[Electronic Reporting of PRO-CTCAE in Outpatients Receiving Chemotherapy-A Single-Center Feasibility Study].

To investigate the feasibility of utilizing electronically provided patient-reported outcomes(ePRO)to detect adverse events, we conducted a single-center prospective study targeting patients with advanced cancers who were receiving chemotherapy at our outpatient clinic. Participants were asked to respond to 71 relevant items from the PRO-CTCAE once a week for 8 consecutive weeks. An outpatient nurse evaluated the corresponding items on the CTCAE. Forty of 85 outpatients were enrolled. Thirty-four patients were excluded because of Bring Your Own Device(BYOD)restrictions and 11 were excluded for other reasons, including poor physical conditions. Those without BYOD were significantly older than the study participants(median age: 72 and 66 years, respectively)and were more likely to be male(65% and 35%, respectively). The overall response rate was 77%. The median number of symptoms per participant rated as ≥Grade 1 was 26(range: 0-48) by ePRO and 6(range: 1-15)by the nurse(p<0.01). Among the total number of symptoms detected by ePRO, the percentage of symptoms detected by both the nurse and ePRO was low(median: 4%, range: 0-67%). Symptoms detected consistently by both the nurse and ePRO were alopecia(67%), anorexia(38%), paresthesia(36%), diarrhea(28%), malaise(27%), oral mucositis(25%), constipation(24%), limb edema(24%), pain(22%), and dysgeusia(21%), suggesting that healthcare professionals tend to pay more attention to the symptoms that they think lead to intervention. Our findings indicate that the implementation of the ePRO system in outpatient care may help clinicians accurately recognize adverse events at earlier stages.

Treatment of metastatic refractory colorectal cancer following regorafenib failure.

At present, there is no set strategy for the treatment of patients with colorectal cancer subsequent to the failure of standard treatment, other than the use of regorafenib (RGR) and TAS-102. The best order in which to use these drugs, and their safety and efficacy in combination with other drugs, are currently under investigation. It has been reported that RGR has a resensitizing effect on tumors that have previously failed to respond to anticancer drugs; this makes it a promising salvage therapy for colorectal cancer. The present report describes the results of a retrospective study on 17 patients with metastatic colorectal cancer who received RGR treatment following the failure of standard therapy. Following RGR failure, 71% of the patients were fit for further anticancer treatment, and these patients survived longer than those who did not receive further treatment. Furthermore, this intervention did not shorten the period of best supportive care. As a considerable number patients were fit for further anticancer therapy after RGR treatment, which resulted in prolonged survival without shortening the period of best supportive care, it may be beneficial for future research to focus on finding the optimal time at which to switch from RGR to further anticancer therapy.

[An effective case of gemcitabine therapy with post-operative peritoneal recurrence of intrahepatic cholangiocarcinoma].

The patient was a 53-year-old man who had undergone left hepatectomy due to intrahepatic cholangiocarcinoma in August 2007. Pathologically, the tumor was diagnosed as a cholangiocellular carcinoma (T2, N0, M0, Stage II). Ascites appeared about one year after surgery and control was difficult using diuretics. Since abdominal CT revealed peritoneal recurrence with massive ascites, we conducted chemotherapy using gemcitabine (GEM) in September 2008. In the outpatient setting, GEM at a dose of 1, 000 mg/body was administered once a week with a 1-week rest as 1 course. The response was assessed as a complete response (CR) because abdominal CT after 7 courses of chemotherapy showed the disappearance of both ascites and the peritoneal nodules. An adverse effect for GEM was grade 3 anemia, but we could continue the chemotherapy until September 2009. At present, CR has been observed, and one year and three months have passed since the peritoneal reccurrence.