[Effectiveness of Nivolumab in a Case of Inoperable Advanced Gastric Cancer with Lung Metastasis].

A 66-year-old man was diagnosed with inoperable advanced gastric cancer with liver and peritoneal metastases. The patient underwent SOX therapy as primary chemotherapy; subsequently, liver and peritoneal metastases disappeared. However, lung metastasis was detected later, and weekly paclitaxel(PTX)combined with ramucirumab(RAM)chemotherapy was initiated; subsequently, lung metastasis and advanced gastric cancer disappeared. During remission, lung metastasis was detected again. Although weekly PTX combined with RAM chemotherapy was reinitiated, a progressive disease status was achieved. As tertiary chemotherapy, nivolumab therapy(240 mg/body, every 2 weeks)was initiated for 20 courses over 11 months. This therapy was significantly effective, which aid the patient to achieve a complete response. The patient survived and is healthy for 5 years due to chemotherapy administration alone.

[A Case of Non-Resectable Advanced Gastric Cancer for Which Nivolumab Was Markedly Effective].

A 74-year-old man presented to our hospital because of anorexia. Upper gastrointestinal endoscopy revealed type 3 gastric cancer. Further examination disclosed metastasis to the perigastric lymph nodes and to the liver, and a diagnosis of non- resectable advanced gastric cancer(cT4N2H1P0M0)in cStage Ⅳ was made. A total of 4 courses of S-1 plus oxaliplatin therapy(80 mg/body/day and 100 mg/m2/cycle, respectively, for 2 weeks followed by a 1-week rest)were administered as the primary chemotherapy. Then, another metastasis to the abdominal lymph nodes and increased liver metastasis were found; thus, the patient's condition was rated as progressive disease(PD). Secondary chemotherapy comprising 10 courses of weekly nab-paclitaxel(nab-PTX)plus ramucirumab(RAM)therapy(100 mg/m2 on days 1, 8, and 15 and 8 mg/kg on days 1 and 15, respectively, every 4 weeks)were administered. Although temporary reductions in the perigastric lymph node metastasis and liver metastasis as compared with the baseline were observed, another metastasis to the abdominal lymph nodes occurred subsequently, resulting in PD. As tertiary chemotherapy, nivolumab therapy(240 mg/body, every 3 weeks) was repeated up to a total of 30 courses over 13 months. This therapy was markedly effective, achieving a near complete response. The patient is currently being followed up as an outpatient.

[Effect of Pharmacist Interview before Doctor's Examination for Breast Cancer Chemotherapy Patients].

Patients treated with anticancer drugs are likely to have serious physical and mental anxieties due to severe adverse events. Continuous information provision with the expertise of pharmacists will lead to the improvement of quality of life (QOL) of patients and efficient administration of chemotherapy. At Koyama Memorial Hospital, a pre-consultation service by pharmacists has been initiated to reduce adverse events in patients undergoing breast cancer chemotherapy. The service has allowed pharmacists to continuously intervene with treatment from the start and if necessary, suggest that physicians change supportive care or conduct additional tests. Pre-consultations were provided for 503 breast cancer patients who received outpatient chemotherapy between January 2016 and October 2017. For 68(13.5%)of the 503 cases, pharmacists suggested prescriptions or tests. In the 68 cases, the adoption rate of suggestions among physicians was 95.6%(65/68). As a result of the adopted suggestions, adverse events disappeared or were alleviated in 89.2%(58/65)of the patients. Therefore, in breast cancer patients undergoing chemotherapy, adverse events associated with chemotherapy may be alleviated early through pharmacist-led pre-consultation and provision of appropriate pharmaceutical interventions based on the preconsultations.

[Transverse Colon Cancer with Peritoneal Metastasis Successfully Treated with mFOLFOX6 plus Bevacizumab-A Case Report].

A male patient in his 80s, diagnosed with rectal cancer, underwent transverse colon resection(pT3, pN0, cM0, and pStage Ⅱa, RAS wild-type, BRAF-mutant). However, 19 months later, intraperitoneal metastasis was detected and the patient received 8 courses of mFOLFOX6 plus bevacizumab. Following the observation of an allergic reaction that was attributable to oxaliplatin, the regimen was changed to a total of 7 courses of sLV5FU2 plus bevacizumab. Subsequently, a marked decrease was observed in intraperitoneal metastasis. The patient completed sLV5FU2 plus bevacizumab chemotherapy. At 1 year after the marked decrease, the metastatic recurrence was not exacerbated.

[Long-Term Survival of a Patient with Inoperable Gastric Cancer with Distant Lymph Node Metastasis-A Case Report].

A 76-year-old female patient was diagnosed with inoperable gastric cancer with distant lymph node metastasis(cT3N2M1 [LYM], cStage Ⅳ), for which she received S-1 chemotherapy(orally administered on days 1-14 ofa 28-day courses). The patient received a total of4 2 treatment courses. After an initial phase of stable disease due to chemotherapy, she eventually showed progressive disease. S-1 chemotherapy was discontinued. Because ofher social background, she decided against any further chemotherapy. After 1 year, she underwent metallic stent insertion through the gastric cancer, which enabled her to consume food. She is currently alive as of 5 years and 3 months from the date of first diagnosis.

[A Case Report of Inoperable Gastric Cancer with Peritoneal Dissemination, Liver Metastasis, and Lung Metastasis Successfully Treated with Weekly Paclitaxel and Ramucirumab].

A 63-year-old man diagnosed with a perforated gastric ulcer and generalized peritonitis underwent surgical intervention. However, computed tomography(CT), esophagogastroduodenoscopy(EGD), and positron emission tomography-CT(PETCT) revealed an inoperable gastric cancer with liver and peritoneal metastases(cT4NxH1P1M0, cStage Ⅳ, for which he received S-1 and oxaliplatin chemotherapy[SOX therapy]). The patient underwent 10 SOX therapy cycles. Following the initial chemotherapy course, the peritoneal and liver metastases disappeared on radiographic images. However, lung metastasis was detected, and the patient initiated weekly paclitaxel(PTX)and ramucirumab(RAM)chemotherapy. After 4 treatment cycles, lung metastasis and gastric cancer disappeared.

[A Case Report of Sigmoid Colon Cancer with Multiple Lung Metastases Successfully Treated with S-1].

A patient in his 70s was diagnosed with sigmoid colon cancer[pT3pN1cM1(PUL1), pStage IV ]for which he underwent sigmoid colectomy and received S-1 adjuvant therapy for the lung metastases. The patient received a total of 10 courses of S- 1, administered orally on days 1-14 of a 21-day cycle. The lung metastases showed a complete response, and the patient completed the S-1 chemotherapy. No recurrence of lung metastases was detected up to 6 months later.

[Study of the Efficacy of Aprepitant in FOLFOX/FOLFIRI for Elderly Patients with Advanced Colorectal Cancer].

For patients undergoing cancer chemotherapy, sufficient supportive antiemetic therapy is important for maintaining the quality of life. Although there are many studies on antiemetic support therapy for high emetic risk regimens, studies on moderately emetic risk regimens are scarce. FOLFOX and FOLFIRI are generic regimens for the treatment of advanced colorectal cancer; evidence for antiemetic supportive therapy at the time of this treatment is scarce. In addition, research on patients over 65 years of age is limited. Among the advanced colorectal cancer patients who received treatment with FOLFOX or FOLFIRI at Koyama Memorial Hospital, patients older than 65 years of age were selected in order to assess the effectiveness of aprepitant as an antiemetic supportive therapy. Aprepitant was used in combination with granisetron and dexamethasone in 14 patients. After 5 days of treatment, complete control rate of emesis was 100%, and complete control rate of nausea was 64.3%. Our results suggest that aprepitant can be used as a safe antiemetic supportive therapy in elderly advanced colorectal cancer patients undergoing FOLFOX and FOLFIRI, as well as granisetron and dexamethasone.

[A Case of Rectal Cancer with Multiple Liver, Lung, and Para-Aortic Lymph Node Metastases Successfully Treated with FOLFOX4 plus Bevacizumab].

A patient in his 70s was diagnosed with rectal cancer (pT3, pN1, cM0, and pStage IIIa) for which he underwent low anterior resection of the rectum and received adjuvant therapy with UFT/LV. Multiple liver, lung, and para-aortic lymph node metastases were detected after 6 months, and the patient then received a total of 24 courses of FOLFOX4 plus bevacizumab instead of UFT/LV. The liver and para-aortic lymph node metastases showed a complete response (CR), and the lung metastases markedly diminished. Therefore, the patient completed the FOLFOX4 plus bevacizumab chemotherapy regimen. After 2 years, a recurrence of the initial liver metastases was detected. A CR on radiological imaging does not correspond to a pathological CR. Therefore, a careful follow-upis required even when a CR on radiological imaging is achieved.