[A Case of Postoperative Pulmonary Metastasis of Breast Cancer with Complete Response by Abemaciclib plus Fulvestrant Therapy].

A 66-year-old woman underwent total mastectomy with level Ⅰ and Ⅱ axillary lymph node dissection for right breast cancer in July 2007. The pathology results indicated the presence of T2N0M0 invasive ductal carcinoma(tubule forming type), that was estrogen receptor-positive and human epidermal growth factor 2-negative. She received postoperative adjuvant therapy with oral anastrozole(ANA)for 5 years. Eleven years after surgery, at the age of 77 years, a chest X-ray examination during a routine health checkup identified a mass shadow in the right lung. Further investigation revealed bilateral multiple lung metastases due to breast cancer recurrence. Histological examination of a tissue obtained by computed tomography(CT)-guided lung biopsy confirmed that the histological type and subtype were identical to those found in the initial surgery. Hence, endocrine therapy with ANA plus CDK4/6 inhibitor was started in November 2018. However, the first CDK4/6 inhibitor, palbociclib, caused severe myelosuppression even when the dose was reduced by 2 levels. Therefore in January 2019, the patient was switched to abemaciclib, with the dose reduced by 1 level initially and then reduced by 2 levels from August 2019. In June 2019, new multiple lung metastases appeared, and the patient was switched from ANA to fulvestrant, after which complete response was achieved in 6 months. CT in June 2021 showed no recurrence, and the patient(now 80-year-old)continues to take abemaciclib plus fulvestrant therapy.

[Primary Peritoneal Carcinoma with Long Term Survival-A Case Report].

A 62-year-old woman underwent upper endoscopy in January 2009 to reveal the presence of an extrinsic compression measuring approximately 3 cm in the anterior wall of the gastric antrum. Further examinations suggested that it was caused by peritoneal cancer of an unknown origin; thus, staging laparoscopy was performed in May 2009. Multiple white nodules of varying sizes were found scattered throughout the right upper quadrant of the abdomen and the right abdomen. Based on a biopsy of the greater omentum, the patient was diagnosed with papillary serous adenocarcinoma. As no abnormalities were observed in the uterus and ovary, it was suspected that the patient had primary peritoneal cancer. Hence, in July 2009, the patient underwent resection of the greater omentum, gastric pylorus, gall bladder, and right hemicolon where the tumors were localized, as well as bilateral adnexectomy. Based on intraoperative findings and postoperative histology, the patient was diagnosed with high-grade primary peritoneal serous adenocarcinoma and received paclitaxel and carboplatin therapy. Subsequent follow-up examinations, including positron emission tomography-computed tomography(PET-CT), indicated repeated recurrences in the mesentery, the pelvic floor, and around the remnant stomach. After identifying these recurrences, the patient was treated with platinum-based drugs, experiencing repeated response and cessation cycles. Since September 2019, the patient has received olaparib therapy. PET-CT examination performed in September 2020 indicated that the patient remained in complete remission.

Association between Comorbidity and Relative Dose Intensity in Patients with Diffuse Large B-Cell Lymphoma.

BACKGROUND: Comorbidities among cancer patients are becoming more common. Comorbidity and relative dose intensity (RDI)are 2 major host-dependent prognostic factors for diffuse large B-cell lymphoma(DLBCL), but the clinical evidence demonstrating a relationship between those 2 factors is limited. METHODS: We retrospectively analyzed the clinical records of patients with de novo DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone(R-CHOP) therapy at the Okitama Public General Hospital between January 2010 and October 2018 to evaluate the relationship between comorbidity and RDI. RESULTS: A total of 104 patients with a median age of 73 years(range, 36-90 years)were included. More than half of the patients(n=58, 55.8%)had at least one comorbidity. 3-year progression-free survival(p=0.043)and 3- year overall survival(p=0.049)were lower in the comorbidity group than in the no comorbidity group. The RDI was also lower in the comorbidity group than in the no comorbidity group(p=0.011). Univariate analysis of various factors influencing the RDI revealed that the presence of comorbidity was associated with insufficient RDI(p=0.016), but multivariate analysis revealed that only age ≥75(p<0.001)was independently associated with insufficient RDI. CONCLUSIONS: Our results demonstrated that the presence of comorbidity was associated with insufficient RDI and poor treatment outcome in DLBCL patients treated with R-CHOP. To optimize the RDI maintenance to achieve better outcomes for DLBCL patients, further investigation of comorbidities is required.

[A Case of Recurrent Breast Cancer with Complete Response to Eribulin Monotherapy after Bevacizumab plus Paclitaxel Combination Therapy].

A 65-year-old woman underwent mastectomy and dissection of a level I axillary lymph node in January 2002 for left breast cancer. The diagnosis was T1N0M0 scirrhous carcinoma that was estrogen receptor-positive, progesterone receptorpositive, and human epidermal growth factor receptor 2-negative. After 3 years 10 months, during which the patient underwent adjuvant therapy with oral aromatase inhibitors, she developed bilateral multiple lung metastases. These were treated with the anticancer agents anthracycline and taxane. Progressive disease(more and larger lung metastases)was diagnosed in April 2013, and bevacizumab plus paclitaxel combination therapy was started. After completion of 4 courses, a lung abscess appeared, which was conjectured to represent rapid tumor necrosis that had become infected. As several tumors remained solid even after the lung abscess improved, the patient received 18 courses of eribulin monotherapy. Computed tomography in April 2016 revealed only patches of linear or cord-like scarring in both lungs, with no metastatic or recurrent foci. In this case, a patient with recurrent breast cancer responded to the sequential administration of bevacizumab plus paclitaxel combination therapy followed by eribulin monotherapy.

[Total Gastrectomy for Advanced Gastric Cancer after Coronary Artery Bypass Grafting Using the Right Gastroepiploic Artery: Report of a Case].

An 82-year-old man, who had undergone coronary artery bypass grafting(CABG) with the right gastroepiploic artery( RGEA) 13 years previously, suffered with abdominal pain after meal and tarry stools, and was diagnosed with advanced gastric cancer. Gastroscopy revealed an advanced Borrmann type 4 cancer at the lesser curvature of the gastric body to the pyloric ring. The gastrogram showed poor extension and stenosis at the same part. Abdominal computed tomography showed the tumor reached the subserosal layer and infrapyloric lymph nodes were swollen. Abdominal angiography showed the RGEA graft remained well patent. Total gastrectomy with D2 lymph nodes dissection and arterial reconstruction between the splenic artery and the RGEA graft was performed. He has been well without any sign of cancer recurrence since the operation. Recently, more patients with CABG using RGEA are found to have gastric cancer and require the resection of RGEA for lymph nodes dissection as this case. We consider this procedure one of the options for advanced gastric cancer after coronary bypass grafting using RGEA.

[A case of relapsed colon cancer successfully treated by capecitabine].

We report a case of advanced relapsed colon cancer, which had multiple liver and spleen metastasis, controlled for about two years by capecitabine therapy. A 60-year-old female had been diagnosed with ileus due to sigmoid colon cancer in August, 2005. She received sigmoidectomy and adjuvant chemotherapy (Leucovorin/5-fluorouracil therapy). In postoperative observation, multiple liver and spleen metastasis were detected by computed tomography in February, 2008. Therefore, she was administered twenty courses of FOLFOX therapy. However, a peripheral nerve disturbance appeared. There fore chemotherapy was changed from FOLFOX therapy to FOLFIRI therapy. After 2 courses of FOLFIRI therapy, she had severe nausea, vomiting, appetite loss and diarrhea. Therefore, chemotherapy was changed from FOLFIRI therapy to capecitabine therapy. After capecitabine therapy, her multiple liver and spleen metastasis disappeared, and complete response has continued for about 2 years. She has remained on capecitabine therapy and has a good quality of life.