[A case of unresectable gastric cancer successfully treated with combination chemotherapy of S-1 + CPT-11].

A 70-year-old female, with type III gastric cancer underwent a staging laparoscopy in September 2004. Judging from the results of endoscopy, enhanced CT and staging laparoscopy, we finally diagnosed the patient with stage IV (T3N2MOHOP1CY1), and we started a combination chemotherapy of S-1 + CPT-11 (S-1: 80 mg/m2, day 1-21/35 days, CPT-11: 80 mg/m2, day 1, 15/35 days) from October 2005 to January 2007. Enhanced CT after 2 courses of the combination chemotherapy showed partial response (PR) in the primary lesion. PR continued up to the 13 courses. The CT and gastro fiberscope finally showed complete response (CR) with Group I in biopsy. During these procedures, the grade 3 of neutropenia, grade 1 of diarrhea and grade 1 of fatigue occurred as adverse events. In January 2007, Virchow and, abdominal lymph node metastases were detected, and that we judged the metastases as progressive disease (PD). Nevertheless, the second-line of paclitaxel chemotherapy (70 mg/m2, days 1, 8,15/28 days) has started and she was being judged PD after 2 courses, she died in April 2007.

[A case of S-1 resistant multiple lung metastases after curative total gastrectomy for gastric cancer successfully treated by S-1 combined with CPT-11 as the third-line chemotherapy].

A 78-year-old female underwent a curative total gastrectomy with D2 lymphandectomy for advanced gastric cancer in March 2003. S-1 mono-therapy (80 mg/m2, day 1-28/42 days) began as the first-line chemotherapy from October 2004 when multiple lung metastases were detected by CT. Paclitaxel mono-therapy (80 mg/m2, days 1, 8, 15/28 days) began as the second-line chemotherapy from April 2005 when prior S-1 mono-therapy judged as progressive disease (PD) by CT. Paclitaxel mono-therapy judged it as partial response (PR) in June, but the final judgement was as PD in September 2005. S-1 + CPT-11 combination therapy (S-1: 80 mg/m2, day 1-21, CPT-11: 80 mg/m2, days 1, 15/35 days) began as the third-line chemotherapy from September 2005. After 10 courses, multiple lung metastases were judged as complete response (CR) in September 2006. During the third-line chemotherapy, any adverse event of grade 2 or more did not occur. After judgment of CR, the patient has been followed without chemotherapy due to patient's desire, and is still alive without any recurrence in July 2007.

[A case of advanced gastric cancer which has kept partial response with the fifth-line chemotherapy].

We report a case of a 48-year-old male with advanced gastric cancer. A total gastrectomy was performed for cancer of remnant stomach. S-1 was administered for cytological cancer cells detected by abdominal cavity lavage as the first-line chemotherapy. After 2 cycles of S-1, cervical lymph nodes were enlarged, and the patient underwent paclitaxel monotherapy as the second-line chemotherapy. After 8 cycles, Virchow lymph nodes were enlarged. The regression of Virchow lymph nodes were observed with a S-1 /CPT-11 combination therapy as the third-line chemotherapy and DOC/CPT-11 as the fourth-line chemotherapy. We then used a combination chemotherapy of CPT-11 60 mg/m2 and CDDP 30 mg/m2 at day 1 and 15, every 4 weeks as the fifth-line chemotherapy. A partial response was achieved after 2 cycles, and has been continued for 7 months. The hematological toxicities and the non-hematological toxicities of grade 2 or higher were not observed. This regimen may be effective for patients with advanced gastric cancer resistant to prior chemotherapy with several agents.

[A case of advanced gastric cancer with obstructive jaundice due to liver metastases successfully treated with chemotherapy].

We report a successful case of chemotherapy for primary far-advanced gastric cancer accompanied with poor general condition related to jaundice due to hepatic metastasis. A 54-year-old man, who had been admitted to another hospital in October 2006 with a complaint of tarry stool, was referred to our hospital. The result of detailed examination revealed an advanced gastric cancer, multiple lymph node metastases and jaundice (T-Bil 3.3 mg/dL) due to multiple hepatic metastases. The performance status (PS) was level 4. In parallel with a whole body control, a combined therapy with S-1 and CPT-11 was performed from October 27 as the first-line therapy. As a consequence of the first course, the jaundice disappeared. After the second course, the patient left the hospital. However, the patient was re-admitted to hospital in January 2007 by a reason of fever and a deterioration of PS. As exacerbation of cancerous peritonitis and the primary tumor were seen, a weekly paclitaxel therapy was performed as the second-line therapy. Two courses of treatment resulted in the disappearance of ascites and a reduction of hepatic/lymph node metastasis. PS was improved to level 0 as well. After these therapies, the patient was discharged from the hospital. As of June 2007, he continuously receives chemotherapy as an outpatient.

[A case of an elderly patient with gastric cancer successfully treated with TS-1 considering impaired renal function caused by aging].

A 75-year-old female patient with impaired renal function caused by aging was treated with TS 1 for gastric cancer with extensive multiple liver metastases. TS-1 contains CDHP, which inhibits DPD activity and maintains a high blood concentration of 5-FU. Because CDHP is excreted from the kidney, a careful TS-1 administration is necessary for patients with impaired renal function considering an occurrence of severe adverse events. Based on the result previously reported by us about pharmacokinetic study and recommended administration dosage of TS-1 for patients with impaired renal function, we administered 50 mg/day of TS-1 for four weeks followed by two weeks rest per one course for this patient. The patient's creatinine clearance calculated by the Cockcroft-Gault method was 38 ml/min, and we reduced the administration dosage in consideration of her impaired renal function, although normal dosage of TS-1 calculated from body surface area for this patient was 100 mg/day. As this patient underwent TS-1 treatment, sizes of multiple liver metastases and the blood concentration level of CEA were gradually reduced, and the reductive rate of the former was more than 90% and the level of the latter fell to a normal range after 12 courses of TS 1 treatment. Through all the treatment courses, relative drug intensity was 100% and the performance status of this patient was kept 0 without any grade 3 or more adverse events under ambulatory treatment. A successful treatment for this patient might indicate that it was important to consider the appropriate reduction of the dosage of TS-1 administration for elderly patients with gastric cancer, because there is a reverse correlation between aging and renal function. To clarify this problem, a multicenter prospective phase II study about TS-1 reductive administration depending on the renal function for elderly patients with gastric cancer (OGSG0404) is ongoing in our clinical study group (OGSG; Osaka Gastrointestinal Chemotherapy Study Group).

[A case of complete remission of carcinomatous ascites refractory for TS-1 monotherapy treated with TS-1 plus paclitaxel combined therapy for gastric cancer].

A 38-year-old female patient with gastric cancer, of which histological type was a poorly differenciated adenocarcinoma and a clinical finding was T3N1MO (Stage IIIA), underwent total gastrectomy with D2 lymphadenectomy as the surgical treatment. However, CY1 was detected during the operation and the final finding was T3N1MOHOPOCY1 (Stage IV). Because this surgical treatment ended in curative C, we administered 80 mg/m2/day of TS-1 for four weeks followed by two weeks rest per one course for CY1 after the surgical treatment. After two courses of TS-1 monotherapy, extensive carcinomatous ascites appeared and blood concentration level of CA19-9 increased. We next treated this patient with TS-1+paclitaxel as a second line chemotherapy, because both of them have been reported to migrate to peritoneal very well and to be effective for peritoneal dissemination. The regimen of this combined therapy consisted of four weeks administration of TS-1 (80 mg/m2/day) followed by two weeks rest and injections of paclitaxel (50 mg/m2) at day 1 and 8 for 21 days as one course. When this patient underwent TS-1+paclitaxel combined treatment, the amount of carcinomatous ascites and blood concentration level of CA19-9 were gradually reduced and the former completely disappeared, and the latter fell to a normal range after five courses. Through all treatment courses, a performance status of this patient was kept 0 without a severe adverse event under ambulatory treatment. After 29 courses, the blood concentration level of CA19-9 rose again and local recurrence was detected at the lesion of esophagoenterostomy, though carcinomatous ascites had been kept in complete remission. We treated surgically for this local recurrence because of CY0 at the operation. At the present, 3 years and 8 months have passed since the first treatment started. This patient is still alive without cancer in ambulatory.