end of the second cycle,a significant improvement was noted with a decrease rate of 82.5%. The S-1 monotherapy was thus considered to be an effective treatment for advanced or recurrent breast cancer resistant to anthracyclines and taxanes.

Topics: Anthracyclines; Antimetabolites, Antineoplastic; Antineoplastic Agents; Breast Neoplasms; Bridged-Ring Compounds; Carcinoma, Ductal, Breast; Drug Administration Schedule; Drug Combinations; Drug Resistance, Neoplasm; Female; Humans; Liver Neoplasms; Mastectomy, Segmental; Middle Aged; Oxonic Acid; Pyridines; Taxoids; Tegafur

We had 2 patients with marked shrinkage of liver metastasis by administration of the oral fluorinated pyrimidine anticancer drug S-1 for advanced/recurrent breast cancer that was resistant to taxane and another antitumor drugs. Both patients almost completed the full dose through the whole course of treatment,and the drug showed good tolerability. S-1 was considered to possess beneficial antitumor efficacy and tolerability and to be promising as home chemotherapy for advanced/recurrent breast cancer.

Topics: Administration, Oral; Anthracyclines; Antimetabolites, Antineoplastic; Breast Neoplasms; Bridged-Ring Compounds; Carcinoma, Ductal, Breast; Drug Administration Schedule; Drug Combinations; Drug Resistance, Neoplasm; Female; Humans; Liver Neoplasms; Middle Aged; Oxonic Acid; Pyridines; Taxoids; Tegafur

A 74-year-old man was revealed to have type 3 gastric cancer with synchronous multiple liver metastases. Despite treatment with TS-1 (120 mg/body), an increase in tumor size was demonstrated by computer tomography and endoscopy. We tried a course of a combination chemotherapy consisting of paclitaxel (PTX) plus doxifluridine (5'-DFUR ) to reduce the tumor. 5'-DFUR (600 mg/m(2)) was administered day 1 to 14 followed by 7 days'rest as one course. PTX (80 mg/m(2)) was infused on days 1 and 8. After 5 courses, the tumor markers decreased markedly, and computer tomography and endoscopy revealed remarkable tumor reduction which was thought to show a partial response. After 13 courses we discontinued this chemotherapy, so increase of the tumor marker was remarkable. This case suggests that PTX/5'-DFUR protocol is effective for clinical management of gastric cancer resistant to TS-1.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Drug Administration Schedule; Drug Combinations; Drug Resistance, Neoplasm; Floxuridine; Humans; Irinotecan; Liver Neoplasms; Male; Oxonic Acid; Paclitaxel; Pyridines; Stomach Neoplasms; Tegafur

The patient was a 71-year-old man. Chemotherapy was conducted in two courses combining TS-1 (120 mg) and CDDP (80 mg) under the diagnosis of AFP-producing gastric cancer with multiple liver metastasis and peritoneal dissemination. Peritoneal dissemination disappeared, liver metastasis almost disappeared after completion of two courses, and the therapeutic efficacy was rated as PR. Then, the patient underwent distal gastrectomy and lymph node dissection. He received TS-1 monotherapy after surgery, but his condition gradually became worse. TS-1 and CDDP combination were given again, but an ileus resulted due to peritonitis carcinomatous. We therefore administered bi-weekly paclitaxel (80 mg/m(2)) intravenously. The ileus disappeared after one week, liver metastatic lesions and ascites were improved after completion of one course, and therapeutic efficacy was rated as PR. Grade 3 neutropenia and grade 1 alopecia occurred, but no other adverse reaction occurred. This therapy made it possible to eat foods, conduct chemotherapy safely while ambulatory. Paclitaxel can be expected to show good therapeutic efficacy and improve QOL of a peritonitis carcinomatosa patient with TS-1 resistant advanced gastric cancer.

Topics: Aged; alpha-Fetoproteins; Antineoplastic Agents, Phytogenic; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Drug Resistance, Neoplasm; Gastrectomy; Humans; Liver Neoplasms; Lymph Node Excision; Male; Oxonic Acid; Paclitaxel; Peritoneal Neoplasms; Pyridines; Quality of Life; Stomach Neoplasms; Tegafur

Pancreatic acinar cell carcinomas are rare, and little is reported on their chemotherapy. We report a 49-year old male patient with pancreatic acinar cell carcinoma and multiple liver metastases, which responded to oral TS-1 and hepatic arterial infusion of cisplatin. The patient underwent a partial hepatectomy, MCT abrasions and excision of the pancreatic tumor. Postoperative pathological studies revealed metastases of acinar cell carcinoma to the liver and lymph nodes; the primary lesion was undetermined. After surgery, the patient was treated with hepatic arterial infusion of cisplatin and oral TS-1. Metastatic tumors completely disappeared, and serum lipase decreased to normal levels. Abdominal CT one year after surgery revealed a pancreatic body tumor, which was surgically removed. Pathological studies showed primary pancreatic acinar cell carcinoma, while previous metastases remained under control. To summarize, TS-1 and cisplatin can be effective treatments for pancreatic acinar cell carcinomas.

Topics: Administration, Oral; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Acinar Cell; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Hepatectomy; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Pyridines; Tegafur

In December 2002, a 67-year-old man underwent right colectomy (stage IIIa, cur B) for cancer of the ascending colon. Chemotherapy with 5'-DFUR and PSK was performed after surgery, but was discontinued due to grade 3 diarrhea. The patient refused treatment with other drugs. An increased CEA level was observed in July 2004, and metastasis of his colon cancer to the liver, lungs, and supraclavicular lymph nodes was confirmed. The patient agreed to resume chemotherapy in December 2004, and received outpatient treatment with CPT-11 (70 mg/m(2) on days 1 and 8) and TS-1 (100 mg/day on days 1-14). There was a significant decrease of tumor markers and a decrease in the size of the metastatic tumors, with these findings being judged as PR. Diarrhea (grade 1) and oral ulceration (grade 2) were observed during treatment. However, these side effects were transient and resolved temporarily without suspending therapy. Although hepatic dysfunction (grade 2) was observed after the completion of cycle No.5, the patient decided to discontinue treatment. CPT-11/TS-1 chemotherapy seems to be useful for maintaining the QOL of patients with metastatic colon cancer.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colectomy; Colonic Neoplasms; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Humans; Irinotecan; Liver Neoplasms; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Oxonic Acid; Pyridines; Quality of Life; Tegafur

The patient diagnosed as recurrent pancreatic cancer was treated with UFT combined gemcitabine (GEM) chemotherapy. After one cycle of therapy, the anti-tumor effect was progressive disease with obstructive jaundice and enlargement of lymph node metastasis and liver metastasis. The chemotherapy was changed to TS-1 combined GEM chemotherapy and resulted in partial response. Only grade 3 leukopenia was observed as an adverse effect. Some cases may be effectively treated by TS-1 combined chemotherapy after treatment failure of UFT combined GEM chemotherapy. This therapy is simple and possible to continue safely on an ambulatory basis while maintaining quality of life.

Topics: Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Drug Administration Schedule; Drug Combinations; Female; Gemcitabine; Humans; Jaundice, Obstructive; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Pancreatic Neoplasms; Pyridines; Quality of Life; Remission Induction; Tegafur; Uracil

Dihydropyrimidine dehydrogenase (DPD) is a reducing enzyme for fluoropyrimidine which is a widely-used anti-cancer agent, and its deficiency leads to serious toxicities. We report a rare patient with a DPD deficiency. A 39-year-old man was suspected to have a gastric cancer recurrence from the elevation of CEA. Although TS-1 was administered for five days, it was stopped due to the development of grade 2 anorexia and nausea. Although we administered UFT at his request after a one-month drug rest, grade 1 stomatorrhagia besides the former adverse events developed after five days. Therefore he discontinued it and was admitted to our hospital. After 19 days, he died from multiple brain hemorrhage despite the intensive therapies. We considered that the congenital DPD deficiency caused the development of these adverse events because the DPD value was less than 5 pmol/mg/min in mononuclear cells of peripheral blood.

Topics: Adult; Anorexia; Antimetabolites, Antineoplastic; Bone Neoplasms; Cerebral Hemorrhage; Dihydropyrimidine Dehydrogenase Deficiency; Drug Combinations; Fatal Outcome; Humans; Liver Neoplasms; Male; Nausea; Oxonic Acid; Stomach Neoplasms; Tegafur; Uracil

We have reported a remarkably high anti-tumor efficacy using intra arterial 5-FU infusion chemotherapy combined with subcutaneous interferon-alpha injection to treat advanced hepatocellular carcinoma (HCC) with portal vein thrombus. However, we have been confirming distant metastases along with a prognosis extension as hepatic lesions could possibly be controlled to a certain extent. Even though there has been no effective chemotherapy against hepatocellular carcinoma with distant metastases, we performed S-1 and interferon-alpha combination chemotherapy for the cases where good results were exhibited from interferon-alpha combined with arterial 5-FU infusion. As a result, we confirmed CR in the anti-tumor effect against distant metastases with no severe adverse effects. It was suggested that a combination therapy of S-1 and interferon-alpha may be one of the most effective treatment modalities against advanced HCC with distant metastases.

Topics: Administration, Oral; Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Drug Administration Schedule; Drug Combinations; Humans; Interferon-alpha; Liver Neoplasms; Middle Aged; Neoplastic Cells, Circulating; Oxonic Acid; Remission Induction; Tegafur

In cases with advanced/recurrent gastric cancer undergoing single therapy with TS-1, we retrospectively discussed the antitumor effects and adverse events and considered the clinical utility of TS-1. The subjects consisted of 131 cases with advanced/recurrent gastric cancer who received one or more courses of therapy with TS-1 alone between July 1999 and August 2003. We carried out 4-week administration of 80-120 mg/day of TS-1 according to body surface area, followed by a 2-week discontinuation, then repeated administration which adjusting the dosage according to the incidence of side effects, and discussed the antitumor effects and adverse events. The response rate in all cases was 21% and the median survival time (MST) was 343 days, or 25.3% and 265 days if limited to unresectable and recurrent cases. The response rates were 38.2% for unresectable cases, 16.3% for recurrent cases and 14.6% for curability C cases, and the MSTs were 250 days, 276 days and 419 days, respectively. The response rates in terms of whether or not patients had received chemotherapy were 11.6% for those who had received chemotherapy and 40.0% for those who had not, and the MSTs were 239 days and 325 days, respectively. Thus, both were significantly better in patients who had not received chemotherapy. The response rates for patients who had not received chemical therapy by target organs were favorable on the order of 50% for stomach and 33% for liver metastasis, and the MSTs were on the order of 474 days for peritoneum, 39 1 days for liver metastasis and 326 days for lymph nodes. There were 10 cases of long-term survival of 600 days or longer, but not in unresectable cases, and the target organs in many of the cases were the peritoneum and lymph nodes. Adverse reactions were observed in 34.4% of all cases and those of grade 3 or more in 9.4%, all of which were improved only by discontinuation of the drug. It was again confirmed that single therapy with TS-1 for advanced/recurrent gastric cancer is an excellent therapy providing both high antitumor effects and safety.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Retrospective Studies; Stomach Neoplasms; Survival Rate; Tegafur

Endocrine cell carcinoma (ECC) of the stomach is a rare pathological type with a poor outcome. Standard chemotherapy has not yet been established. We experienced a case of partial response in the liver metastasis from the gastric ECC treated with TS-1. The patient was a 68-year-old female. An upper GI series and gastroendoscopy revealed pyrolus stenosis and CT-scan showed liver metastasis. A non-curative total gastrectomy was performed to allow oral intake. Since the histopathological examination revealed that tumor cells were partially positive for chromogranin A on immunohistochemical study, we diagnosed tumor ECC of the stomach. The patient with liver metastasis was treated using TS-1, and CT-scan showed a remarkable decrease (PR) in the metastatic lesion. TS-1 administration can improve the clinical outcome for ECC of the stomach.

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Small Cell; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Female; Gastrectomy; Humans; Liver Neoplasms; Oxonic Acid; Remission Induction; Stomach Neoplasms; Tegafur

A 72-year-old man was diagnosed as gastric cancer with pyloric stenosis by an upper gastorintestinal endoscopy for anemia in July 2001. Computed tomography (CT) of the abdomen showed multiple liver metastases. Serum CEA was 6.2 ng/ml. At laparotomy to improve anemia and pyloric stenosis in September 2001, lymphnode metastases invaded the stomach and the pancreatic body. Gastro-jejunostomy was performed without gastrectomy. Oral administration of 100 mg of TS-1 for 28 consecutive days followed by a 14-day rest was given postoperatively. The response assessment of chemotherapy after 1 year was no change (NC) of the primary lesion on endoscopic examination, and liver metastases showed a partial response (PR) on CT. Serum CEA was raised to 86.1 ng/ml in April 2004. The treatment was changed to weekly paclitaxel. The patient died in July 2005. This case with unresectable gastric cancer had been treated by oral administration of TS-1 as an outpatient for 3 years and 7 months.

Topics: Administration, Oral; Aged; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Neoplasm Invasiveness; Oxonic Acid; Pyloric Stenosis; Stomach Neoplasms; Tegafur

We treated a patient with multiple liver metastases arising from colon cancer in whom the metastatic tumors were responsive to treatment with the combination of TS-1 and CPT-11. The patient was a 71-year-old woman with cancer of the ascending colon and metastatic hepatic tumors. She had undergone surgery on July 28, 2004, and abdominal contrast CT scans obtained after discharge from hospital revealed numerous LDA (low-density areas) in both lobes of the liver. The patient was given ambulatory chemotherapy with TS-1 (120 mg/day on days 1-14) and CPT-11 (100 mg/day on days 1 and 8). After completion of 2 courses of chemotherapy, abdominal contrast CT scans revealed that most of the LDAs in both lobes of the liver had disappeared, and the patient was judged to have achieved PR. No adverse reactions were observed except for a slight decrease of WBC, and her chemotherapy is being continued at present. This case suggests that the combination of TS-1 and CPT-11 may be an effective form of chemotherapy for the treatment of colon cancer with multiple hepatic metastases.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colonic Neoplasms; Drug Administration Schedule; Drug Combinations; Female; Humans; Irinotecan; Liver Neoplasms; Oxonic Acid; Remission Induction; Tegafur

The case was a 54-year-old man with type-3 gastric cancer in the cardia accompanied by multiple liver metastasis. He received combination chemotherapy consisting of CPT-11 (60 mg/body, day 1 and 8)+low-dose 5-FU and CDDP (5-FU 500 mg/body/day and CDDP 5 mg/body/day, day 1-5 and 8-12, continuous infusion) every 3 weeks. The initial 2 courses were administered on an inpatient basis,and further courses as an outpatient. After 7 courses of therapy without severe adverse events, not only primary lesion but also hepatic metastasis disappeared. He has been free from disease for 4 months, and chemotherapy was further continued with TS-1 (100 mg/body, day 1-14)+CPT-11 60 mg/body, day 1, 8), every 3 weeks. CPT-11 in combination with low-dose 5-FU+CDDP can be one of the most effective regimens for unresectable advanced gastric cancer.

Topics: Adenocarcinoma; Ambulatory Care; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cardia; Cisplatin; Drug Administration Schedule; Drug Combinations; Fluorouracil; Humans; Irinotecan; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Remission Induction; Stomach Neoplasms; Tegafur

A 63-year-old woman was referred to our hospital with complaints of anal pain, constipation and abdominal distention caused by a rectal tumor. After examinations, she was diagnosed as rectal cancer with multiple liver metastases. The CEA level was 70.0 ng/ml and the CA19-9 level was more than 5,000 U/ml at admission. To prevent bowel obstruction, low anterior resection of the rectum was performed. At 34 days after operation, TS-1 chemotherapy was started as outpatient treatment (each course consisted of daily oral administration of 100 mg TS-1 for 4 weeks followed by 2 drug-free weeks). After the first course, the CEA level was reduced to 3.3 ng/ml and the CA19-9 level to 15 U/ml, both under the normal value. After the second course, administration was discontinued due to diarrhea, and restarted as a daily oral administration of 80 mg TS-1. After the five courses, the CEA level was 4.0 ng/ml and the CA19-9 level was 4 U/ml, both under the normal value. Multiple liver metastases had remarkably reduced in the CT findings. The patient continues to undergo outpatient treatment with good QOL.

Topics: Adenocarcinoma; Ambulatory Care; Antimetabolites, Antineoplastic; Biomarkers, Tumor; CA-19-9 Antigen; Carcinoembryonic Antigen; Drug Administration Schedule; Drug Combinations; Female; Humans; Liver Neoplasms; Middle Aged; Oxonic Acid; Rectal Neoplasms; Tegafur

The patient was a 66-year-old male who had descending colon cancer with multiple liver metastases and paraaortic lymph node metastases. He underwent a left colectomy with lymph node dissection, but the operation resulted in curability C. The serum CEA level before the operation was 205.5 ng/ml. After 2 courses of 5-FU/LV as first-line chemotherapy, this treatment could not be continued due to grade 3 anorexia. As second-line chemotherapy, the patient was treated with daily oral administration of TS-1 (100 mg/day) for 3 weeks. Due to grade 3 anorexia, this treatment could not be continued. Tailored TS-1/CPT-11 (TS-1 80 mg/day from day 1 to day 21, CPT-11 65 mg/m(2) day 1, 15) combination therapy was then chosen as third-line chemotherapy. After 6 courses of combination therapy, the tumor marker (CEA) was decreased and para-aortic lymph nodes could not be detected by computed tomography (CT). Only grade 1 fatigue was noted as an adverse reaction to the treatment. The patient's good QOL was achieved during follow-up over 24 months with the cancer controlled. This case suggests that patients with non-curative resected colon cancer could benefit from TS-1/CPT-11 combination therapy as a second-line or third-line treatment.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Carcinoembryonic Antigen; Colectomy; Colonic Neoplasms; Drug Administration Schedule; Drug Combinations; Humans; Irinotecan; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Oxonic Acid; Tegafur

This study was designed to examine the efficacy and compliance of S-1 for the patients with peritoneal metastasis of gastric cancer.. Sixteen consecutive patients with peritoneal metastasis of gastric cancer were treated with S-1. Their survival was compared with that of the historical control group (25 patients). Thymidylate synthase, dihydropyrimidine dehydrogenase, thymidine phosphorylase and orotate phosphoribosyl transferase mRNA expression in the tumor were evaluated.. The median survival time of S-1-treated patients was 550 days, which was significantly longer than that of the historical control group (215 days). We elucidated some factors to prolong the survival of the patients treated with S-1 for peritoneal metastasis: peritoneal metastasis without other distant metastases, the combination of S-1 treatment and gastrectomy, and low expression of thymidine phosphorylase mRNA in primary tumors.. S-1 showed a surprisingly long-term survival with minimum toxicity in patients with peritoneal metastasis of gastric cancer.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Biomarkers, Tumor; Dihydrouracil Dehydrogenase (NADP); Drug Combinations; Female; Gastrectomy; Humans; Intestinal Neoplasms; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Orotate Phosphoribosyltransferase; Oxonic Acid; Patient Compliance; Peritoneal Neoplasms; Stomach Neoplasms; Survival Rate; Tegafur; Thymidine Phosphorylase; Thymidylate Synthase; Time Factors; Treatment Outcome

A 74-year-old man was revealed to have type 3 gastric cancer with lymph-node metastasis in the third group (N 3) and liver metastasis (H 1). Since we regarded a curative operation as impossible, we started preoperative chemotherapy using TS-1 plus irinotecan hydrochloride (CPT-11) on the premise that we would perform surgical cytoreduction after the chemotherapy. After two courses of chemotherapy, both the primary lesion and the liver metastasis were reduced in size, and the paraaortic lymph-nodes disappeared. Subsequently, a distal gastrectomy (D 0, curability C) was performed. The patient has been receiving postoperative chemotherapy using TS-1 and paclitaxel as an outpatient for 2.3 years. Although there is not enough evidence to support the benefit of surgical cytoreduction, chemotherapy combined with surgical cytoreduction would improve the survival time without deterioration of quality of life (QOL) in patients with advanced gastric cancer. This combined therapy should be considered as one of the promising strategies for advanced gastric cancer.

Topics: Adenocarcinoma, Mucinous; Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Gastrectomy; Humans; Irinotecan; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Oxonic Acid; Quality of Life; Stomach Neoplasms; Survivors; Tegafur

A 75-year-old man was admitted to our hospital with hematoemesis. Gastrofiber-scopy revealed that type 3 gastric cancer was widespread in the lesser curvature. Multiple liver metastases 5 cm in diameter were shown on CT. We thought that the case was unresectable, and TS-1/CDDP chemotherapy was performed. TS-1 (80 mg/body/day) was orally administered and CDDP at 20 mg/body/day by intravenous drip infusion a week for 3 weeks followed by a drug-free 2 week period as the first course. After the third course, the primary lesion and the liver metastasis showed a partial response in terms of size. No serious drug adverse reaction was observed. Since there was no longer any reduction of the tumor, gastrectomy and coagulation therapy for liver metastasis were performed, and he has been alive for 15 months without recurrence. Combined use of TS-1 and CDDP is effective as neoadjuvant chemotherapy for advanced gastric cancer.

Topics: Adenocarcinoma; Administration, Oral; Aged; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Gastrectomy; Humans; Infusions, Intravenous; Liver Neoplasms; Male; Oxonic Acid; Remission Induction; Stomach Neoplasms; Tegafur

In two patients with advanced pancreatic cancer with cervical lymph node or liver metastasis and no indication of pancreatic resection and radiotherapy, oral treatment with S-1 (an anti-cancer agent of fluoropyrimidine derivative) exerted high anti-tumor activity on the metastatic lesions. Both cases responded well to this therapy in the late phase II study of S-1 in patients with advanced pancreatic cancer designed to evaluate efficacy and safety. In Case 1 (with cervical lymph node metastasis), the anti-tumor efficacy of this therapy was evaluated as a partial response (PR) after the first four courses of treatment. In Case 2 (with liver metastasis), the efficacy was evaluated as PR for overall response. Thus, the therapy indicated excellent efficacy in both cases. No grade 3 or severe adverse event was noted in either of the two cases. In Case 1, grade 2 anemia, stomatitis, vomiting and fatigue, and some other mild events were noted. When used as a systemic chemotherapy for metastatic pancreatic cancer, oral treatment of S-1 is highly effective, tolerable and convenient in an outpatient clinic. This drug is a promising way to improve and preserve the QOL essential to long-term home care.

Topics: Adenocarcinoma; Administration, Oral; Aged; Anemia; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Female; Humans; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neck; Oxonic Acid; Pancreatic Neoplasms; Quality of Life; Stomatitis; Tegafur; Vomiting, Anticipatory

We report a case in a late phase II clinical study investigating the efficacy and safety of the oral fluoropyrimidine anticancer drug S-1. The drug proved effective in a patient with inoperable advanced pancreatic cancer in whom radiation therapy was not indicated. The antitumor effect after 4 courses was rated excellent, with a target site (liver) evaluation of CR and overall evaluation of PR. In particular, two liver metastases, measuring 18.7 x 15.4 mm and 16.2 x 14.6 mm, respectively, both resolved, and S-1 was found to exert a potent antitumor effect against metastases. Assessment of adverse events revealed no grade 3 or 4 adverse reactions, and other adverse events were all mild. Based on the above results, S-1 appeared to be effective against advanced pancreatic cancer and showed excellent tolerability.

Topics: Adenocarcinoma; Antimetabolites, Antineoplastic; Clinical Trials, Phase II as Topic; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Pancreatic Neoplasms; Remission Induction; Tegafur

We report two metastatic pancreatic cancer patients who showed marked tumor shrinkage following administration of the oral fluorinated pyrimidine anticancer drug, S-1. In the early phase II trial of S-1 for metastatic pancreatic cancer, both patients showed a partial response (Japan Society for Cancer Therapy Criteria): the reduction ratio of the tumor volume was 81.4% in the patient with liver metastasis (Case 1) and 86.9% in the patient with lung metastasis (Case 2). Case 1 showed grade 3 anorexia and decrease of the serum hemoglobin as severe adverse effects, but the other adverse reactions were mild. Both patients could be treated as outpatients. S-1 showed a promising antitumor effect and tolerability in patients with metastatic pancreatic cancer, and it was also considered to be beneficial for patients in terms of convenience of administration, that is, by the oral route.

Topics: Adenocarcinoma; Aged; Anorexia; Antimetabolites, Antineoplastic; Clinical Trials, Phase II as Topic; Drug Administration Schedule; Drug Combinations; Female; Hemoglobins; Humans; Liver Neoplasms; Lung Neoplasms; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Tegafur

We report a patient with chemotherapy-naïve advanced pancreatic cancer having multiple liver metastases which dramatically responded to S-1, an oral fluoropyrimidine. The patient was enrolled in the "Late Phase II Clinical Study of S-1 in Patients with Advanced Pancreatic Cancer." Anti-tumor efficacy after the first four courses of S-1 monotherapy was confirmed to be partial response (PR) in overall response by Response Evaluation Criteria in Solid Tumors (RECIST). Grade 3 neutropenia was observed, but no other severe toxicities were noted. On the basis of the results of the late phase II clinical study, S-1 is a promising agent for systemic chemotherapy against advanced pancreatic cancers because of its excellent efficacy, high tolerability, and convenient route of oral administration.

Topics: Adenocarcinoma; Antimetabolites, Antineoplastic; Clinical Trials, Phase II as Topic; Deoxycytidine; Drug Administration Schedule; Drug Combinations; Female; Gemcitabine; Humans; Liver Neoplasms; Middle Aged; Neutropenia; Oxonic Acid; Pancreatic Neoplasms; Tegafur; Tomography, X-Ray Computed

An intrahepatic arterial injection of CDDP, doxorubicin and 5-FU, followed by 17 courses of oral TS-1 administration (80 mg/day x 14 days, q=28 days), induced a partial response for 9 months after 18 months of stable disease in a 76-year-old male with asynchronous liver metastasis due to ascending colon cancer. TS-1 showed an excellent anticancer effect against colorectal metastatic liver cancers for a long time without loss of QOL or safety.

Topics: Administration, Oral; Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Colectomy; Colonic Neoplasms; Doxorubicin; Drug Administration Routes; Drug Combinations; Fluorouracil; Humans; Injections, Intra-Arterial; Liver Neoplasms; Male; Oxonic Acid; Quality of Life; Remission Induction; Tegafur

A 54-year-old man was admitted Osaka University Hospital for hepatocellular carcinoma (HCC) with portal vein thrombus and multiple intrahepatic metastases that extended to the bilateral lobes of the liver. He underwent multimodal therapy, including extended left lobectomy followed by intra-arterial 5-fluorourcil (5-FU) infusion chemotherapy combined with subcutaneous interferon-alpha (IFN-alpha) to treat the lesions in the residual liver. Seven months after the initial resection, recurrent tumors in the spleen, lung, and residual liver were detected by follow-up examination. We started a new regimen of per oral administration of S-1 and subcutaneous IFN-alpha injection, because the combined therapy with intra-arterial 5-FU infusion was not considered effective for distant metastases. After two cycles of S-1 and IFN-alpha, the metastatic tumor in the spleen and the recurrence in the residual liver had disappeared, and the diagnosis was complete remission with no adverse effect; the pulmonary metastasis showed a partial response, and was finally resected. This patient is still alive with no recurrence 32 months after initial hepatic resection. This outcome suggests that combination therapy with S-1 and IFN-alpha may be a promising treatment modality against advanced HCC with distant metastasis.

Topics: Administration, Oral; Antimetabolites, Antineoplastic; Carcinoma, Hepatocellular; Dihydrouracil Dehydrogenase (NADP); Drug Combinations; Drug Therapy, Combination; Follow-Up Studies; Hepatectomy; Humans; Immunologic Factors; Injections, Subcutaneous; Interferon-alpha; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Splenic Neoplasms; Tegafur; Tomography, X-Ray Computed

Case 1: A 77-year-old man was revealed to have type 3 gastric cancer with synchronous liver metastases. He underwent total gastrectomy with lymphatic dissection of D1+a and tubing of the hepatic artery. After surgery, two courses of hepatic arterial infusion of low-dose 5-FU plus CDDP were performed. The patient was discharged, and TS-1 (60 mg/day) was administered from day 1 to 14 followed by 7 days rest as one course. CDDP (10 mg/ body) was infused in the hepatic artery bolus on day 8 and 15 as outpatient treatment. After 8 months, the CEA was decreased from 3,098 ng/dl to 5.4 ng/dl, hepatic metastases were decreased by 85% assessed as a partial response. Case 2: A 71-year-old man was diagnosed with multiple liver metastases 10 months after distal gastrectomy for early gastric cancer. After tubing of the hepatic artery, three courses of hepatic arterial infusion of low-dose 5-FU plus CDDP were performed. TS-1 with hepatic arterial infusion of CDDP was administered using the same regimen as an outpatient. After 4 months, hepatic metastases decreased by 73%. These cases suggest that TS-1 with hepatic arterial infusion of CDDP in an outpatient may be an effective treatment with low toxicities and no damage to QOL in gastric cancer patients with multiple liver metastases.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Fluorouracil; Gastrectomy; Hepatic Artery; Humans; Infusion Pumps, Implantable; Infusions, Intra-Arterial; Liver Neoplasms; Lymph Node Excision; Male; Oxonic Acid; Pyridines; Quality of Life; Stomach Neoplasms; Tegafur

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Carcinoma, Hepatocellular; Cisplatin; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pyridines; Tegafur

We have experienced three gastric carcinoma cases successfully treated by the combination therapy of docetaxel and TS-1. Case 1: 66-year-old male with advanced gastric cancer invading the pancreas with metastasis to the liver and left neck lymph nodes. Case 2: 50-year-old female with scirrhous gastric carcinoma causing huge amount of malignant ascites. Case 3: 59-year-old male with recurrent gastric cancer of the remnant stomach presenting with obstruction and vessel involvement. Primary and metastatic diseases of these patients were remarkably improved with the combination therapy, indicating that the combination therapy of docetaxel and TS-1 can be a new therapeutic tool for advanced and recurrent gastric cancer patients.

Topics: Adenocarcinoma, Scirrhous; Aged; Antineoplastic Combined Chemotherapy Protocols; Docetaxel; Drug Administration Schedule; Drug Combinations; Female; Gastrectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Pyridines; Stomach Neoplasms; Taxoids; Tegafur

The patient was a 66-year-old man who had advanced gastric cancer with metastasis to liver and lymph nodes. He received daily oral administration of 100 mg of TS-1 for 28 days followed by 14 days rest as one treatment course. After 2 coures, regression of the primary lesion and reduction in size of the liver and lymph metastases were observed.

Topics: Adenocarcinoma; Administration, Oral; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Pyridines; Stomach Neoplasms; Survivors; Tegafur

A 73-year-old woman was admitted to our hospital for evaluation of hypochondralgia, and a thorough examination revealed an AFP producing gastric cancer with multiple liver metastases. One course of TS-1 100 mg/day for 4 weeks and discontinuation for 2 weeks was started from February, 2003. After 3 months, the level of AFP reduced remarkably from 53,700 ng/ml to the normal limit. The metastatic tumors in the liver showed regression, and after 14 months, CT scanning showed that the tumors had disappeared. Since the size of the original tumor showed no change, distal gastrectomy was performed, and curability A was achieved. We consider this rare case has significant value in terms of treatment of AFP producing gastric cancer with multiple liver metastases. We think the combination of surgery and chemotherapy such as TS-1 will lead to a better prognosis in such cases.

Topics: Adenocarcinoma; Aged; alpha-Fetoproteins; Antimetabolites, Antineoplastic; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Female; Gastrectomy; Humans; Liver Neoplasms; Oxonic Acid; Preoperative Care; Prognosis; Pyridines; Stomach Neoplasms; Tegafur

Combined chemotherapy consisting of oral TS-1 and low-dose CPT-11 by hepatic arterial infusion is suggested to be a new effective treatment for multiple liver metastases from colorectal cancer. A 53-year-old man was diagnosed with multiple hepatic metastases from advanced colon cancer (Stage IV). The patient underwent partial resection of the colon and catheter insertion into hepatic artery for arterial infusion in November 2003. He was treated with postoperative combination chemotherapy consisting of UFT and low-dose CPT-11. UFT was administered orally at 400 mg/body/day everyday and CPT-11 was injected at 40 mg/body/week for 6 weeks, followed by a 2 weeks rest interval as 1 cycle. In spite of the reduction of metastatic liver tumors after 2 cycles of the chemotherapy, a metastatic pleural tumor appeared. Therefore, we judged the effect of the chemotherapy to be a progressive disease and changed UFT in the regimen to TS-1. TS-1 was administered orally at 80 mg/body/day under a 2-weeks-on and 1-week-off regimen for 3 times. CPT-11 was injected at 40 mg/body/week for 6 weeks, followed by a 3 weeks rest interval as 1 cycle. A stable disease was maintained for 3 months. Outpatient care was possible because no severe events were observed. Tumors showed a reduction rate of 37.4% after the combination therapy. The patient survived for 285 days after the operation.

Topics: Adenocarcinoma; Administration, Oral; Ambulatory Care; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colonic Neoplasms; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Hepatic Artery; Humans; Infusion Pumps, Implantable; Infusions, Intra-Arterial; Irinotecan; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pyridines; Tegafur

The patient was a 66-year-old female with Borrmann's type 4 gastric cancer complicated by metastasis to the liver and invasion of the head of the pancreas. Radical resection was not indicated, and only gastrojejunostomy was performed to bypass an existing pyloric obstruction. One course of chemotherapy was defined as 3 weeks of drug administration(TS-1 100 mg/body/day po for 21 days + CDDP 9 0 mg/body/day by iv drip on day 8), followed by a 2-week rest period. Chemotherapy was started 13 days after the operation, and it was possible to continue it for 7 courses. TS-1/CDDP therapy improved the patient's general condition. The tumor marker levels were also decreased. However, the efficacy of treatment began to decline,and ascites gradually developed during the fourth course of therapy. The treatment regimen was then switched to TS-1 100 mg/body/day po for 14 days, followed by a 14-day rest period, combined with PTX 9 0 mg/body/day iv drip on day 1 and day 15, while the ascites was being controlled. The ascites decreased significantly after the change in regimen, and the new regimen was continued for 6 courses. However, PTX was switched to CPT-11 because of gradual progression of peripheral neuropathy as a side effect of chemotherapy, and the patient subsequently died without any improvement in symptoms. This report describes a case of advanced gastric cancer treated by combination chemotherapy with TS-1 as a key drug, which resulted in a long survival (1 year and 5 months)and improvement in quality of life.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Administration Schedule; Drug Combinations; Female; Humans; Liver Neoplasms; Neoplasm Invasiveness; Oxonic Acid; Paclitaxel; Pancreatic Neoplasms; Pyridines; Quality of Life; Stomach Neoplasms; Tegafur

We report the case of a 79-year-old female with gastric cancer accompanied by liver invasion. She underwent simple subtotal gastrectomy in another hospital. Five months after surgery, combination chemotherapy with TS-1 (100 mg/body/day, 3 weeks) and CDDP (10 mg/body/day, day 1, 8, 15 drip infusion) in 1 course was performed, and complete response (CR) was noted. No severe adverse effects were observed during this combined therapy. TS-1 and low-dose CDDP therapy may prove effective for treating gastric cancer with liver invasion in advanced age.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Administration Schedule; Drug Combinations; Female; Gastrectomy; Humans; Liver Neoplasms; Neoplasm Invasiveness; Oxonic Acid; Pyridines; Quality of Life; Remission Induction; Stomach Neoplasms; Tegafur

TS-1/CPT-11 combination therapy was carried out in a case of advanced gastric cancer with liver and lymph node metastases and obstructive jaundice after percutaneous transhepatic cholangio drainage (PTCD). Regression of the primary carcinoma and reduction in size of metastases were observed. Grade 1 fatigue and grade 2 neutropenia were noted as adverse reactions to the treatment. TS-1/CPT-11 combination therapy was useful in this case of advanced gastric cancer with liver and lymph node metastases.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biliary Tract; Camptothecin; Combined Modality Therapy; Drainage; Drug Administration Schedule; Drug Combinations; Gastroscopy; Humans; Irinotecan; Jaundice, Obstructive; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

A 61-year-old man with multiple liver and lung metastases from advanced gastric cancer was admitted to our hospital. We selected the patient from the outpatient department and started a single administration of TS-1 as a first line chemotherapy. TS-1 was markedly effective and the CEA level decreased 4,528 ng/ml to 44 ng/ml only in three months. The clinical response was assessed to be partial response (PR) comparable to complete response (CR) according to the tumor regression effect. The effect had been continued for almost six months. Because the CEA level elevated again, we estimated that the tumor acquired a drug tolerance to TS-1. Therefore, we applied CDDP with TS-1 as a second line chemotherapy. Unfortunately, it was not effective. Then we combined paclitaxel (PTX) to TS-1. The CEA level was remarkably reduced again, but transiently. Thereafter, we continued a sequential administration of TS-1 plus other drugs (CPT-11, docetaxel and MMC). Over 2 years, the patient is alive with a good quality of life.

Topics: Antibiotics, Antineoplastic; Antineoplastic Agents; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Carcinoembryonic Antigen; Cisplatin; Docetaxel; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Mitomycin; Oxonic Acid; Paclitaxel; Pyridines; Remission Induction; Taxoids; Tegafur

A 44 year-old woman presented with epigastralgia in March 2004 was diagnosed as having type II gastric cancer by gastrofiberscope, and histological diagnosis of biopsy specimens was group V (tub2, por1). Since multiple liver metastases were observed in subsegments 2, 3, and 5 by abdominal ultrasonography, systemic chemotherapy was first conducted for tumor down sizing. The patient was treated by three cycles of the one month regimen (CDDP 70 mg/m2, day 8, for 24hrs, and TS-1 80 mg/m2, day 1-14; 2 week cessation of the drugs). CT scan taken on May 16, 2005 revealed that the tumor diameters in subsegments 2, 3, and 5 were 1 cm, 3 cm, and 1.5 cm, respectively. On September 14, liver tumors were markedly shrunk. Tumor in subsegment 2 became undetectable, and the diameters in those in subsegments 3 and 5 were 1.5 cm, and 0.5 cm, respectively. On September 28, a distal gastrectomy associated with S3 partial hepatectomy and microwave coagulation therapy for S5 tumor was performed without any macroscopic residual lesions. The prognosis of liver metastasis of gastric cancer is generally poor, and there is no comprehensive therapy. The marked clinical response in this patient suggests that this combination therapy with CDDP and TS-1 might be a promising preoperative chemothepapy for unresectable gastric cancer.

Topics: Adult; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Catheter Ablation; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Female; Gastrectomy; Hepatectomy; Humans; Liver Neoplasms; Microwaves; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

A 56-year-old male was admitted to our hospital for hepatoma with portal vein thrombus and multiple intrahepatic metastases. He underwent an extended left lobectomy and a partial resection of the liver in May 2002. After two weeks from the surgery, he received intra arterial 5-FU infusion chemotherapy combined with subcutaneous interferon-alpha injection to treat the lesions in the residual liver. Four months after the surgery, hepatic vein tumor thrombus appeared in the remnant liver and it extended to the inferior caval vein. And another 4 months later, multiple pulmonary metastases were detected with computed tomography and they grew rapidly in the view of their sizes and numbers. Because the combined therapy of 5-FU/interferon-alpha was not effective to distant metastases, we started a new regimen of oral administration of TS-1 and a subcutaneous interferon-alpha injection. After 1 treatment cool, hepatic vein thrombus was markedly reduced the size and vascularity in the CT. Multiple pulmonary metastases also decreased in their sizes and numbers. No adverse effect was seen during this treatment. It was suggested that a combination therapy of TS-1 and interferon-alpha may be one of the most effective treatment modalities against advanced HCC with distant metastasis.

Topics: Administration, Oral; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Combined Modality Therapy; Drug Combinations; Hepatectomy; Humans; Infusions, Intra-Arterial; Injections, Subcutaneous; Interferon-alpha; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplastic Cells, Circulating; Oxonic Acid; Pneumonectomy; Pyridines; Tegafur; Thrombectomy; Vena Cava, Inferior

A 62-year-old man was revealed to have type 2 gastric cancer with synchronous liver metastasis. We considered liver metastasis to be a prognostic factor, and performed two courses of combination thermochemotherapy consisting of hepatic arterial infusion of MMC and TS-1 and thermotherapy. Partial response was observed in the liver metastases,but the primary lesion showed no changes; therefore, we performed four courses of combination thermochemotherapy consisting of TS-1/CDDP therapy and thermotherapy. By the end of three courses of this therapy,the primary lesion had cicatrized,and endoscopic biopsy revealed no cancer cells. These results suggest that gastric cancer,in which liver metastasis is considered to be a prognostic factor,can be effectively treated by combination therapy with hepatic arterial infusion therapy, followed by thermochemotherapy for the primary lesion.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Hepatic Artery; Humans; Hyperthermia, Induced; Infusions, Intra-Arterial; Liver Neoplasms; Male; Middle Aged; Mitomycin; Oxonic Acid; Pyridines; Remission Induction; Stomach Neoplasms; Tegafur

A 75-year-old man underwent distal gastrectomy for advanced gastric cancer with liver and lymph node metastases and synchronous hepatocellular carcinoma in April 2004. HAI with low-dose CDDP/TS-1 combination therapy was initiated after gastrectomy. Liver and lymph node metastases decreased significantly, with achievement of a partial response (PR) and a complete response (CR), respectively, and the hepatocellular carcinoma was reduced to 54.1% of its initial size after 3 sessions of this chemotherapy. These results suggested that combined chemotherapy with TS-1 and HAI with low-dose CDDP was not only useful for liver and lymph node metastases from gastric cancer, but for hepatocellular carcinoma as well.

Topics: Administration, Oral; Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Cisplatin; Combined Modality Therapy; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Gastrectomy; Hepatic Artery; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Neoplasms, Multiple Primary; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

A patient with lung metastasis of breast cancer was reported. The patient underwent surgery in December, 1999. Her breast cancer then recurred in December, 2000. After treatment failure with anthracycline and taxane antitumor drugs,she participated in a phase II study of S-1, a fluorinated pyrimidine anticancer drug, which was given orally at 80 mg/m2/day (2 doses). After completion of 4 courses of treatment,the target lesions of the lung metastasis markedly shrunk by 47.5% as compared with the pretreatment. Because salvage therapy with S-1 alone showed good antitumor efficacy and beneficial tolerability when the standard dosage was maintained, it was considered that this home therapy was effective for advanced/recurrent breast cancer that was resistant to anthracycline and taxane antitumor drugs.

Topics: Administration, Oral; Anthracyclines; Antimetabolites, Antineoplastic; Breast Neoplasms; Bridged-Ring Compounds; Carcinoma, Ductal, Breast; Clinical Trials, Phase II as Topic; Drug Administration Schedule; Drug Combinations; Drug Resistance, Neoplasm; Female; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Middle Aged; Oxonic Acid; Pyridines; Quality of Life; Salvage Therapy; Taxoids; Tegafur

Cardiotoxicity is a rare complication occurring during 5-fluorouracil (5-FU) treatment for malignancies. We herein report the case of a 70-year-old man with 5-FU-induced cardiotoxicity, in whom a high serum level of alpha-fluoro-beta-alanine (FBAL) was observed. The patient, who had unresectable colon cancer metastases to the liver and lung, was referred to us for chemotherapy from an affiliated hospital; he had no cardiac history. After admission, the patient received a continuous intravenous infusion of 5-FU (1000 mg/day), during which precordial pain with right bundle branch block occurred concomitantly with a high serum FBAL concentration of 1955 ng/ml. Both the precordial pain and the electrocardiographic changes disappeared spontaneously after the discontinuation of 5-FU. As the precordial pain in this patient was considered to have been due to 5-FU-induced cardiotoxicity, the administration of 5-FU was abandoned. Instead, oral administration of S-1 (a derivative of 5-FU), at 200 mg/day twice a week, was instituted, because S-1 has a strong inhibitory effect on dihydropyrimidine dehydrogenase, which catalyzes the degradative of 5-FU into FBAL. The serum FBAL concentration subsequently decreased to 352 ng/ml, the same as the value measured on the first day of S-1 administration. Thereafter, no cardiac symptoms were observed. The patient achieved a partial response 6 months after the initiation of the S-1 treatment. The experience of this case, together with a review of the literature, suggests that FBAL is related to 5-FU-induced cardiotoxicity. S-1 may be administered safely to patients with 5-FU-induced cardiotoxicity.

Topics: Aged; Antimetabolites, Antineoplastic; beta-Alanine; Cardiovascular Diseases; Colonic Neoplasms; Drug Combinations; Electrocardiography; Fluorouracil; Heart; Humans; Liver Neoplasms; Lung Neoplasms; Male; Oxonic Acid; Tegafur

Topics: Adenocarcinoma; alpha-Fetoproteins; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

We report a case of advanced gastric cancer with antral stenosis that responded to an oral anticancer agent, TS-1, after metallic stent insertion. A 59 year-old man was admitted to our hospital because of abdominal distension and vomiting after meals. The diagnosis was advanced gastric cancer with antral stenosis and multiple liver metastases. FP therapy (CDDP 80 mg/m2 day 1 div, 5-FU 700 mg/m2 day 1-5 continuous div) was administered. Although endoscopic findings showed improvement after the first course, the condition of the patient did not improve. We therefore inserted a self-expandable metallic stent into the antral stenosis. After implantation, the patient was able to have regular meals, leave the hospital and return to work. TS-1 (120 mg daily), an oral fluorouracil derivative, was administered in the outpatient setting. A partial response (PR) was obtained after 2 courses with regression of multiple liver metastases and the primary tumor.

Topics: Antimetabolites, Antineoplastic; Drug Combinations; Gastric Outlet Obstruction; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pyridines; Stents; Stomach Neoplasms; Tegafur

Since the introduction of TS-1 for clinical treatment of the progression or recurrence of stomach cancer, the effectiveness of combination therapy incorporating other agents with CDDP has been reported. Low-dose CDDP/TS-1 combination treatment was carried out in a case of Stage IV progressive stomach cancer showing multiple liver metastases and spleen metastasis. Regression of the primary carcinoma and reduction in size of liver metastases and spleen metastasis were observed. Grade 2 leukocyte decrease and grade 1 stomatitis were noted as adverse reactions to the treatment. Low-dose CDDP/TS-1 combination therapy was useful in this case of advanced gastric cancer.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Pyridines; Splenic Neoplasms; Stomach Neoplasms; Tegafur

Case 1: A 77-year-old woman with advanced gastric cancer and peritoneal dissemination was treated with TS-1/CDDP therapy. TS-1 (100 mg/day) was orally administered for 21 days and CDDP (70 mg/body) was administered intravenously on day 8. After 2 courses reduction in size of the primary carcinoma was observed (PR). The duration of the PR and the survival time were over 1 year and 6 months. Case 2: A 77-year-old woman with recurrent abdominal and liver metastasis from advanced gastric cancer was treated with TS-1/CDDP therapy. TS-1 (100 mg/day) was orally administered for 21 days and CDDP (80 mg/body) was administered intravenously on day 8. The reduction was judged to be CR for the liver metastasis and PR for the abdominal tumor (total judgment: PR). The duration of the PR and the survival time were over 1 year and 5 months. It is suggested that TS-1/CDDP chemotherapy is useful for advanced and recurrent gastric cancer.

Topics: Administration, Oral; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Administration Schedule; Drug Combinations; Female; Humans; Infusions, Intravenous; Liver Neoplasms; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

We report a case of a 65-year-old male with stage IV gastric cancer accompanied by liver metastases, which showed a significant response after administration of TS-1. One hundred and twenty mg/body/day of TS-1 was orally administered without hospitalization. After 3 months, upper GI endoscopy showed improvement of primary gastric lesion, and cancer cells could not be detected under biopsy. After 2 months, computed tomography (CT) showed a reduction in the multiple liver metastases. Moreover, after 15 months, CT showed a complete regression of the multiple liver metastases, for a complete response (CR). The serum level of carcinoembryonic antigen (CEA) was reduced from 115 to within normal range. Noticeable critical adverse effects did not appear. Treatment on an outpatient basis, therefore, greatly contributed to his quality of life. We judged that TS-1 might be a candidate anti-cancer drug for first-line chemotherapy for advanced gastric cancer.

Topics: Adenocarcinoma; Administration, Oral; Aged; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Pyridines; Quality of Life; Remission Induction; Stomach Neoplasms; Tegafur

A 75-year-old male patient with small cell carcinoma of the stomach and liver metastasis was treated by combined chemotherapy of TS-1 and CDDP. One course consisted of TS-1 (120 mg/day) administered for 14 days followed by 14 days rest. CDDP (108 mg/day) was administered by 24-hour continuous intravenous infusion at day 8 after the start of TS-1. After 3 courses, endoscopic examination revealed complete disappearance of the primary tumor with no cancer cells detected by endoscopic biopsy. CT-scan showed that the metastasis of the left lobe of the liver had disappeared and also that the metastasis of the right lobe of the liver was remarkably reduced (75%). The primary lesion was estimated CR, the metastasis PR, and the synthesis PR. The TS-1/CDDP chemotherapy regimen is considered effective for small cell carcinoma of the stomach with liver metastasis.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Small Cell; Cisplatin; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Pyridines; Remission Induction; Stomach Neoplasms; Tegafur

Chemotherapy with TS-1 has recently become the first-line chemotherapy for recurrent and unresectable gastric cancer in Japan. Therefore, the establishment of a second-line chemotherapy is needed for cases that show resistance and aberrant effect to TS-1. In this study, 7 patients were treated with weekly administrations of paclitaxel after TS-1 treatment. We assessed the therapeutic effect and feasibility of chemotherapy with weekly administration of paclitaxel. Our results showed that weekly administration of paclitaxel could be a promising regimen as a second-line chemotherapy after TS-1.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Phytogenic; Drug Administration Schedule; Drug Combinations; Drug Resistance, Neoplasm; Edema; Feasibility Studies; Female; Humans; Infusions, Intravenous; Leukopenia; Liver Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Paclitaxel; Pyridines; Stomach Neoplasms; Tegafur

A standard treatment for hepatocellular carcinoma with extrahepatic metastasis is not established and chemotherapy is ineffective. We experienced a case of hepatocellular carcinoma with bone metastasis that responded to concurrent TS-1/low-dose cisplatin (CDDP) therapy and radiotherapy. A 58-year-old male patient with left iliac bone metastasis after 2 hepatectomies was admitted to our hospital. The titer of serum AFP and PIVKA-II showed an extremely high levels, 12,350.5 ng/ml and 993 mAU/ml, respectively. The uptake area was found at the left iliac bone by scintigraphy with 99mTc-HMDP. Treatment with TS-1/low-dose CDDP therapy and radiotherapy (36 Gy) was started concurrently. The chemotherapy regimen comprised daily oral administration of 100 mg of TS-1 for 21 days and CDDP 10 mg/body infusion (day 1-5, 8-12). An additional 2 courses of TS-1/low-dose CDDP therapy were repeated. After that, severe pain diminished and the titer of serum showed AFP and PIVKA-II had improved to within normal ranges. The uptake at the left iliac bone was found to have decreased by scintigraphy. Adverse events were grade 1 nausea and leucopenia. TS-1/low-dose CDDP therapy seems to be applicable for the treatment of hepatocellular carcinoma with bone metastasis.

Topics: alpha-Fetoproteins; Antineoplastic Combined Chemotherapy Protocols; Biomarkers; Biomarkers, Tumor; Bone Neoplasms; Carcinoma, Hepatocellular; Cisplatin; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Hepatectomy; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Protein Precursors; Prothrombin; Pyridines; Tegafur

We report herein a case of heterochronous hepatic metastasis of gastric cancer that responded well to chemotherapy using TS-1. The patient was a 72-year-old man who underwent total gastrectomy for gastric cancer. Liver metastasis (S8, 4 cm in diameter) was found 3 months after surgery. TS-1 (100 mg/day) was administered orally everyday for a total of 33 weeks, after which the liver metastasis showed CR. Grade 2 fever and grade 2 dermatitis were the only adverse reactions observed, and the patient did not require hospitalization by discontinuing TS-1 administration. The present case suggests the usefulness of chemotherapy using TS-1.

Topics: Administration, Oral; Aged; Antimetabolites, Antineoplastic; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Oxonic Acid; Postoperative Period; Pyridines; Stomach Neoplasms; Tegafur

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

S-1 is a novel oral fluorouracil antitumor drug that combines three pharmacological agents: tegafur (FT), a prodrug of 5-fluorouracil (5-FU); 5-chloro-2,4-dihydroxypyridine (CDHP), an inhibitor of dihydropyrimidine dehydrogenase, and potassium oxonate (Oxo), a reducer of gastrointestinal toxicity. S-1 has safe and potent antitumor effects in patients with gastric cancer via these respective functions. However, the plasma 5-FU concentration is suspected to accumulate in patients with renal dysfunction, because 50% of the CDHP is excreted into the urine. There are no useful data on safety and efficacy of S-1 in chronic renal failure patients maintained on hemodialysis (HD). We examined the influence of HD on the pharmacokinetics (PK) of S-1 and its therapeutic efficacy in liver metastases from gastric cancer.. For the HD patient, the dose of S-1 in a single-administration study was set at 50 mg/body/day (41.7% of the recommended dose of 80 mg/m2/day). S-1 was given to the patient 24 h after HD. Blood samples were obtained before administration and 2, 4, 6, 8, and 24 h thereafter and 1, 2, 4, and 72 h after the following HD session. The PK parameters (5-FU, CDHP, Oxo, and FT) were measured, and Cmax, Tmax, AUC0-24, and T1/2 were calculated. The dose of consecutive or maintained administrations was determined.. Both an increase in Cmax and an elongation of T1/2 for 5-FU, CDHP, and Oxo, but not for FT, occurred in this case as compared with controls. The AUC0-24 of 5-FU in this case was similar to that of controls at the standard dose. After HD, 87.8, 54.5, 77.4, and 66.2% of 5-FU, CDHP, Oxo, and FT, respectively, were eliminated. A slight accumulation of CDHP did not alter the 5-FU PK. Consecutive or maintained S-1 oral administration at the same dose showed similar effects on all PK parameters of a single-administration test. Liver metastases almost totally regressed with no adverse events 4 weeks after S-1 treatment (50 mg/body/day three times a week).. Adjusted doses of S-1 according to the results of PK studies may provide therapeutic safety and high efficacy in liver metastases from gastric cancer, even in chronic renal failure patients maintained on HD.

Topics: Administration, Oral; Drug Administration Schedule; Drug Combinations; Fluorouracil; Humans; Kidney Failure, Chronic; Liver Neoplasms; Male; Oxonic Acid; Pyridines; Renal Dialysis; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

The prognosis of gastric cancer with liver metastasis is very poor. Because many gastric cancers with liver metastasis have multiple metastatic tumors in the liver, and the indication for surgical resection is rare. Moreover, the non-curative factors of many cases are not only liver metastasis but also are lymph node metastasis and peritoneal dissemination. However, some authors have reported gastric cancer with liver metastasis was treated effectively by intra-hepatic infusion of an anti-cancer drug. In this article, we report three cases of gastric cancer with liver metastasis that are treated effectively by intra-hepatic arterial infusion of an anti-cancer drug. There were no non-curative factors except liver metastasis. The first was a H3 case treated effectively by intra-hepatic arterial infusion of 5-fluorouracil (5-FU), mitomycin C (MMC) and peroral administration of 5-FU. The metastatic liver tumors had disappeared in 14 weeks. However, the patient eventually died of liver and brain metastases in 7 months after the therapy. The second was a H2 case treated effectively by intra-hepatic arterial infusion of CDDP and peroral administration of 5'-DFUR and PSK. The metastatic liver tumors had disappeared in 4 months, and the patient is still alive without recurrence in 35 months after surgery. The third was a H2 case treated effectively by intra-hepatic arterial infusion of cisplatin (CDDP) and peroral administration of TS-1 and PSK. The size of metastatic nodules had increased, and Virchow lymph node metastasis had appeared in 28 months after surgery. The patient eventually died in 32 months after surgery. These results suggested that intra-hepatic arterial infusion of CDDP with peroral administration of TS-1 or 5'-DFUR was an effective therapy for gastric cancer with liver metastasis.

Topics: Administration, Oral; Adult; Aged; Agmatine; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Female; Fluorouracil; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Mitomycin; Oxonic Acid; Proteoglycans; Pyridines; Stomach Neoplasms; Succinates; Tegafur; Treatment Outcome

This case was a 69-year-old male who had advanced gastric cancer with unresectable multiple liver metastases (Stage IV). He received a combination therapy consisting of a continuous venous infusion (cisplatin: CDDP 10 mg/body, 5-FU 500 mg/body, day 1-28). As a result, metastatic tumors in the liver completely disappeared and a total gastrectomy was sequentially performed. Four years after the surgery, neck lymph node (LN) metastases and the right adrenal metastasis appeared, and chemotherapy (TS-1, and sequentially TS-1+CDDP) was performed. But, the chemotherapy to eradicate the metastases was hardly enough to be effective. Next, docetaxel (DOC 60 mg/m2 q3w) was started. After 9 courses, they were effective and marked regressions (70%). A total of 15 courses of docetaxel administration were possible until tumor progression recurred. This regimen was not severe in toxicity for the duration except for grade 3 poor appetite. Docetaxel will be a key drug for the gastric cancer. In case of responding well to the chemotherapy, we can hope for an extended long-term survival with a continuation of this regimen.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Docetaxel; Drug Combinations; Fluorouracil; Gastrectomy; Hepatectomy; Humans; Infusions, Intravenous; Liver Neoplasms; Male; Oxonic Acid; Pyridines; Stomach Neoplasms; Taxoids; Tegafur

We report three successful cases with continuous systemic chemotherapy for advanced gastric cancer. Case 1: A 67-year-old male with gastric cancer. Abdominal CT showed the invasion in the pancreas and as a result, continuous systemic infusion of low-dose cisplatin (CDDP 20 mg/day) and 5-fluorouracil (5-FU 1,000 mg/day) was performed. This infusion chemotherapy, CDDP and 5-FU, was continued for 5 days and discontinued for 25 days. Three months after the chemotherapy, the main tumor was remarkably reduced (downstaging was obtained), and consequently, total gastrectomy was performed. Case 2: A 78-year-old male with gastric cancer and hepatic multiple metastases. Abdominal CT scan before operation did not reveal the hepatic metastasis. In the operation for distal gastrectomy, we found multiple metastases on the surface of the liver. Continuous systemic infusion of low-dose CDDP (20 mg/day) and 5-FU (1,000 mg/day) was performed. This infusion chemotherapy, CDDP and 5-FU, was continued for 5 days and discontinued for 2 days. One month after the chemotherapy, Liver metastases had almost disappeared. Case 3: A 73-year-old male had received a distal gastrectomy based on the diagnosis of gastric cancer. The tumor marker, CA19-9, immediately decreased after the operation, but had increased again. He was treated with a combination chemotherapy of TS-1 and CDDP. The treatment consisted of 4 weeks of TS-1 administration (100 mg daily) followed by a 2-week break. CDDP of 10 mg/day was infused intravenously (day 1-5). Four weeks after the infusion, CA19-9 had returned to almost normal. We conclude that the combination chemotherapy of 5-FU (or TS-1) and CDDP might be an effective treatment for advanced and metastatic gastric cancer.

Topics: Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; CA-19-9 Antigen; Cisplatin; Drug Administration Schedule; Drug Combinations; Fluorouracil; Gastrectomy; Humans; Infusions, Intravenous; Liver Neoplasms; Male; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

A 52-year-old male was admitted to our hospital with huge hepatoma of the right lobe. He underwent a right lobectomy of the liver in July 1999. After five months from the surgery, multiple recurrences in the liver and lung were revealed with Computed tomography (CT). TAE was performed for intrahepatic recurrence and a combination therapy, consisting of UFT and interferon-alpha, was started for pulmonary metastasis. Then 5-FU/CDDP/interferon-alpha therapy was given in 2001 and TS-1/interferon-beta therapy was given thereafter in 2002. Consequently, the patient survived for 31 months with no disturbance in quality of life. No intrahepatic recurrence was also detected during the survival period. It was suggested that a good prognosis may be expected, even in the HCC case with distant metastasis after hepatic resection, if the primary cite was curatively treated.

Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Cisplatin; Drug Combinations; Fluorouracil; Hepatectomy; Humans; Interferon-alpha; Interferon-beta; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Pyridines; Tegafur; Time Factors; Uracil

It is reported that TS-1 administered orally shows a significant anti-neoplasm effect on advanced gastric cancer, and, furthermore, approximately 70% or greater effectiveness is reported for combination chemotherapy with cisplatin (CDDP). Lentinan is reported to extend the survival period in advanced cancer, and in combination with Tegafur. In the present study, combination chemotherapy with TS-1/CDDP/Lentinan was conducted for patients with inoperable advanced gastric cancer, and the validity, safety and resultant QOL of the treatment were evaluated. TS-1 was administered for 3 weeks at 80 mg/m2, followed by withdrawal for 2 weeks, and CDDP was prescribed once for patients at 70 mg/m2 on the 8th day after starting TS-1 administration. For patients aged 80 or above, however, the dose was reduced, and given separately to the patients. Lentinan was administered at 2 mg/week. The rate of effectiveness for the 9 registered patients was 100%. This high rate was obtained regardless of changes in the histopathological findings. Critical side effects (grade three or above) were anemia and pigmentation, in one case each. An improvement in QOL was also observed for combination therapy including Lentinan. In cases of inoperable advanced gastric cancer, TS-1/CDDP combination chemotherapy showed higher efficacy regardless of the pathological alterations, and higher and sustained improvement of QOL was also observed with the addition of Lentinan to the protocol.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Administration Schedule; Drug Combinations; Female; Humans; Lentinan; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pyridines; Quality of Life; Remission Induction; Stomach Neoplasms; Tegafur

A Case of Advanced Gastric Cancer with Multiple Liver Metastases Successfully Treated with TS-1 and CDDP: Akihiro Tsukahara, Kazuhiro Kaneko and Syuji Tanaka (Dept. of Surgery, Niigata Prefectural Koide Hospital) Summary A 70-year-old advanced gastric cancer patient with liver and lymph node metastases was treated by chemotherapy with TS-1 and CDDP. One course consisted of administration of TS-1 100 mg/body for 21 days followed by 14 days rest and infusion of CDDP 80 mg/body on day 8. At the end of 2 courses, the primary tumor showed a hypertrophic wall, but a partial response of the liver metastases (reduction ratio was 78.3%) and a complete response of the LN metastasis were achieved. PR and CR were maintained after 4 courses. There were no remarkable side effects for 4 courses. This chemotherapy may have therapeutic efficacy in cases of advanced gastric cancer with liver and lymph node metastases.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

Case 1: A 62-year-old man was introduced to our hospital for Type 1 cardiac gastric cancer. On the abdominal CT, there was evidence of multiple liver metastases. The patient was treated with daily oral administration of TS-1 (120 mg/day) for 3 weeks followed by 2 weeks' rest and infusion of CDDP (60 mg/m2) on day 8 as 1 course. After completion of 1 course, partial response in the primary tumor, and complete responses in the liver and lymph node metastases had been assessed, although the primary tumor increased during the 2 months' rest after 4 courses. Case 2: A 67-year-old man was hospitalized for Type 3 cardiac gastric cancer with multiple liver and lymph node metastases. A combination of TS-1 (100 mg/day), and CDDP (60 mg/m2), and TS-1 (80-50 mg/ day) was used. After 2 courses of TS-1/CDDP and 4 courses of TS-1, the primary tumor decreased significantly in size, and complete responses in the liver and lymph node metastases had been assessed, although the primary tumor, liver and lymph node metastases increased after 6 courses of TS-1. The two cases under study suggest that the combination systemic chemotherapy of TS-1 and CDDP is an effective treatment for advanced gastric cancer with multiple liver metastases in terms of its antitumor effect and QOL of the patients.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Cardia; Cisplatin; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Pyridines; Quality of Life; Radiography, Abdominal; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed

In the present report, we describe the treatment results of paclitaxel in patients with metastatic gastric cancer previously treated with TS-1 or combination chemotherapy of TS-1 and CDDP. Paclitaxel was administered to 4 patients at a weekly dose of 80 mg/m2/day for three weeks followed by a one week interval. Remarkable tumor reduction was observed in 2 patients. Case 1: A 52-year-old male patient with gastric cancer and multiple liver metastases was treated by weekly infusion of paclitaxel as a 2nd line chemotherapy. After 1 course, the tumor was remarkably reduced, and the reduction was judged PR. Case 2: A 31-year-old male patient presented with lymphoangitis carcinomatosa and obstructive jaundice resulting from cancerous lymphoadenopathy. After 1 course, chest radiographs and abdominal CT scan showed remarkable reduction of these lesions. The adverse effects observed with this drug were leucocytopenia and liver dysfunction, both of which improved soon. These results indicate paclitaxel is effective for advanced gastric cancer pretreated with TS-1.

Topics: Adenocarcinoma; Adult; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Signet Ring Cell; Cisplatin; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Oxonic Acid; Paclitaxel; Pyridines; Remission Induction; Stomach Neoplasms; Tegafur; Treatment Outcome

The prognosis and QOL of unresectable pancreatic cancer are very poor. A symptomless 60-year-old male was admitted for examination of a high serum CA19-9 level. Following ultrasound and abdominal CT, we diagnosed unresectable advanced pancreatic cancer with multiple liver metastasis. After we obtained his informed consent, we administered continuous infusion of 5-FU and low-dose cisplatin (CDDP) infusion (low-dose FP therapy) for 3 weeks. He then underwent combination chemotherapy with low-dose CDDP and TS-1 on an outpatient basis. During the chemotherapy, he did not experience any major adverse event and his QOL was relatively good. On follow-up CT 3 months later, the primary tumor in the pancreas was found to be stable. However, the size and number of liver tumors were remarkably reduced. The serum CA19-9 level had also remarkably decreased from 48,300 U/ml to 1,480 U/ml. In conclusion, the combination chemotherapy using low-dose CDDP and TS-1 can be effective in cases of unresectable pancreatic cancer with multiple liver metastasis.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Fluorouracil; Humans; Infusions, Intravenous; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Pyridines; Quality of Life; Tegafur

S-1 (TS-1) is a novel oral anticancer drug. Because of the excellent results of phase II studies, we continued to prescribe S-1 for advanced or recurrent gastric cancer after we participated in the phase I and II studies.. Twenty-nine patients with advanced or recurrent gastric cancer were treated with S-1. Clinicopathological features, survival, and adverse reactions were analyzed.. One course of treatment consisted of 40, 50, or 60 mg/body twice a day for 28 days followed by withdrawal for 2 weeks. The mean number of treatments was 3.6 courses (range, 1-12 courses). The response rate was 37.9% (11 partial responses [PRs] in 29 patients). Although the response rate of patients who did not receive prior chemotherapy was 47.6% (10 PRs in 21 patients), that of patients with prior chemotherapy was 12.5% (1 PR in 8 patients). The median survival time was 14.1 months, and that of patients who responded to treatment was 22.1 months, which was significantly longer than that of nonresponder patients. One-year and 2-year survivals in the 29 patients were 50.2% and 24.3%, respectively. Adverse reactions were noted in 17 of 29 patients, and the most frequent one was leukocytopenia. Only 2 patients experienced grade 3 leukocytopenia and neutrocytopenia.. Because of the high response rate and low incidence of severe adverse reactions, S-1 is a first-line chemotherapy that can be used for outpatients, especially for patients without prior chemotherapy. As the response rate for patients with prior chemotherapy was low, combined therapy with S-1 is worth evaluating for these patients.

Topics: Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Female; Fluorouracil; Forecasting; Humans; Japan; Liver Neoplasms; Lymphatic Metastasis; Male; Methotrexate; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Pyridines; Severity of Illness Index; Stomach Neoplasms; Survival Analysis; Tegafur; Time Factors; Treatment Outcome

S-1(TS-1), a novel oral fluoropyrimidine, has been commercially available for gastric cancer in Japan. A nationwide post-marketing survey for safety was carried out after its approval. The aim of this analysis was to evaluate the efficacy and safety profile of this agent in clinical practice for patients with advanced gastric cancer registered in the postmarketing survey from our institution.. Between April 1999 and April 2000, a total of 51 chemo-naive patients were registered in the survey from the National Cancer Center Hospital East. S-1 was administered at 80 mg/m2/day for 4 weeks, followed by a 2-week rest, repeated every 6 weeks until disease progression, unacceptable toxicity, or the patient's refusal.. Of the 51 patients, 41 (80%) fulfilled the criteria of the guidelines determined by the company as appropriate patients for the drug administration. The median number of treatment courses was five. Toxicities were generally mild: grade 3 or 4 toxicities were seen in 10% or fewer patients, and no treatment-related deaths occurred. In the 47 patients with evaluable lesions, there were 2 complete responses and 18 partial responses, with a response rate of 43%. With a minimum follow-up of 2 years, median survival time and 2-year survival were 11.1 months and 33%, respectively. The majority of the 17 2-year survivors had diffuse-type histology and peritoneal metastasis and achieved an objective response.. S-1 appears to be safe and highly active, with favorable longterm survival in patients with metastatic gastric cancer, particularly in those with diffuse-type histology and peritoneal metastasis.

Topics: Adenocarcinoma; Adult; Aged; Antimetabolites, Antineoplastic; Drug Combinations; Drug Evaluation; Female; Humans; Japan; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Oxonic Acid; Peritoneal Neoplasms; Product Surveillance, Postmarketing; Pyridines; Stomach Neoplasms; Survival Analysis; Tegafur; Time Factors; Treatment Outcome

An oral tegafur compound, S-1 (TS-1), was developed to potentiate antitumor activity and to reduce gastrointestinal toxicities for patients with gastric cancer. It has achieved a high response rate against advanced and recurrent gastric cancer (ARGC) in Japan; however, the efficacy and adverse reactions of longterm administration of S-1 remain to be elucidated.. Sixty-nine patients with ARGC treated with S-1 were studied; 58 patients had measurable lesions, while 11 patients did not. S-1 was orally administered at doses of between 40 and 60 mg/body twice daily for 28 days, followed by 14 days' rest, as one course.. The overall response rate was 38% (complete response [CR], 2/58; partial response [PR], 25/58; stable disease [SD], 9/58 progressive disease [PD] 23/58). Response rate by target organ was 40% for the primary lesion, 45% for lymph node metastasis, 38% for peritoneal metastasis, and 25% for liver metastasis. When S-1 was administered as second-line chemotherapy (n = 25), the response rate was 36%. Of the 69 patients, 14 received S-1 for more than a year. The median survival time (MST) after S-1 administration in these 14 patients, including 3 patients with stable disease, was 918 days (range, 536 to 1107 days). There were no grade 3 to 4 toxicities in these 14 patients receiving longterm therapy with S-1.. S-1 therapy was performed with a high response rate, irrespective of the target organ or the presence of prior chemotherapy. Longterm administration of S-1 may benefit patients with ARGC, providing prolonged disease control with acceptable toxicities.

Topics: Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic; Dose-Response Relationship, Drug; Drug Combinations; Female; Follow-Up Studies; Humans; Incidence; Japan; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Oxonic Acid; Peritoneal Neoplasms; Pyridines; Severity of Illness Index; Stomach Neoplasms; Survival Analysis; Tegafur; Time; Treatment Outcome

Dihydropyrimidine dehydrogenase (DPD) is an enzyme that catabolizes 5-fluorouracil (5-FU). The effect of DPD inhibitory fluoropyrimidines (DIF) is presumably related to DPD activity. We studied the efficacy of DIF (tegafur + uracil UFT], tegafur + gimeracil + osteracil [S-1 (TS-1)]) relative to DPD activity, with other fluoropyrimidines as controls.. The efficacy of DIF relative to DPD activity was evaluated in 58 gastric cancer patients who received postoperative administration of fluoropyrimidines, consisting of DIF in 42 patients (UFT in 23; S-1 in 19) and non-DIF in 16 patients.. In patients with low DPD activity (under 40 U/mg protein), curative potential tended to be lower for DIF than for non-DIF, but the survival rate was the same for both. In patients with high DPD activity (40 U/mg protein or more), such a tendency was not detected. In a comparison between those treated with UFT and those treated with S-1, prognosis was better in the latter group, in spite of their predominance of lower curative potentials of B or C. In 27 patients with measurable lesions, a partial response (PR) or higher response occurred in 33% (5/15) of those with low DPD activity, and in 17% (2/12) of those with high DPD activity. In the patients with low DPD activity, non-DIF induced no change (NC) in 17% (16), and progressive disease (PD) in the rest. UFF induced PD in all 5 patients, while S-1 induced a response rate of 44% (7/16), with NC in 25% (4/16). In the patients with high DPD activity, on the other hand, non-DIF (n = 3) and UFT (n = 3) induced PD in all the patients, while S-1 induced PR in 33% (2/6) and NC or a higher response in 67% (4/6).. It is recommended to use S-1 rather than UFF in patients with high DPD activity. Measurement of DPD was useful in drug selection.

Topics: Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Dihydrouracil Dehydrogenase (NADP); Disease Progression; Drug Combinations; Enzyme Inhibitors; Fluorouracil; Humans; Japan; Leucovorin; Liver Neoplasms; Lymphatic Metastasis; Oxidoreductases; Oxonic Acid; Peritoneal Neoplasms; Prognosis; Pyridines; Statistics as Topic; Stomach Neoplasms; Survival Analysis; Tegafur; Treatment Outcome; Uracil

A no change (NC) status could be maintained in a patient with remnant gastric cancer for more than 500 days with low-dose TS-1. The patient was a 68-year-old woman who was found to have remnant gastric cancer during an endoscopic examination in follow-up on an outpatient basis after surgery for hepatocellular carcinoma in our department. Surgery was rejected as a treatment option because of severe liver dysfunction, and the patient was started on oral TS-1 80 mg/day. Both AST and ALT levels increased immediately after the start of TS-1, and TS-1 was discontinued until these levels improved. It was resumed at 50 mg/day, and there were no subsequent adverse reactions. Endoscopic examination on day 69 after the start of TS-1 showed that a partial response (PR) had not been achieved, but the lesion had shrunk. Endoscopy on day 454 after the start of TS-1 showed it had been possible to maintain a similar state. This was a rare case in which it was possible to achieve prolonged same status with low-dose TS-1.

Topics: Adenocarcinoma; Administration, Oral; Aged; Antimetabolites, Antineoplastic; Carcinoma, Hepatocellular; Drug Administration Schedule; Drug Combinations; Female; Humans; Liver Neoplasms; Neoplasm, Residual; Neoplasms, Multiple Primary; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

A 65-year-old man, who had been admitted to another hospital with complaints of severe cough and dyspnea, was transferred to our hospital for the further examination and therapy. The patient was diagnosed with advanced gastric cancer (type-3) with lymphangitis carcinomatosa of the lung. He was treated with combination therapy of 5-FU and cisplatin, and showed a complete response. However, because resistance was seen in the lymphangitis of the lung and the gastric lesion; and a liver metastasis was also seen, we attempted combination therapy with paclitaxel and TS-1. Sixty mg/m2/day of paclitaxel was administered intravenously on day 1 and 8, and TS-1 of 60-80 mg/m2/day was administered orally for 2 weeks followed by one drug-free week. After 2 courses of the combination therapy, the patient achieved a remarkable response in the lymphangitis carcinomatosa of the lung, but a slight response in the liver metastasis and gastric lesion.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Drug Resistance, Neoplasm; Fluorouracil; Humans; Liver Neoplasms; Lung Neoplasms; Lymphangitis; Male; Oxonic Acid; Paclitaxel; Pyridines; Stomach Neoplasms; Tegafur

We encountered a patient in whom TS-1/cisplatin (CDDP) combination chemotherapy was effective. The cancer became operable, and complete disappearance of liver metastasis was histopathologically confirmed. The patient was a 65-year-old man who presented with complaints of epigastric discomfort and anorexia. Based on upper GI endoscopy and abdominal CT, type 1 gastric cancer associated with liver and abdominal lymph node metastases was diagnosed. The cancer was judged to be inoperable, and chemotherapy with a combination of TS-1 and CDDP was initiated. One course of treatment consisted of administration of 120 mg/day of TS-1 for 21 days followed by 14 days of withdrawal, and administration of 100 mg/body/day of CDDP on day 8 (80 mg/body/day in the second course). After two courses of treatment, the primary lesion and the liver and lymph node metastatic lesions decreased in size (reduction ratios were 42.3%, 90.5% and 85.2%, respectively). The tumor marker values became normal. Subsequently, the cancer was judged to have become operable. After consultation with the patient, total gastrectomy, splenectomy, partial hepatectomy, and D3 dissection were performed, and curability B was achieved. The only adverse event of Grade 2 or more severity observed during drug administration was anorexia. Liver metastasis was judged from pathological findings to have disappeared. The postoperative course was uneventful and the patient was discharged from the hospital. To date, there have been no signs of recurrence. TS-1/CDDP therapy is believed to provide effective treatment against liver metastasis and lymph node metastasis of gastric cancer.

Topics: Adenocarcinoma, Mucinous; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Gastrectomy; Hepatectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Oxonic Acid; Pyridines; Remission Induction; Splenectomy; Stomach Neoplasms; Tegafur

We treated five cases for multiple hepatic metastases from gastric cancer with a novel combination of TS-1 and low-dose cisplatinum (CDDP). TS-1 was orally administered at 100 mg/body/day every day or only on weekdays, and 10 mg of CDDP was infused once or twice a week. The efficacy was evaluated by body CT after the treatment. The CT showed more than a 60% reduction of hepatic tumors in four patients. The tumor markers, CEA and CA19-9, were reduced to 10%. The response rate was 80%. Adverse reactions of grade 1 anemia were observed in two patients and grade 1 leucopenia in one patient. The liver function normalized in one patient. The hemoglobin level was increased from 6.8 g/dl to 11.8 g/dl in one patient. In conclusion, this combined chemotherapy of TS-1 and low-dose CDDP proved useful for advanced gastric cancer patients with multiple hepatic metastases, in view of its therapeutic efficacy, patients' quality of life and low toxicity.

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

Topics: Aged; Antimetabolites, Antineoplastic; Carcinoma, Hepatocellular; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Pyridines; Tegafur; Tomography, X-Ray Computed

A 44-year-old male presented to our hospital with abdominal pain. The upper endoscopy revealed advanced gastric cancer. On the abdominal CT, there was evidence of multiple, massive liver metastases. After total gastrectomy, the patient was treated with daily oral administration of 120 mg TS-1 for 4 weeks followed by 2 weeks' rest and 6 weekly infusions of 10 mg CDDP in an intra-hepatic artery as 1 cycle. On the follow-up CT, the liver metastases had decreased significantly both in size and number after 2 cycles. The current case suggests that TS-1 and CDDP may have a potent therapeutic efficacy in cases of advanced gastric cancer with multiple liver metastases.

Topics: Administration, Oral; Adult; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Administration Schedule; Drug Combinations; Hepatectomy; Hepatic Artery; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Lymphatic Metastasis; Male; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

A 57-year-old woman was admitted to our hospital for advanced gastric cancer located in the gastric antrum. Abdominal CT scan revealed multiple liver metastases and lymph node metastasis along the abdominal aorta which was diagnosed as stage IV gastric cancer. The patient received daily oral administration of 75 mg TS-1, a novel oral anticancer agent. Each treatment course consisted of a four-week administration followed by two drug-free weeks. No change (NC) was observed in the liver metastasis on the abdominal CT scan after TS-1 administration, but lymph node swelling along the abdominal aorta decreased (PR). Grade 2 depilation was observed as the only adverse effect. The patient had a performance status of 1 or 2, and kept a fair QOL. TS-1 is an excellent new anticancer agent and, we have high expectations for its use in combined therapy with other drugs.

Topics: Administration, Oral; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Female; Humans; Liver Neoplasms; Lymphatic Metastasis; Middle Aged; Oxonic Acid; Pyridines; Stomach Neoplasms; Survival Analysis; Tegafur

The patient was a 74-year-old woman with gastric cancer with multiple liver metastasis. She was treated with daily oral administration of TS-1 100 mg/day (day 1-21) and systemic administration of CDDP 90 mg (day 8) as neoadjuvant chemotherapy for 2 courses. As metastatic lesions became smaller, we performed distal gastrectomy. TS-1 was started for the residual cancer lesion. However, liver metastatic lesions increased in size, so we carried out intraarterial chemotherapy (IAC), Nausea appeared at 9 days, pancytopenia at 28 days and ARDS at 78 days after IAC. She died due to ARDS.

Topics: Aged; Antimetabolites, Antineoplastic; Cisplatin; Drug Combinations; Female; Fluorouracil; Gastrectomy; Hepatic Artery; Humans; Infusions, Intra-Arterial; Liver Neoplasms; Oxonic Acid; Pancytopenia; Pyridines; Respiratory Distress Syndrome; Stomach Neoplasms; Tegafur

TS-1 is a novel oral anticancer drug that is a formation of 5-FU. It consists of tegafur, CDHP (which inhibits 5-FU degradation enzyme), and Oxo (which reduces gastrointestinal toxicities) for an increased anticancer effect. We applied individual TS-1 therapy in 22 cases (cs) of inoperable gastric cancer and studied the clinical and adverse effects. Patients were treated with daily oral administration of 80-100 mg TS-1 for 4 weeks, followed by a rest for 1 or 2 weeks. The response rate was found to be 27.3% (6/22) (PR: 6 cs, NC: 4 cs, PD: 10 cs, NE: 2 cs). Overall, the median survival time was 8.2 months and the one-year survival rate was 23.6%. By location, the response rate of the primary lesion was 27.3% (6/22), abdominal lymph node metastasis 18.8% (3/16), and liver metastasis 33.3% (4/12). There was no significant difference in the response rate by tissue type. A comparison by whether or not patients had undergone previous chemotherapy revealed a response rate of 37.5% (6/16) in patients who had undergone previous chemotherapy, and 0% (0/6) in those who had not. The prevalence of adverse effects was 68.2% (15/22), with the main adverse effects being myelosuppression, pigmentation and appetite loss. However, adverse effects with a grade of more than 3 occurred in only one case of neutropenia. We could observe the course of all patients on an outpatient basis.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Female; Humans; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pyridines; Stomach Neoplasms; Survival Rate; Tegafur

We used a novel combination chemotherapy of TS-1 and low-dose cisplatin (CDDP) with 4 gastric cancer patients with liver metastases (one far advanced and 3 recurrent patients). TS-1 was administered at 80 mg-120 mg/body/day, twice daily for 3 weeks followed by a 2-week interval as one cycle, and CDDP was administered at 6 mg/m2/day div, for 5 days followed by a 2-day interval (1 cycle for an inpatient) or at 6 mg/m2/day div, at 5 times for 2-3 weeks (1 cycle for an outpatient). Efficacy and toxicity were evaluated after 3-6 cycles of the regimen, as long as the patients tolerated the regimen without severe side effects. This regimen resulted in 1 complete response, 2 partial responses and 1 progressive disease, showing a 75% efficacy rate. One patient experienced grade 2 nausea from this regimen, which was ameliorated by means of prolonging the interval of CDDP-administration. Thus, the regimen is useful to maintain patients' quality of life without severe adverse effects, and has a high efficacy in gastric cancer patients with liver metastases.

Topics: Administration, Oral; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Administration Schedule; Drug Combinations; Humans; Infusions, Intravenous; Liver Neoplasms; Male; Middle Aged; Oxonic Acid; Pyridines; Quality of Life; Stomach Neoplasms; Tegafur

TS-1, a novel oral formation of 5-fluorouracil that consists of 1 M tegafur (FT), 0.4 M gimeracil and 1 M otacil potassium, was reported to achieve a relatively high response rate of 49% in patients with advanced gastric cancer in a late phase II study. We report a case of inoperable gastric cancer with multiple liver metastases, which responded significantly to the short-term administration of TS-1 following intravenous FMP therapy. A 79-year-old man, who had nothing of note in his past or family history, presented with multiple liver tumors and type 3 gastric tumor. His diagnosis was inoperable gastric cancer with liver metastases, and he underwent outpatient treatment of oral administration of TS-1, following FMP therapy under hospitalization. The main and metastatic lesions shrunk dramatically with the two courses of the chemotherapy. There were no noticeable adverse effects. QOL has been maintained and the patient remains in good condition. TS-1 can be considered well-tolerable and quite effective for inoperable gastric cancer, especially if preceding therapy with 5-FU shows significant efficacy. TS-1 may therefore be a new candidate as a first line drug in outpatient cancer treatment.

Topics: Adenocarcinoma; Administration, Oral; Adult; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Administration Schedule; Drug Combinations; Fluorouracil; Hospitalization; Humans; Infusions, Intravenous; Liver Neoplasms; Male; Mitomycin; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur; Treatment Outcome

S-1 is an anticancer drug in which tegafur is combined with modulators, gimeracil and oteracil potassium. We encountered a patient with gastric cancer for whom oral administration of S-1 was effective, and we report this case. A 79-year-old woman visited our hospital with a major complaint of anorexia. Tests revealed severe anemia, with a hemoglobin (Hb) level of 6.5 g/dl, and the patient was admitted to the hospital for treatment. The primary lesion was a large type-1 gastric cancer (poorly differentiated adenocarcinoma) in the middle gastric body. In addition, a lesion with a diameter of 50 mm was observed in the left hepatic lobe and small metastatic lesions were also scattered in the right lobe. When a performance status (PS) of 0 was obtained after her systemic condition had been improved, S-1 was started, at a dose of 80 mg/day (with one course consisting of administration for 4 weeks, followed by 2 weeks' rest). No severe adverse drug reaction was observed. After one course of administration was completed, the patient received administrations at the outpatient clinic. Upon the completion of two courses, computed tomography (CT) showed disappearance of the metastatic lesions and marked regression of the primary lesion. At present, upon completion of the sixth course, no hepatic metastasis is observed and the primary gastric lesion shows a tendency to regress. Her PS is maintained at 0.

Topics: Adenocarcinoma; Aged; Antimetabolites, Antineoplastic; Drug Combinations; Female; Humans; Liver Neoplasms; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

It is believed that multiple hepatic metastases from stomach cancer are highly refractory, and resistant to clinical treatment. In the present study, TS-1 neoadjuvant therapy administered orally in a single course brought about CR in the hepatic metastatic foci and PR in the primary foci, thus enabling grade A radical extirpation in a case of advanced stomach cancer. The patient continued to be treated on an ambulatory basis. His peri- and post-operative courses were satisfactory and the treatment was completed without the development of adverse effects.

Topics: Adenocarcinoma, Scirrhous; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Male; Middle Aged; Neoadjuvant Therapy; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

We present the case of a 72-year-old man with gastric tube cancer accompanied by multiple liver metastases, after esophagectomy for esophageal cancer, whose quality of life (QOL) was improved with a small dosage of TS-1. The patient's high serum AFP level suggested alpha-fetoprotein-producing gastric cancer. He was treated with half the standard dose of TS-1, because the patient's poor general condition necessitated chemotherapy with low toxicity and high efficacy. The daily dose was 40 mg for the first three courses and 50 mg for the last two. Each treatment course consisted of a four-week administration followed by two drug-free weeks. The patient received five courses of chemotherapy at our outpatient clinic before his death from re-progression of liver metastasis. No serious side effect except temporary stomatitis was observed. A decrease in tumor markers, alpha-fetoprotein and carcinoembryonic antigen, was obtained after 4 weeks. After 2 cycles, computed tomography and endoscopy examinations showed regression of the primary tumor and liver metastases, and tumor markers were decreased remarkably. The patient's QOL improved gradually after the treatment. His performance status before the chemotherapy was 3, and improved to 1 after two cycles. The small dosage of TS-1 was effective without any adverse effects, and improved the patient's QOL, for 6 months.

Topics: Adenocarcinoma; Aged; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Pyridines; Quality of Life; Stomach Neoplasms; Tegafur

We report three patients with recurrent gastric cancer responding to TS-1 therapy after combination chemotherapy with 5-fluorouracil, mitomycin C and cisplatin. All 3 cases had undergone total gastrectomy with lymphadenectomy for advanced gastric cancer. Postoperative follow-up computed tomography (CT) showed liver metastases (cases 1 and 3), peritoneal dissemination (case 2) and enlargement of paraaortic lymph nodes (case 1) due to cancer recurrence. After 2 to 4 courses of combined treatment with 5-fluorouracil (500-750 mg/body/day, days 1-5, civ), mitomycin C (6-8 mg/body, day 6) and cisplatin (60-80 mg/body, day 7), CT revealed considerable reduction of the metastatic tumors. Subsequently oral administration of TS-1 (80-100 mg/body/day) for 4 weeks was performed. All 3 patients are well without any signs of increase in tumor size.

Topics: Administration, Oral; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Administration Schedule; Drug Combinations; Female; Fluorouracil; Gastrectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Mitomycin; Oxonic Acid; Peritoneal Neoplasms; 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

Despite the improvement in the operative results for patients with gastric cancer, the prognosis of those with liver metastasis remains dismal. Multimodal therapy has attracted considerable attention as a breakthrough in the strategy for treating cases of highly advanced gastric cancer. We report the case of a 62-year-old female with gastric cancer accompanied by multiple liver metastases successfully treated by TS-1, a novel oral fluoropyrimidine derivative. One treatment course consisted of 4 weeks of TS-1 administration (100 mg daily) followed by a 2-week break. After 3 courses of treatment, an abdominal CT scan showed no evidence of liver metastases and gastroscopy revealed that the primary gastric lesion was reduced. Grade 1 toxicity (nausea and diarrhea) was seen but 6 days rest improved the condition. Distal gastrectomy was subsequently performed without any finding of residual tumor. TS-1 may have a promising role in neoadjuvant chemotherapy for gastric cancer.

Topics: Administration, Oral; Antimetabolites, Antineoplastic; Drug Combinations; Female; Humans; Liver Neoplasms; Middle Aged; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

We report the case of a 72-year-old male with Stage IV gastric cancer accompanied by multiple liver metastases and carcinomatous ascites which responded to chemotherapy using TS-1. Treatment of the patient with daily oral administration of 120 mg TS-1 for 4 weeks resulted in complete regression of the liver metastases and ascites, as well as a 35% reduction in the size of the primary lesion. After 2 cycles, the primary tumor size was reduced to 55% and serum CA19-9 and CA125 levels were decreased to the normal ranges. This regimen was effective without any adverse effects, and improved the patient's QOL, for 6 months before progression of liver lesions. The patient received chemotherapy at our outpatient clinic for 10 months after the first treatment, after which he died of peritonitis carcinomatosa. The current case suggests that TS-1 may have a potent therapeutic efficacy in advanced gastric cancer patients.

Topics: Aged; Antimetabolites, Antineoplastic; Ascitic Fluid; Disease Progression; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

We have treated a case of hepatic metastasis of gastric cancer that has responded well to TS-1. The patient was a 68-year-old male, who underwent distal gastrectomy for gastric cancer. After surgery 5'-deoxy-5-fluorouridine (5'-DFUR) 800 mg/day was administered orally for two months. Grade 4 diarrhea appeared, so administration of 5'-DFUR was discontinued. Afterward the patient was followed with no chemotherapy. Liver metastasis (S6, 3 cm in diameter) was found at twelve months after surgery. 5'-DFUR (800 mg/day) was administered orally everyday. Grade 3 diarrhea appeared and metastasis showed NC after four weeks. 5'-DFUR administration was discontinued. Seventeen days later TS-1 (80 mg/day) was administered orally everyday for 2 weeks, followed by 1 week rest, as one course. Two courses of TS-1 administration resulted in a marked reduction of the liver metastasis, for a PR (75% reduction). After 3 courses, the liver metastasis showed CR. The patient is alive without recurrence after 12 courses. This TS-1 administration regimen was effective and tolerable for a patient with liver metastasis from gastric cancer.

Topics: Adenocarcinoma, Scirrhous; Aged; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Male; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

TS-1 is an oral anticancer drug that produces biochemical modulation. TS-1 is composed of FT (tegafur), CDHP (gimestat), and Oxo (ostat potassium), in a molar ratio of 1:0.4:1. We administered TS-1 to a patient with liver and pulmonary metastasis of rectal cancer (phase II study). Each treatment course consisted of a four-week administration followed by two drug-free weeks. The daily dose was 120-150 mg/day. Before the administration, hepatic metastasis was 30 x 20 mm. After 2 courses, it was reduced to 20 x 15 mm (reduction rate: 50%). Three pulmonary metastases that were recognized in chest radiographs before the administration tended to reduction after 3 courses. The reduction rate after 4 courses was 42.5%. The reduction was judged PR for the hepatic metastasis and MR for pulmonary metastases. There was no side effect and hospitalization was not required during the treatment. Thus, the administration of TS-1 enhanced the quality of life of this patient.

Topics: Adenocarcinoma; Administration, Oral; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Oxonic Acid; Pyridines; Rectal Neoplasms; Tegafur

We report a case of advanced gastric cancer producing Alpha Fetoprotein (AFP) with multiple liver metastases in which TS-1 is effective. Prognosis of gastric cancer producing AFP is well known to poor. A 74-year-old female was admitted complaining of anemia. She was diagnosed as having advanced gastric cancer with multiple liver metastases producing AFP by endoscopy, computed tomography and angiography. Her serum AFP level was 17,666 ng/ml and her serum CEA level was 5-2 ng/ml. After transarterial embolization (TAE), her family rejected her operation because it would not be curative. So, she was treated with TS-1, 40 mg, administered orally every day, followed by 14 days rest, as the first course. The next was TS-1, 80 mg orally administered for 6 courses. Her serum AFP level was down from 17,666 ng/ml to 94 ng/ml after 6 courses of TS-1. CT revealed that liver metastases did not change and endoscopy showed the primary lesion has diminished. Our report is the first to demonstrate that TS-1 is effective for patients with advanced gastric cancer producing AFP with multiple liver metastases.

Topics: Adenocarcinoma; Aged; alpha-Fetoproteins; Antimetabolites, Antineoplastic; Drug Administration Schedule; Drug Combinations; Female; Humans; Liver Neoplasms; Oxonic Acid; Pyridines; Stomach Neoplasms; Tegafur

S-1 is a novel oral anticancer drug, composed of tegafur (FT), gimestat (CDHP) and otastat potassium (Oxo) in a molar ratio of 1:0.4:1, based on the biochemical modulation of 5-fluorouracil (5-FU). In this study the combined effect of S-1 and low-dose CDDP as a modulator for colon 26 liver metastasis in mice was evaluated. In an experiment with S-1 (5 mg/kg/day: po) and CDDP (0.25 mg/kg/day: i.p.) for 14 days, the combined effects for both liver metastasis and tumor of spleen were not superior to those with S-1 or CDDP alone group. Body weight loss was not greater in the S-1 + CDDP group than in the control group. In an experiment with S-1 (5 mg x 2/kg/day: po) and CDDP (0.25 mg/kg/day: i.p.) for 7 days, the inhibitory effects of S-1 + CDDP of liver metastasis and tumor of the spleen were remarkable compared with the S-1 alone group. However a greater loss of body weight was seen in the S-1 + CDDP group than in other groups. This study suggests that low-dose CDDP might be a modulator of S-1 for colon 26 liver metastasis. Further study is needed to determine the optimum dose and duration of treatment.

Topics: Animals; Antimetabolites, Antineoplastic; Body Weight; Cisplatin; Colonic Neoplasms; Drug Combinations; Liver Neoplasms; Male; Mice; Mice, Inbred BALB C; Oxonic Acid; Pyridines; Splenic Neoplasms; Tegafur

S-1 [1 M tegafur (FT)-0.4 M 5-chloro-2,4-dihydroxypyridine (CDHP)-1 M potassium oxonate (Oxo)], was developed as a new oral antineoplastic agent based on biochemical modulation of fluorouracil (5-FU) by CDHP and Oxo. The therapeutic effect of S-1 on human colon cancer xenografts (TK-13) with high metastatic potential to the liver was evaluated. Small pieces of TK-13 were sutured into the cecal wall of 52 nude mice, and the animals were randomly divided into 3 groups [control (n=17), UFT (combination of 1 M FT and 4 M uracil) (n=18) and S-1 (n=17)]. S-1 or UFT was administered orally at an equitoxic dose (S-1, 7.5 mg/kg; UFT, 17.5 mg/kg as FT) for 37 consecutive days beginning 10 days after the transplantation. S-1 showed higher tumor growth inhibition than UFT (P<0.05) and also showed a significant anti-metastatic effect on liver metastasis, while UFT did not. Liver metastasis developed in only 2 of the 17 mice (12%) in the S-1 group, whereas it developed in 9 of the 17 (53%) and 7 of the 18 (39%) in the control and UFT group, respectively. Analysis of AUC (area under the curve) revealed that S-1 yielded higher 5-FU levels in both tumor tissue (1.6 times) and plasma (2.5 times) than UFT. These results suggest that S-1 will show a higher clinical therapeutic effect against human colorectal cancer than UFT.

Topics: Animals; Antimetabolites, Antineoplastic; Colonic Neoplasms; Drug Combinations; Humans; Liver Neoplasms; Male; Mice; Mice, Nude; Neoplasm Transplantation; Oxonic Acid; Pyridines; Tegafur; Transplantation, Heterologous