s-1-(combination) and Venous-Thrombosis

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

In our previous randomized controlled trial, the addition of S-1 to gemcitabine for advanced pancreatic cancer did not prolong overall survival (OS) significantly, despite its higher response rate and longer progression-free survival (PFS). Leucovorin is known to enhance efficacy of S-1, and we conducted this phase I trial of combination therapy of gemcitabine, S-1 and leucovorin (GSL).. Patients with advanced pancreatic cancer who had received no prior chemotherapy were eligible for this study. Gemcitabine was administered at an escalating dose of 600, 800 and 1,000 mg/m(2) over 30 min on day 1, and oral S-1 at a dose of 40 mg/m(2) twice daily and oral leucovorin at a dose of 25 mg twice daily on days 1-7, every 2 weeks. A standard "3 + 3" phase I dose escalation design was utilized.. Fifteen patients were enrolled across three dose levels. Three patients developed DLTs: two patients in level 1 (grade 3 anorexia in 1 and grade 3 anorexia, stomatitis and diarrhea in 1) and one patient in level 2 (grade 3 deep vein thrombosis). No DLT was observed in level 3. Response rate and the disease control rate were 33 and 93 %, respectively. The median PFS and OS were 5.4 and 16.6 months. Ten of 12 patients (83 %) with elevated CA19-9 at baseline had a ≥ 50 % decline.. RD of gemcitabine in GSL was determined as 1,000 mg/m(2). GSL was well tolerable and showed promising results in advanced pancreatic cancer.

Topics: Aged; Anorexia; Antineoplastic Combined Chemotherapy Protocols; Deoxycytidine; Diarrhea; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Female; Gemcitabine; Humans; Leucovorin; Male; Middle Aged; Oxonic Acid; Pancreatic Neoplasms; Stomatitis; Survival Analysis; Tegafur; Treatment Outcome; Venous Thrombosis

Gastric cancer with portal vein tumor thrombosis (GC-PVTT) is a rare condition with a very poor prognosis. A 64-year-old man with GC-PVTT was admitted to our hospital. His carcinoembryonic antigen level was slightly elevated (17.4 ng/ml). Upper gastrointestinal endoscopy showed a type-2 gastric lesion (45 mm × 40 mm) in the gastric antrum. The PVTT originated from the main gastric tumor and continued to the superior mesenteric vein. Fluorodeoxyglucose-positron emission tomography showed high uptake both by the main tumor and PVTT. A distal gastrectomy with D2 lymphadenectomy was performed with simultaneous removal of the PVTT. Pathological examination showed a poorly differentiated adenocarcinoma with neuroendocrine differentiation. Adjuvant chemotherapy with S-1 was administered for 1 year. The patient survived for >5 years with no recurrence. Surgical gastrectomy and complete removal of the PVTT followed by S-1 chemotherapy could be a treatment option that offers improved long-term survival for patients with GC-PVTT.

Topics: Adenocarcinoma; Chemotherapy, Adjuvant; Combined Modality Therapy; Disease-Free Survival; Drug Combinations; Gastrectomy; Humans; Male; Middle Aged; Oxonic Acid; Portal Vein; Stomach Neoplasms; Tegafur; Venous Thrombosis

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

The following is a case report of moderately differentiated tubular adenocarcinoma of the stomach with widespread thrombosis of the portal vein, for which chemotherapy proved effective. A 75-year-old man presented to the clinic with a new onset ofmalaise. The patient had anemia, elevation ofliver and biliary enzymes, and significantly elevated CA19-9 levels at 43,581 U/mL and CEA levels at 2,560 ng/mL. An upper endoscopy revealed a mass lesion extending from the fundus to the pylorus as well as to the duodenum along the smaller curvature of the stomach. A biopsy revealed moderately differentiated tubular adenocarcinoma. Abdominal CT showed a mass lesion extending from the body of the stomach and penetrating through the gastric wall, and extensive lymphadenopathy in the surrounding areas. In addition, multiple thromboses were identified in the portal vein and its tributaries, including the inferior mesenteric vein, splenic vein, and intrahepatic capillaries. The patient subsequently received a single round ofS -1 and CDDP. The tumor demonstrated a marked response; the tumor size and lymphadenopathy showed a significant improvement and the CA19-9 level decreased. Because the patient's condition deteriorated, this chemotherapy regimen was discontinued. The patient was switched to S-1 monotherapy and is still alive today, 2 years 10 months after the initial diagnosis.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Drug Combinations; Humans; Male; Oxonic Acid; Portal Vein; Stomach Neoplasms; Tegafur; Venous Thrombosis

A 63-year-old male admitted for hematemesis was diagnosed with type 3 advanced gastric cancer located in the upper and middle body of the stomach in an endoscopic examination. Abdominal computed tomography demonstrated lymph nodes metastasis and a splenic vein thrombus. Since curative resection was not deemed possible, we performed neoadjuvant chemotherapy using S-1 (120 mg, day 1-21) plus CPT-11 (135 mg, day 1 and 15) except for down-staging. After 4 courses of chemotherapy, gastric tumor and metastatic lymph nodes were reduced in size and the splenic vein thrombus was disappeared, and then total gastrectomy was performed (tub2, T2 (MP) N0 H0 M0 P0 CY0, Stage IB). S-1 medication was applied as adjuvant chemotherapy. Forty months passed from the operation, the patient remains alive with no signs of relapse.

Topics: Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Drug Combinations; Humans; Irinotecan; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Oxonic Acid; Remission Induction; Splenic Vein; Stomach Neoplasms; Tegafur; Tomography, X-Ray Computed; Venous Thrombosis

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